Laparoscopic treatment of hepatic hydatid cysts.

BACKGROUND: Because of limited experience worldwide, controversies about the laparoscopic treatment of liver hydatid cysts have not been resolved. The aim of this study was to describe the technical details of a laparoscopic method we developed in 1992 and report the initial results from an endemic area. METHODS: Of the 30 consecutive patients with 33 liver hydatid cysts considered for laparoscopic treatment during a 6-year period at a university hospital in Turkey, conversion to an open procedure was required in 7 patients (23%) while 23 patients with 25 cysts were able to be treated laparoscopically. RESULTS: By using a special trocar to suspend the cyst against the abdominal wall, laparoscopic simple drainage was performed in 16 patients (70%) and unroofing and drainage in 6 patients (26%). Pericystectomy was performed in 1 patient (4%). Complications were observed in 1 patient (4%) perioperatively and 4 patients (17%) postoperatively. Eleven patients (48%) were followed-up for a mean of 17 months (range, 3-72 months) and 1 recurrence (9%) was detected. CONCLUSIONS: This report is a very large experience with the laparoscopic treatment of liver hydatid cysts in the literature. We have established a technique yielding a comparable morbidity and recurrence rate to open series in early follow-up. We advocate that it is a safe and simple technique with potentially a decreased risk of intra-abdominal spillage compared with the other laparoscopic methods described.

The effects of sodium deoxycholate, lactulose and glutamine on bacterial translocation in common bile duct ligated rats.

BACKGROUND/AIMS: Sepsis is a major cause of post-operative morbidity and mortality in obstructive jaundice as a result of bacterial translocation from the gut. This study was conducted to investigate the effects of glutamine, lactulose, and the bile salt Na deoxycholate in preventing bacterial translocation in an animal model where obstructive jaundice was developed by common bile duct ligation. METHODOLOGY: Fifty Wistar albino rats were divided into 5 groups of 10 animals each. The animals in groups I-IV underwent common bile duct ligation and received, respectively, either saline, Na deoxycholate, lactulose or glutamine, orally. Group V had sham ligation and received saline orally. The animals were sacrificed at the end of the 7th day, and serum concentrations of bilirubin, aspartate aminotransferase (ALT), alanine aminotransferase (ALT), and alkaline phosphatase (AP) were measured. In addition, mesenteric lymph nodes were removed and cultured together with cecal content. Histopathologic examination of terminal ileum specimens was made. RESULTS: Na deoxycholate, lactulose and glutamine all reduced bacterial translocation rates to mesenteric lymph nodes (p<0.05), with glutamine causing the greatest effect. Na deoxycholate and lactulose prevented bacterial translocation by causing a decrease in cecal intraluminal bacterial content (p<0.001), while glutamine exerted its effect by preserving intestinal mucosal integrity. CONCLUSIONS: The integrity of the intestinal mucosal barrier is of paramount importance in preventing bacterial translocation, and the measures taken to protect mucosal integrity reduce bacterial translocation to a greater extent than those taken to decrease the number of bacteria in the gut.

The effect of intestinal transit time on bacterial translocation.

Increase in intraluminal bacterial count, disruption of the mucosal integrity, changes in intestinal immunity and transit time are the factors involved in bacterial translocation. The relationship between intestinal transit time, intra luminal bacterial count and translocation rate were investigated in 40 Wistar-albino rats. The study was conducted in 4 groups with 10 animals in each. Group I (controls): saline + laboratory chow, Group II: saline + oral total parenteral nutrition (TPN) solution, Group III: morphine sulfate (MS) + oral TPN solution, Group IV: neostigmine bromide (NB) + oral TPN solution. Intestinal transit time was measured by using Indium111-labeled diethylene triamine pentaacetic acid (DTPA). It was prolonged in the MS-treated group and shortened in the NB-treated group (p < 0.01). The frequency of bacterial translocation was 60% in the oral TPN solution group, 100% in the MS-treated group, 20% in the NB-treated group and 10% in controls. Bacterial counts in duodenum, jejunum, ileum and caecum were significantly increased (p < 0.001) in the MS-treated group and decreased (p < 0.05) in the NB-treated group in comparison with the control group. In conclusion, the prolongation of intestinal transit time increased the intraluminal bacterial count and augmented bacterial translocation. The decrease in intestinal transit time had a converse effect.

Ileocolic invagination in adult due to caecal carcinoma.

In adult invagination, the leading point is usually an organic lesion. It is mostly a benign lesion in enteric, ileocolic and ileocaecal invaginations, however in colocolic invaginations the leading point is often malign. In our patient we diagnosed an ileocolic invagination due to a caecal tumour, evidenced by CT (Computerized tomography) and colonoscopy. Right hemicolectomy and ileotransversostomy were performed.

Effect of resuscitation on bacterial translocation in haemorrhagic shocked rats.

The aim of this study was to investigate the resuscitative effects of various intravenous solutions on intestinal mucosal damage and bacterial translocation due to haemorrhagic shock. Seventy Sprague-Dawley rats were anaesthetised and subjected to thirty minutes of haemorrhagic shock (systolic blood pressure 40 mmHg). Resuscitation was established with either autologous-blood, three per cent hypertonic saline (HS), 7.5% HS, 0.9% NaCl and Ringer's lactate and Dextran 70 solution. Animals in sham shock group were only cannulated and not resuscitated. Bacterial translocation was evaluated by culture of mesenteric lymph nodes taken 24 hours after resuscitation. The rates of bacterial translocation observed were 50% in autologous blood group, 60% in Dextran 70 group, 40% in Ringer's lactate group, 10% each in 3% HS and 7.5% HS group and 20% in 0.9% NaCl group. A statistically significant difference was observed between the groups resuscitated with HS solution and the other solutions. No meaningful difference was noted between the various concentrations of hypertonic saline solution. The reduction in the rate bacterial translocation with hypertonic solution is assumed to be due to preservation of intestinal microcirculation and thus prevention of intestinal ischaemia.