Laparoscopic cholecystectomy performed by surgical trainees.

OBJECTIVE: The aim of this study was to assess morbidity, mortality, and outcome in select patients after laparoscopic cholecystectomy performed by consultants or by Specialist Registrars (SpRs) and Senior House Officers (SHO), in the General Hospital of Ioannina 'G. Hatzikosta' in northwestern Greece. METHODS: Between January 1, 2001 and December 31, 2005, 1370 laparoscopic cholecystectomies were performed, 445 (33%) by SpRs and SHO and 925 (67%) by consultants. Patients included 982 (71.3%) women and 388 (28.7%) men. The mean age was 46.2 years (range, 17 to 79). All patients had routine blood tests (including liver function tests), electrocardiography, chest x-ray, and abdominal ultrasound scan performed preoperatively. All patients received a general anesthesia, and the standard Reddick and Olsen technique was performed. The Harmonic scalpel was used in all cases. RESULTS: Four conversions (0.3%) were required to an open procedure, (2 in the SpRs and SHO group and 2 in the group of consultants), because of impossible recognition of anatomy around Calot's triangle. The mean operative time was 57 minutes (range, 33 to 97) for SpRs and SHO, while for the consultants it was 49 minutes (range, 27 to 78, P=0.25). Mortality rate was 0% in both groups. There were 44 major complications (2.7%), 17 in the SHO and SpRs group (3.7%) and 27 in the consultant group (1.7%, P=0.11). The complications included bowel thermal injury (consultants [cons], 1; residents [res], none); bile duct injury (cons, 1; res, none); bile leak (cons, 3; res, 5); hemorrhage (cons, 2; res, 2); hematomas at the trocar sites (cons, 5; res, 4); inflammation of the port site at the umbilicus (cons, 4; res, 5); paralytic ileus (cons, 4; res, 3); and hemorrhage from the subxiphoid trocar (cons, 2; res, 3), which stopped spontaneously. The mean hospital stay was 1.3 days, while all the patients resumed their normal activities after 11.7 days (range, 7 to 19). CONCLUSION: Supervised laparoscopic cholecystectomy performed by trainees does not increase surgical morbidity and does not compromise surgical outcome.

Intracystic pressure and viability in hydatid disease of the liver.

BACKGROUND: Knowledge on the viability of hydatid cysts of the liver during operation is important to the surgeon may dictate the peri-operative therapeutic manoeuvre undertaken. PATIENTS AND METHODS: A prospective study was performed on 23 patients with 28 hydatid cysts of the liver to assess whether intracystic pressure (ICP) could predict viability of protoscoleces. All patients received albendazole (10 mg/kg body weight/day) for 5 days pre-operatively. The ICP was measured from the apex of the cyst, after laparotomy, using a 16-G needle connected to a water manometer. After manometry, the cyst contents were aspirated and the viability of protoscoleces assessed by their flame cell activity, motility and ability to exclude 5% aqueous eosin. RESULTS: The median ICP was 54 +/- 21 cmH2O for 17 viable cysts and zero for 8 non-viable cysts, while 1 additional non-viable cyst and 2 sterilized cysts had high ICP (sensitivity, 100%; specificity, 72%; accuracy, 89%). The median diameter of the viable cysts was 9.3 +/- 3.5 cm and the non-viable cysts 10.7 +/- 2.6 cm. In the right lobe were located 12 viable and 8 non-viable cysts and in the left lobe, 5 viable and 3 non-viable cysts. No significant difference in diameter or ICP were noted between the hepatic lobes. CONCLUSIONS: These findings suggest that the measurement of ICP is a simple, cheap and reliable method for assessment of the viability of hydatid cysts of the liver.

The role of oxygen-derived free radicals in peritoneal adhesion formation induced by ileal ischaemia/reperfusion.

The effectiveness of superoxide dismutase (SOD), catalase (CAT), dimethyl sulphoxide (DMSO) and allopurinol in prevention of peritoneal adhesion formation induced by complete vascular obstruction and reperfusion of an ileal segment was investigated in rats. The ischaemic period was 30 min. Group A (n = 20) were controls, group B (n = 15) received SOD 15,000 U/kg i.v. and group C (n = 17) the same dose of CAT immediately before induction of ischaemia. In group D (n = 20) DMSO 20 mg/kg was given i.v. 5 min before ischaemia, and group E (n = 20) received allopurinol orally 50 mg/kg daily for 2 days and also 2 hours before ischaemia. Ten days later adhesions had developed in 80% of group A, 40% of group B, 47% of group C and 45% of groups D and E (p less than 0.05). The severity of the adhesions was significantly less in the pretreated groups than in the controls. Oxygen-derived free radicals may be pathogenetically important for such adhesion formation. Xanthine oxidase is the principal source of oxygen radicals after a 30-min period of complete regional intestinal ischaemia.

Ranitidine and oxygen derived free radical scavengers in haemorrhagic shock induced gastric lesions.

The role of oxygen derived free radicals in gastric lesions induced by haemorrhagic shock and the protective effect of oxygen radical scavengers, allopurinol and ranitidine, were investigated. Forty five rabbits underwent haemorrhagic shock for 30 minutes and reinfusion of shed blood. They were killed 30 minutes later. The animals were divided in five groups: A (n = 10): Control, B (n = 10): intravenous ranitidine pretreatment, C (n = 10): oral allopurinol, 24 and 2 h before surgery; D (n = 10): intravenous pretreatment with superoxide Dismutase plus catalase, E (n = 5): 60 minute haemorrhagic shock without reinfusion and treatment. Erosions and/or petechiae in all animals in Group A were observed. Three animals in group B and C and 2 in group D (p less than 0.005, p less than 0.001) had gastric lesions. The lesions in the pretreatment groups were significantly smaller than in controls. Oxygen radicals plus HCl play an important role in shock induced gastric lesions. Oxygen radical antagonists show a significant protective role.