[The consequences of cholecystectomy]. / Posledstviya kholetsistektomii (s kommentariem).

AIM: to analyze the consequences of cholecystectomy. MATERIAL AND METHODS: 348 patients were under observation within 10  years after cholecystectomy. Surgery for destructive and chronic cholecystitis was performed in 115 and 233 patients respectively. The consequences of cholecystectomy were assessed using bile acids level in blood plasma, stomach and duodenal pressure, pancreatic and stomach changes. RESULTS AND DISCUSSION: It was established that lithocholic, deoxycholic, taurodeoxycholic acids were increased by 44% within 10 years after surgery. At the same time glycocholic and tauroursodeoxycholic acids were decreased by 21.5% in 5 years after surgery. Bile acids level changes were associated with changes of stomach and duodenal pressure. The most pronounced disorders were observed in distal duodenum. There was more than 2.8-fold excess of normal pressure in this area. Duodenal hypertension was accompanied by pancreatic ducts enlargement in 9.5% of cases and increased echogenicity in 93% of cases. CONCLUSION: Changes of the level and proportion of blood plasma bile acids and hypertension in upper gastrointestinal tract are the most important in chronic pancreatitis pathogenesis after cholecystectomy. Such conditions occur within first 3 years after surgery.

[Changes in concentration of cholecystokinin-pancreozymin in patients with cholelithiasis before and after cholecystectomy].

The level of cholecystokinin and secretin in 50 patients after cholecystectomy (from 1 to 10 years ago) was analyzed to study connection between cholecystectomy and gastrointestinal hormones concentration. 30 patients with gall bladder stone disease were included into the group of comparison. Cholecystokinin and secretin concentration in the groups of research was compared with indicated hormones concentration in the group of control formed of healthy volunteers. After anamnestical clinical and diagnostical features in every group had been studied we concluded, that cholecystokinin level changes depending on period after operation and outflow of bile conditions.

[Antithrombin III, protein C and thrombin/antithrombin III complexes (TAT) in patients suffering from chronic cholecystolithiasis treated by classical and laparoscopic cholecystectomy]. / Antytrombina III, bialko C oraz kompleksy trombina/antytrombina III (TAT) u chorych poddanych klasycznej lub laparoskopowej cholecystektomii z powodu przewleklego kamiczego zapalenia pecherzyka zólciowego.

Surgery is the basic treatment method of cholecystolithiasis. Traditional methods have been replaced laparoscopy. The aim of the study was the evaluation of haemostasis after classical and laparoscopic cholecystectomy. The studies were conducted in 48 patients suffering from chronic cholecystolithiasis--29 of them were operated on by laparoscopy, 19 patients were operated on by classical way. We revealed, that classical and laparoscopic cholecystectomy cause a similar increase of thrombin generating in vascular bed and are risk factors for occurrence of thrombo-embolic complications.

Heparin reduces oxidative stress in the postoperative period.

BACKGROUND: The purpose of our study was to investigate the influence of low-dose heparin on peroxide levels and the antioxidant activity of superoxide dysmutase (SOD), catalase (CAT), and glutathione peroxidase in the red blood cells of patients undergoing minor abdominal surgery. MATERIAL/METHODS: 49 patients scheduled for open cholecystectomy, with a median age of 43, were randomly assigned to either the heparin group (HG) or the placebo group (PG). HG patients received a subcutaneous dose of 100 IU/kg body weight of standard heparin for 6 days, beginning the first day after surgery. On the day prior to surgery and on the 1st, 2nd and 6th postoperative days, blood samples from peripheral veins were collected, and the levels of peroxides, superoxide dysmutase (SOD), catalase (CAT) and glutathione peroxidase activity in the hemolysate of red blood cells were determined. The level of malondialdehyde was also measured. RESULTS: Significantly lower levels of peroxides, as well as higher antioxidant activity of SOD and CAT, was found in the erythrocytes of HG patients. Heparin administration did not significantly influence the activity of glutathione peroxidase. There were also no differences in the levels of malondialdehyde between HG and PG patients. CONCLUSIONS: Low-dose standard heparin administered subcutaneously in patients undergoing minor abdominal surgery shows an antioxidant effect. Further studies are required to clarify the mechanism of increased SOD and CAT activity in red blood cells induced by heparin.

[The pathogenesis of liver functional disorders after cholecystectomy in cholelithiasis]. / O patogeneze narushenii funktsii pecheni posle kholetsistéktomii pri zhelchnokamennoi bolezni.

AIM: To study hepatic function after cholecystectomy and the role of absorptive-excretory function of the liver and hormonal factors in development of postcholecystectomy syndrome. MATERIALS AND METHODS: 106 patients long after cholecystectomy for cholelithiasis were examined for absorptive-excretory function of the liver and blood hormones (hydrocortisone, insulin, gastrin, thyroxine, triiodothyronine, thyrotropine). I-131-bengal-rose hepatography, dynamic hepatobiliscintigraphy with brommeside-Tc-99m, radioimmunoassay were employed. RESULTS: Impairment, often subclinical, of hepatic absorption and excretion after cholecystectomy was found in 94% of the patients. External function of the liver after cholecystectomy was disturbed depending on the condition of its absorptive-excretory function. Hepatic dysfunctions and changes in blood hormones correlated. CONCLUSION: Absorptive-excretory function and hormonal factors are essential in pathogenesis of postcholecystectomy syndrome.