8 research outputs found
Comparison of hepatoprotective effect from ischemia-reperfusion injury of remote ischemic preconditioning of the liver vs local ischemic preconditioning of the liver during human liver resections
AIM:
To compare and evaluate the hepatoprotective effect of remote ischemic preconditioning (RIPC) with local ischemic preconditioning (LIPC) of the liver during human liver resections. ----- METHODS:
A prospective, single-centre, randomised control trial was conducted in the Clinical Hospital "***" from April 2017 to January 2018. A total of 60 patients, who underwent liver resection due to colorectal cancer liver metastasis, were randomised to one of three study arms: 1) a RIPC group, 2) an LIPC group and 3) a control group (CG) in which no ischemic preconditioning was done before liver resection. The hepatoprotective effect was evaluated by comparing serum transaminase levels, bilirubin levels, albumin, and protein levels, coagulograms and through pathohistological analysis. The trial was registered on ClinicalTrials.gov (NCT****). ----- RESULTS:
Significant differences were found in serum levels of liver transaminases and bilirubin levels between the groups, the highest level in the CG and the lowest level in the LIPC group. Levels of cholinesterase were also significantly higher in the LIPC group. Pathohistological findings graded by the Rodriguez score showed favourable changes in the LIPC and RIPC groups versus the CG. ----- CONCLUSION:
Strong evidence supports the hepatoprotective effect of RIPC and LIPC preconditioning from an ischemia-reperfusion injury of the liver. Better synthetic liver function preservation in these two groups supports this conclusion
Laparoscopic surgery at University hospital Department of endoscopic surgery - complications and conversions
Laparoskopski pristup prihvaÄen je u potpunosti na podruÄju abdominalne kirurgije. ViÅ”e gotovo i nema klasiÄnih zahvata koji nisu izvedeni laparoskopski dok su neki, kao Å”to je laparoskopska kolecistektomija, postali zlatni standard u kirurÅ”kom lijeÄenju bolesti.
Cilj ovoga rada bila je analiza rezultata naÅ”eg odjela u laparoskopskoj kirurgiji. Materijali i metode: Na Odjelu endoskopske kirurgije KB Dubrava u 2011. godini izvrÅ”eno je 620 operativnih zahvata, od Äega 150 laparoskopskih. Od svih laparoskopskih operacija uÄinjeno je 98 elektivnih i 52 hitna laparoskopska zahvata te su analizirane njihove komplikacije i postotak konverzija.
Rezultati: NajÄeÅ”Äa operacija meÄu elektivnim laparoskopskim zahvatima bila je laparoskopska kolecistektomija dok je kod hitnih zahvata neÅ”to ÄeÅ”Äe izvoÄena laparoskopska apendektomija. Uz te operacije, laparoskopski su izvedene joÅ” i laparoskopska splenektomija, laparoskopska pericistektomija ehinokoknih cisti jetre i slezene, ekstirpacija simpleks ciste Douglasovoga prostora, laparoskopske suture perforiranoga duodenuma i sigmoidnoga kolona te laparoskopske eksploracije trbuÅ”ne Å”upljine, elektivne i hitne. U svim tim operacijama zabilježene su samo tri komplikacije (apsces lože žuÄnjaka, postoperativni paralitiÄki ileus i krvarenje iz uprapubiÄnoga porta), uz napomenu da su se sve tri komplikacije javile nakon hitnih operativnih zahvata. Stopa konverzije u elektivnih laparoskopskih zahvata iznosila je 3%, a u hitnih 11%.
ZakljuÄak: Laparoskopski zahvati sve viÅ”e postaju primarna metoda izbora i u elektivnim i u hitnim operacijskim zahvatima. Uz dokazane prednosti laparoskopske kirurgije, kao Å”to je brži postoperativni oporavak i blaži kirurÅ”ki stres, unaprjeÄenjem laparoskopskih tehnika i veÄom educiranosti osoblja joÅ” se viÅ”e smanjuje, ionako malen, broj postoperativnih komplikacija i stopa konverzija.Laparoscopic approach in abdominal surgery has been fully established and accepted. There is practically no classic abdominal operation that has not been successfully performed laparoscopically, whereas some of them, like laparoscopic cholecystectomy, have long ago become golden standard in treating cholelithiasis and cholecystitis. The goal of this study was to analyze the results in laparoscopic surgery, which had been obtained at our department during 2011.
Materials and methods: At our Department in year 2011 the authors had performed 620 surgical procedures, 150 of which were laparoscopic procedures. Of all laparoscopic procedures, 98 were elective and 52 urgent procedures. We analysed complications and conversion rates of those procedures.
Results: The most common laparoscopic procedure among elective laparoscopic operations was laparoscopic cholecystectomy, while among urgent procedures it was laparoscopic appendectomy. Some other laparoscopic procedures were also performed, such as laparoscopic splenectomy, laparoscopic pericystectomy of echinococcal cyst of liver and spleen, extirpation of simple cyst from the cavity of Douglas, laparoscopic sutures of perforated duodenum and sigmoid colon and laparoscopic explorations of abdominal cavity, both urgent and elective. Only three complications were recorded (gallbladder abscess, postoperative paralytic ileus and bleeding from the supraumbilical port), and all three complications appeared after urgent procedures. Conversion rate in elective procedures was 3%.
Conclusion: The popularity of laparoscopic procedures is increasing in both elective and urgent laparoscopic procedures. Some benefits of laparoscopic surgery, like shorter postoperative recovery and milder surgical stress, have already been established. Advancing laparoscopic techniques and training of surgical staff will bring the, already low, number of postoperative complications and conversion rates to a minimum
Emergency Surgery for Large Bowel Obstruction caused by Cancer
There are several options for surgical treatment of large bowel obstruction caused by cancer, depending on location of obstruction, intraoperative local findings (perforation, peritonitis, bowel dilatation proximal to obstruction) and patients\u27 condition. Resection and anastomosis as one stage surgery would be preffered procedure. Anastomotic leakage, on the other hand, highly elevates risk of mortality and mobidity. The most important question is whether to, in resectable cases, perform primary resection with anastomosis or not. This study was retrospective and included 40 patients that have undergone emergency surgery for large bowel obstruction caused by cancer. According to whether resection and anastomosis was made at initial surgery or not, patients were grouped in group A (N=18) and group B (N=21), respectively. We have analysed the type of surgical procedure, days of hospitalization, mortality, anastomotic leakeage, wound infection and other postoperative complications. Our results show that there is no major difference in mortality and morbidity in these two groups, suggesting that for selected patients primary resection and anastomosis is a safe option of tratment with acceptable risk. Since there are no strict guidelines or scorring system which would point the tratment option the decision about the choice of procedure still remains the burden of surgeon and depends on its experience and subspeciality. Our experience recomends primary resection and anastomosis except in cases of bowel perforation on tumor site, in cases of extreme dilatation and atony of bowel proximal to obstruction site and severe hypoproteinemia and anemia
Laparoscopic surgery at University hospital Department of endoscopic surgery - complications and conversions
Laparoskopski pristup prihvaÄen je u potpunosti na podruÄju abdominalne kirurgije. ViÅ”e gotovo i nema klasiÄnih zahvata koji nisu izvedeni laparoskopski dok su neki, kao Å”to je laparoskopska kolecistektomija, postali zlatni standard u kirurÅ”kom lijeÄenju bolesti.
Cilj ovoga rada bila je analiza rezultata naÅ”eg odjela u laparoskopskoj kirurgiji. Materijali i metode: Na Odjelu endoskopske kirurgije KB Dubrava u 2011. godini izvrÅ”eno je 620 operativnih zahvata, od Äega 150 laparoskopskih. Od svih laparoskopskih operacija uÄinjeno je 98 elektivnih i 52 hitna laparoskopska zahvata te su analizirane njihove komplikacije i postotak konverzija.
Rezultati: NajÄeÅ”Äa operacija meÄu elektivnim laparoskopskim zahvatima bila je laparoskopska kolecistektomija dok je kod hitnih zahvata neÅ”to ÄeÅ”Äe izvoÄena laparoskopska apendektomija. Uz te operacije, laparoskopski su izvedene joÅ” i laparoskopska splenektomija, laparoskopska pericistektomija ehinokoknih cisti jetre i slezene, ekstirpacija simpleks ciste Douglasovoga prostora, laparoskopske suture perforiranoga duodenuma i sigmoidnoga kolona te laparoskopske eksploracije trbuÅ”ne Å”upljine, elektivne i hitne. U svim tim operacijama zabilježene su samo tri komplikacije (apsces lože žuÄnjaka, postoperativni paralitiÄki ileus i krvarenje iz uprapubiÄnoga porta), uz napomenu da su se sve tri komplikacije javile nakon hitnih operativnih zahvata. Stopa konverzije u elektivnih laparoskopskih zahvata iznosila je 3%, a u hitnih 11%.
ZakljuÄak: Laparoskopski zahvati sve viÅ”e postaju primarna metoda izbora i u elektivnim i u hitnim operacijskim zahvatima. Uz dokazane prednosti laparoskopske kirurgije, kao Å”to je brži postoperativni oporavak i blaži kirurÅ”ki stres, unaprjeÄenjem laparoskopskih tehnika i veÄom educiranosti osoblja joÅ” se viÅ”e smanjuje, ionako malen, broj postoperativnih komplikacija i stopa konverzija.Laparoscopic approach in abdominal surgery has been fully established and accepted. There is practically no classic abdominal operation that has not been successfully performed laparoscopically, whereas some of them, like laparoscopic cholecystectomy, have long ago become golden standard in treating cholelithiasis and cholecystitis. The goal of this study was to analyze the results in laparoscopic surgery, which had been obtained at our department during 2011.
Materials and methods: At our Department in year 2011 the authors had performed 620 surgical procedures, 150 of which were laparoscopic procedures. Of all laparoscopic procedures, 98 were elective and 52 urgent procedures. We analysed complications and conversion rates of those procedures.
Results: The most common laparoscopic procedure among elective laparoscopic operations was laparoscopic cholecystectomy, while among urgent procedures it was laparoscopic appendectomy. Some other laparoscopic procedures were also performed, such as laparoscopic splenectomy, laparoscopic pericystectomy of echinococcal cyst of liver and spleen, extirpation of simple cyst from the cavity of Douglas, laparoscopic sutures of perforated duodenum and sigmoid colon and laparoscopic explorations of abdominal cavity, both urgent and elective. Only three complications were recorded (gallbladder abscess, postoperative paralytic ileus and bleeding from the supraumbilical port), and all three complications appeared after urgent procedures. Conversion rate in elective procedures was 3%.
Conclusion: The popularity of laparoscopic procedures is increasing in both elective and urgent laparoscopic procedures. Some benefits of laparoscopic surgery, like shorter postoperative recovery and milder surgical stress, have already been established. Advancing laparoscopic techniques and training of surgical staff will bring the, already low, number of postoperative complications and conversion rates to a minimum
Bypassing major venous occlusion and duodenal lesions in rats, and therapy with the stable gastric pentadecapeptide BPC 157, L-NAME and L-arginine
AIM:
To investigate whether duodenal lesions induced by major venous occlusions can be attenuated by BPC 157 regardless nitric oxide (NO) system involvement. -----
METHODS:
Male Wistar rats underwent superior anterior pancreaticoduodenal vein (SAPDV)-ligation and were treated with a bath at the ligated SAPDV site (BPC 157 10 Ī¼g, 10 ng/kg per 1 mL bath/rat; L-NAME 5 mg/kg per 1 mL bath/rat; L-arginine 100 mg/kg per 1 mL bath/rat, alone and/or together; or BPC 157 10 Ī¼g/kg instilled into the rat stomach, at 1 min ligation-time). We recorded the vessel presentation (filled/appearance or emptied/disappearance) between the 5 arcade vessels arising from the SAPDV on the ventral duodenum side, the inferior anterior pancreaticoduodenal vein (IAPDV) and superior mesenteric vein (SMV) as bypassing vascular pathway to document the duodenal lesions presentation; increased NO- and oxidative stress [malondialdehyde (MDA)]-levels in duodenum. -----
RESULTS:
Unlike the severe course in the SAPDV-ligated controls, after BPC 157 application, the rats exhibited strong attenuation of the mucosal lesions and serosal congestion, improved vessel presentation, increased interconnections, increased branching by more than 60% from the initial value, the IAPDV and SMV were not congested. Interestingly, after 5 min and 30 min of L-NAME and L-arginine treatment alone, decreased mucosal and serosal duodenal lesions were observed; their effect was worsened at 24 h, and no effect on the collateral vessels and branching was seen. Together, L-NAME+L-arginine antagonized each other's response, and thus, there was an NO-related effect. With BPC 157, all SAPDV-ligated rats receiving L-NAME and/or L-arginine appeared similar to the rats treated with BPC 157 alone. Also, BPC 157 in SAPDV-ligated rats normalized levels of NO and MDA, two oxidative stress markers, in duodenal tissues. -----
CONCLUSION:
BPC 157, rapidly bypassing occlusion, rescued the original duodenal flow through IAPDV to SMV flow, an effect related to the NO system and reduction of free radical formation
Effects of pentadecapeptide BPC 157 on opening of existing collaterals and on healing of duodenal mucosa after ligation of anterior pancreaticoduodenal vein in rats
Fokus ovog istraživanja je na znaÄajnoj venskoj okluziji SAPDV i posljediÄnoj pojavi duodenalnih lezija u Å”takora te terapijski uÄinak stabilnog gastriÄnog pentadekapeptida BPC 157, prototipnog citoprotektivnog agensa. Primjena pentadekapeptida BPC 157 je u životinja s okluzijom razliÄitih krvnih žila (npr. lijeva koliÄna arterija i vena; infrarenalni dio donje Å”uplje vene) dovela do premoÅ”ÄujuÄeg efekta na okluziju djelujuÄi na brzu prezentaciju kolateralnog krvotoka i time na (smanjen) broj razliÄitih lezija (ishemijski kolitis, duboka venska tromboza, Virchowljeva trijada). U Å”takora s podvezanom SAPDV, primjenjena je kupka pripravaka (BPC 157 10 ug, 10 ng/kg/1ml kupke po Å”takoru), NOS blokator LāNAME (5 mg/kg/1ml kupke po Å”takoru); supstrat NOSāa Lāarginin (100 mg/kg/1ml kupke po Å”takoru), primjenjivani samostalno ili u kombinacijama; te fizioloÅ”ka otopina u istom omjeru za kontrolne životinje unutar 1 minute po podvezivanju žile. Nakon aplikacije pentadekapeptida BPC 157, kako u mikro tako i u ng dozama, Å”takori su ispoljili poveÄanu prezentaciju krvnih žila uz obilje ogranaka koji su se pokazivali u 60 % veÄem broju izmeÄu arkada u odnosu na inicijalnu vrijednost; niti IAPDV niti SMV nisu bile kongestirane te je uvelike smanjen broj lezija na duodenumu. UoÄeno je takoÄer, kako je uÄinak LāNAME i Lāarginina u intervalima od 5 i 30 minuta doveo do smanjenja broja lezija sluznice, dok se broj lezija u intervalu od 24 sata pogorÅ”avao, bez efekta na kolaterale i prezentaciju krvnih žila. U životinja koje su uz BPC 157 tretirane i s LāNAME ili Lāargininom, uÄinak se pokazao jednakim kao u životinja tretiranih samo pentadekapeptidom BPC 157. ZakljuÄno, djelovanje pentadekapeptida BPC 157 se oÄituje brzom aktivacijom kolaterala i prezentacijom krvnih žila, premoÅ”Äivanjem okluzije putem IAPDV ā SMV te malim brojem duodenalnih lezija, Å”to je ostvareno posredstvom NOāsustava.We focused on the major venous occlusion (superior anterior pancreaticoduodenal vein (SPADV)āligation) and duodenal lesions in rat, and therapy with the stable gastric pentadecapeptide BPC 157, prototype cytoprotective agent. BPC 157 application in rats underwent other vessels occlusions (i.e., left colic artery and vein; infrarenal inferior caval vein) induced bypassing of occlusion through rapid collaterals presentation, and lesions and whole consequent syndrome (ischemic colitis; deep vein thrombosis, Virchow triad) were largely attenuated. In rats underwent SPDAVāligation, medication was bath at the ligated SAPDV (BPC 157 10 Ī¼g, 10 ng/kg/1ml bath/rat; LāNAME 5 mg/kg/1ml bath/rat; Lāarginine 100 mg/kg/1ml bath/rat, alone and/or together); at 1 min ligationātime. Unlike severe course in controls, after BPC 157 application, rats commonly exhibited strong attenuation of mucosal lesion and serosal congestion, improved vessels presentation, much more interconnections, branching raised more than 60 % from the initial value; inferior anterior pancreaticoduodenal vein (IAPDV) and superior mesenteric vein (SMV) were both non congested. Interestingly, while at 5 min and 30 min period alone LāNAME and Lāarginine decreased mucosal and serosal duodenal lesions, their effect was worsening at 24 h period, no effect on the vessels collaterals and branching. With BPC 157 all SAPDVāigated rats receiving LāNAME and/or Lāarginine appear like rats treated with BPC 157 alone. Concluding, by rapid bypassing occlusion, BPC 157 rescued original duodenal flow through IAPDV to SMV flow, duodenal lesions largely mitigated, NOāsystem related effect
Emergency Surgery for Large Bowel Obstruction caused by Cancer
There are several options for surgical treatment of large bowel obstruction caused by cancer, depending on location of obstruction, intraoperative local findings (perforation, peritonitis, bowel dilatation proximal to obstruction) and patients\u27 condition. Resection and anastomosis as one stage surgery would be preffered procedure. Anastomotic leakage, on the other hand, highly elevates risk of mortality and mobidity. The most important question is whether to, in resectable cases, perform primary resection with anastomosis or not. This study was retrospective and included 40 patients that have undergone emergency surgery for large bowel obstruction caused by cancer. According to whether resection and anastomosis was made at initial surgery or not, patients were grouped in group A (N=18) and group B (N=21), respectively. We have analysed the type of surgical procedure, days of hospitalization, mortality, anastomotic leakeage, wound infection and other postoperative complications. Our results show that there is no major difference in mortality and morbidity in these two groups, suggesting that for selected patients primary resection and anastomosis is a safe option of tratment with acceptable risk. Since there are no strict guidelines or scorring system which would point the tratment option the decision about the choice of procedure still remains the burden of surgeon and depends on its experience and subspeciality. Our experience recomends primary resection and anastomosis except in cases of bowel perforation on tumor site, in cases of extreme dilatation and atony of bowel proximal to obstruction site and severe hypoproteinemia and anemia
LAPAROSCOPIC VERSUS OPEN APPENDECTOMY: OUR EXPERIENCE AND LITERATURE REVIEW
O izboru izmeÄu otvorene i laparoskopske apendektomije postoje kontroverzni stavovi. Dobro su poznate prednosti i nedostatci laparoskopije. Tijekom 3 godine proveli smo prospektivnu studiju (1. sijeÄnja 2008.- 31. prosinca 2010.) 123 bolesnika operiranih zbog akutne upale crvuljka. Bolesnici su sluÄajno odabrani, a podijeljeni su u dvije skupine: (LA) - laparoskopska apendektomija sa 42 i (OA) ā otvorena apendektomija sa 81 zapisom. ProuÄavali smo: dob, spol; vrijednosti broja leukocita prije operacije, CRP, nalaz ultrazvuka (UZ), prepisanu analgeziju i poslijeoperacijski PHD nalaz, te usporedili duljinu trajanja kirurÅ”kog zahvata, duljinu hospitalizacije i komplikacije. Provedena je telefonska anketa s pitanjima o osobnom zadovoljstvu nakon operacije. U 90% bolesnika PHD nalaz bio je pozitivan na upalu. CRP je u 42 bolesnika preoperacijski (34%) bio sa srednjom vrijednosti 59; u 31 (74%) bolesnika s poviÅ”enim preoperacijskim vrijednostima CRP PHD nalaz bio je pozitivan. UZV je uÄinjen u 68 bolesnika (55%): u 44 (65%) pozitivni UZV bio je sukladan PHD nalazu. ProsjeÄno vrijeme operacije u LA/OA bilo je 75/72 minute. Jedina statistiÄki znaÄajna razlika izmeÄu dviju skupina bila je za duljinu hospitalizacije: 4 prema 6 dana (p<0,01 ). U zakljuÄku treba istaknuti da je LA i OA moguÄe usporediti brojem komplikacija. Neznatna prednost LA nudi kirurgu slobodu odluÄivanja u hitnom kirurÅ”kom lijeÄenju akutne upale crvuljka.Aim. The controversy of the choice between open and laparoscopic appendectomy still remains. The benefits as well as disadvantages of laparoscopy are well known. Methods. We designed a prospective 3-year clinical study (January 1,2008 ā December 31,2010) with 123 patients operated on for acute appendicitis. They were prospectively divided into laparoscopic appendectomy (LA) group with 42 results and open appendectomy (OA) group with 81 results. The following parameters were analyzed: age, sex, preoperative leukocyte count, C-reactive protein (CRP) value, preoperative ultrasound finding (US), analgesic administration and histopathologic finding. The length of the operation, length of hospitalization (LOS) and complications were compared between the two groups, along with personal postoperative satisfaction estimated by telephone survey after discharge from the hospital. Results. In 90% of cases, histopathology was positive for inflammation. CRP was determined in 42 (34%) patients preoperatively, with a mean value of 59; positive histopathology finding was recorded in 31 (74%) patients with increased preoperative CRP. US was performed in 68 (55%) patients; positive US was consistent with histopathology in 44 (65%) cases. The mean time of LA/ OA was 75/72 minutes. The only statistical difference was found for LOS: 4 versus 6 days (p<0.01). Conclusion. LA and OA are comparable for the number of complications. The slight benefit of LA offers the surgeon free hand in decision when dealing with acute appendicitis needing urgent operation