OUR RESULTS IN LAPAROSCOPIC-ASSISTED PLACEMENT OF PERITONEAL DIALYSIS CATHETERS: TEN-YEAR EXPERIENCE

Prikazujemo analizu naših rezultata i komplikacija pri postavljanju Tenckhoffova katetera za peritonejsku dijalizu laparoskopskom metodom i usporedbu s objavljenima u literaturi. Retrospektivna analiza uključila je 50 bolesnika koji su podvrgnuti postavljanju katetera za peritonejsku dijalizu laparoskopskom tehnikom u Klinici za kirurgiju Kliničkog bolničkog centra Rijeka od siječnja 2000. do studenog 2010. godine. Analizirani su uspješnost rezultata, rane i kasne postoperacijske komplikacije, konverzija u otvoren pristup te stopa reoperacije. Ranim komplikacijama su smatrane one nastale u prvih 4 tjedna od operacije. Komplikacije su se javile u 23 bolesnika (29 komplikacija). Ranih komplikacija bilo je 18, od toga 2 akutna peritonitisa, 2 ileusa, 4 krvarenja, 4 infekcije izlaznog mjesta katetera, 3 propuštanja dijalizata oko peritonejskog katetera, 2 malpozicije katetera te 1 genitalni edem. Kasnih komplikacija je bilo 11, od toga 5 akutnih peritonitisa, 1 recidivni peritonitis, 1 krvarenje, 1 infekcija izlaznog mjesta katetera, 1 malpozicija katetera, 1 propuštanje dijalizata oko peritonejskog katetera i 1 hernija u području implantacije peritonejskog katetera. Nije bilo smrtnih ishoda nakon operacije niti je bilo komplikacija koje su onemogućile provođenje peritonejske dijalize. Zaključujemo da se u liječenju bolesnika s terminalnim renalnim zatajivanjem laparoskopska tehnika pokazala prikladnom i sigurnom metodom postavljanja peritonejskog katetera.The aim was to analyze our results and complications in laparoscopic-assisted placement of the Tenckhoff catheter for peritoneal dialysis in comparison with results reported in the literature. Fifty patients were included in this retrospective analysis. From January 2000 to November 2010, they underwent laparoscopic-assisted placement of catheter for peritoneal dialysis at the University Department of Surgery, Rijeka University Hospital Center. The results of this approach, early and late postoperative complications, conversions to open technique, and reoperation rate were analyzed. The complications that occurred within the fi rst 4 weeks were considered as early complications. In 23 patients, 29 complications were recorded. There were 18 early complications, of which 2 acute peritonitis, 2 ileus, 4 bleeding, 4 catheter infection, 3 fl uid leakage, 2 catheter malpositioning and 1 genital edema. There were 11 late complications, of which 5 acute peritonitis, 1 recurrent peritonitis, 1 bleeding, 1 catheter infection, 1 catheter malpositioning, 1 fl uid leakage and 1 port site hernia. There were no deaths after surgery or any complications disabling the implementation of peritoneal dialysis. In patients with end-stage renal disease, laparoscopic-assisted placement of catheter for peritoneal dialysis is a safe and appropriate method of treatment

Influence of preoperative oral feeding on stress response after resection for colon cancer

Background/Aims: Preoperative management involves patients fasting from midnight on the evening prior to surgery. Fasting period is often long enough to change the metabolic condition of the patient which increases perioperative stress response. That could have a detrimental effect on clinical outcome. The aim of the present study was to investigate the possible effects of carbohydrate-rich beverage on stress response after colon resection. Methodology: Randomized and double blinded study included 40 patients with colon, upper rectal or rectosigmoid cancer. Investigated group received a carbohydrate-rich beverage the day before and two hours before surgery. In the control group patients were in the standard preoperative regime: nothing by mouth from the evening prior to operation. Peripheral blood was sampled 24h before surgery, at the day of the surgery, and 6, 24 and 4813 postoperatively. Results: Colonic resection in both groups caused a significant increase in serum interleukin 6 (IL-6) levels 6,24 and 4813 after the operation. Increase was more evident and statistically significant in the group with fasting protocol. More significant increase of interleukin 10 (IL-10) occurred in patients who received preoperative nutrition. Conclusions: Smaller increase in IL-6 and higher in IL-10 are indicators of reduced perioperative stress

Preoperative oral feeding reduces stress response after laparoscopic cholecystectomy

Background/aims: Fasting period before surgery may change metabolic status of the patient and have influence on perioperative stress response. The aim of the study was to investigate effects of preoperative carbohydrate-rich beverage on stress response after laparoscopic cholecystectomy. Methodology: Patients admitted for laparoscopic cholecystectomy were included into study and they were randomized into a group that was fed prior to surgery and in a group that was in the regime of nothing by mouth from the evening one day before surgery. Concentrations of C-reactive protein and cortisol, were measured before and subsequently up to 48 h postoperatively. Results: Postoperative serum C-reactive protein increased significantly in both groups, but the increase was more evident in the group with fasting protocol both 24 and 48 hours postoperatively. In fed patients cortisol concentration measured in the afternoon immediately after the operation showed physiological decline. In patients with fasting protocol postoperative cortisol values rise above the values measured in the morning. Conclusions: Preoperative feeding has advantage over overnight fasting by reducing preoperative discomfort in patients after laparoscopic cholecystectomy. In fed patients, smaller increase in C-reactive protein and better regulation of cortisol levels are an indicator of decreased perioperative stress response

Preoperative oral feeding reduces stress response after laparoscopic cholecystectomy

Background/aims: Fasting period before surgery may change metabolic status of the patient and have influence on perioperative stress response. The aim of the study was to investigate effects of preoperative carbohydrate-rich beverage on stress response after laparoscopic cholecystectomy. Methodology: Patients admitted for laparoscopic cholecystectomy were included into study and they were randomized into a group that was fed prior to surgery and in a group that was in the regime of nothing by mouth from the evening one day before surgery. Concentrations of C-reactive protein and cortisol, were measured before and subsequently up to 48 h postoperatively. Results: Postoperative serum C-reactive protein increased significantly in both groups, but the increase was more evident in the group with fasting protocol both 24 and 48 hours postoperatively. In fed patients cortisol concentration measured in the afternoon immediately after the operation showed physiological decline. In patients with fasting protocol postoperative cortisol values rise above the values measured in the morning. Conclusions: Preoperative feeding has advantage over overnight fasting by reducing preoperative discomfort in patients after laparoscopic cholecystectomy. In fed patients, smaller increase in C-reactive protein and better regulation of cortisol levels are an indicator of decreased perioperative stress response

Influence of preoperative oral feeding on stress response after resection for colon cancer

Background/Aims: Preoperative management involves patients fasting from midnight on the evening prior to surgery. Fasting period is often long enough to change the metabolic condition of the patient which increases perioperative stress response. That could have a detrimental effect on clinical outcome. The aim of the present study was to investigate the possible effects of carbohydrate-rich beverage on stress response after colon resection. Methodology: Randomized and double blinded study included 40 patients with colon, upper rectal or rectosigmoid cancer. Investigated group received a carbohydrate-rich beverage the day before and two hours before surgery. In the control group patients were in the standard preoperative regime: nothing by mouth from the evening prior to operation. Peripheral blood was sampled 24h before surgery, at the day of the surgery, and 6, 24 and 4813 postoperatively. Results: Colonic resection in both groups caused a significant increase in serum interleukin 6 (IL-6) levels 6,24 and 4813 after the operation. Increase was more evident and statistically significant in the group with fasting protocol. More significant increase of interleukin 10 (IL-10) occurred in patients who received preoperative nutrition. Conclusions: Smaller increase in IL-6 and higher in IL-10 are indicators of reduced perioperative stress

NK cells link obesity-induced adipose stress to inflammation and insulin resistance

An important cause of obesity-induced insulin resistance is chronic systemic inflammation originating in visceral adipose tissue (VAT). VAT inflammation is associated with the accumulation of proinflammatory macrophages in adipose tissue, but the immunological signals that trigger their accumulation remain unknown. We found that a phenotypically distinct population of tissue-resident natural killer (NK) cells represented a crucial link between obesity-induced adipose stress and VAT inflammation. Obesity drove the upregulation of ligands of the NK cell-activating receptor NCR1 on adipocytes; this stimulated NK cell proliferation and interferon-gamma (IFN-gamma) production, which in turn triggered the differentiation of proinflammatory macrophages and promoted insulin resistance. Deficiency of NK cells, NCR1 or IFN-gamma prevented the accumulation of proinflammatory macrophages in VAT and greatly ameliorated insulin sensitivity. Thus NK cells are key regulators of macrophage polarization and insulin resistance in response to obesity-induced adipocyte stress