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Sarma R, Ray S, Baishya NK, Sultana W. Comparative Study of Levels of Serum Bilirubin, Serum Transaminase, Serum Alkaline Phosphatase, and Prothrombin Time After Laparoscopic Cholecystectomy and Open Cholecystectomy. Cureus 2024; 16:e60296. [PMID: 38872670 PMCID: PMC11170308 DOI: 10.7759/cureus.60296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/15/2024] Open
Abstract
Laparoscopic cholecystectomy (LC) is universally accepted as the gold standard treatment for symptomatic gallstones. However, it has some drawbacks. Some of the major drawbacks of LC include increased bile duct injuries and longer operation time. Furthermore, it may cause changes in the body systems, such as alterations in acid-base, pulmonary status, cardiovascular system, and liver function. Thus far, no causes for these changes have been identified. This study aimed to evaluate the effect of laparoscopic and open cholecystectomy on liver enzymes, prothrombin time (PT), and serum bilirubin. In the current study, we found significant increases in aspartate transferase (AST), alanine transaminase (ALT), and total bilirubin, on day 1 and day 3 after LC but no significant change in alkaline phosphatase (ALKP) and PT. It is important for surgeons to know about these transient changes in the immediate postoperative period to avoid misdiagnosis and adopt proper treatment and management.
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Affiliation(s)
- Rahul Sarma
- General Surgery, GNRC Hospital, Guwahati, IND
| | - Sushmita Ray
- General Surgery, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, IND
| | | | - Wahida Sultana
- General Surgery, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, IND
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Zhou C, Xu L, Xu Z, Ge Y, Zhou L, Wang F, Liu J, Pan G, Yang T, Jia R. Pneumoperitoneum preconditioning for the prevention of renal function after laparoscopic partial nephrectomy: protocol for a double-blind randomised controlled trial. BMJ Open 2020; 10:e032002. [PMID: 32461289 PMCID: PMC7259839 DOI: 10.1136/bmjopen-2019-032002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Renal ischaemia reperfusion injury is an inevitable pathophysiology in different clinical situations including laparoscopic partial nephrectomy (LPN), which can obviously decrease the renal function after surgery. Pneumoperitoneum preconditioning (PP) is a promising approach that can yield a protective effect on kidney, which has already been demonstrated in some animal models. The present study is designed to assess whether the PP can yield a clinical renoprotective role after LPN. METHODS AND ANALYSIS This study is a randomised, prospective, double-blind and parallel controlled clinical trial. Eligible participants will be patients with renal tumours and willing to choose elective LPN. Patients randomised to the treatment arm will receive PP consisted of three cycles of 5 min insufflation and 5 min desufflation before LPN, while the control arm will receive a sham operation. The primary endpoints are glomerular filtration rate and the level of serum cystatin C within 6 months after desufflation. The secondary endpoints are serum creatinine, estimated glomerular filtration rate, alanine transaminase, serum amylase, intestinal fatty acid binding protein, postoperative hospital stay, the incidence of adverse events and mortality in postoperative 6 months. ETHICS AND DISSEMINATION This study has been approved by the institutional ethics committee of Nanjing First Hospital. The results of this study will be reported faithfully through scientific conferences or published articles. TRIAL REGISTRATION NUMBER NCT03822338.
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Affiliation(s)
- Changcheng Zhou
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China
| | - Luwei Xu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China
| | - Zheng Xu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China
| | - Yuzheng Ge
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China
| | - Liuhua Zhou
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China
| | - Feng Wang
- Nuclear Medicine Center, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China
| | - Jingyu Liu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China
| | - Gaojian Pan
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China
| | - Tianli Yang
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China
| | - Ruipeng Jia
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nangjing, Jiangsu, China
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Akbulut S, Yagmur Y, Sakarya H, Bahce ZS, Gumus S, Sogutcu N. Relationship between clinical and histopathological features of patients undergoing cholecystectomy. PRZEGLAD GASTROENTEROLOGICZNY 2020; 15:131-137. [PMID: 32550945 PMCID: PMC7294973 DOI: 10.5114/pg.2019.86772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/30/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Cholelithiasis is most common disease of the gallbladder and cholecystectomy is the one of the most performed surgical procedure worldwide. AIM To assess the relationship between the demographic, biochemical, and histopathological variables of patients who underwent cholecystectomy. MATERIAL AND METHODS Demographic, biochemical, and histopathological data of 5077 patients undergoing cholecystectomy were compared in terms of two different aspects: open cholecystectomy (OC group; n = 2090) versus laparoscopic cholecystectomy (LC group; n = 2987), and an elective group (n = 4814) versus an emergency group (n = 263). RESULTS A total of 5077 patients aged between 13 and 97 years were included in the study. Aspartate aminotransferase (AST) levels, alanine aminotransferase (ALT) levels, mean platelet volume, and prevalence of acute/chronic cholecystitis were significantly higher in the LC group than in the OC group. On the other hand, age, direct bilirubin level, thrombocyte count, and prevalence of gallbladder cancer/gangrenous cholecystitis were significantly higher in the OC group than in the LC group. Levels of AST, ALT, white blood cells, neutrophils, and some prevalence of acute/chronic active cholecystitis were higher in the emergency group than in the elective group. On the other hand, the lymphocyte count and prevalence of chronic cholecystitis/hyperplastic polyps were higher in the elective group than in the emergency group. Histopathological analysis identified 32 patients with malignant gallbladder cancer as follows: adenocarcinoma (n = 21), mucinous adenocarcinoma (n = 3), papillary adenocarcinoma (n = 3), adenosquamous carcinoma (n = 1), clear cell adenocarcinoma (n = 2), squamous carcinoma (n = 1), and hepatocellular carcinoma metastasis (n = 1). CONCLUSIONS Even when the appearance of gallbladder specimens is normal, histopathological assessment allows for early diagnosis of many unusual findings such as gallbladder cancer.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
- Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
| | - Yusuf Yagmur
- Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
| | - Hamdi Sakarya
- Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
| | - Zeynep Sener Bahce
- Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
| | - Serdar Gumus
- Department of Surgery, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
| | - Nilgun Sogutcu
- Department of Pathology, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey
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Singh L, Kulshrestha R, Singh N, Jaggi AS. Mechanisms involved in adenosine pharmacological preconditioning-induced cardioprotection. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2018; 22:225-234. [PMID: 29719445 PMCID: PMC5928336 DOI: 10.4196/kjpp.2018.22.3.225] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 02/05/2018] [Accepted: 02/27/2018] [Indexed: 01/11/2023]
Abstract
Adenosine is a naturally occurring breakdown product of adenosine triphosphate and plays an important role in different physiological and pathological conditions. Adenosine also serves as an important trigger in ischemic and remote preconditioning and its release may impart cardioprotection. Exogenous administration of adenosine in the form of adenosine preconditioning may also protect heart from ischemia-reperfusion injury. Endogenous release of adenosine during ischemic/remote preconditioning or exogenous adenosine during pharmacological preconditioning activates adenosine receptors to activate plethora of mechanisms, which either independently or in association with one another may confer cardioprotection during ischemia-reperfusion injury. These mechanisms include activation of KATP channels, an increase in the levels of antioxidant enzymes, functional interaction with opioid receptors; increase in nitric oxide production; decrease in inflammation; activation of transient receptor potential vanilloid (TRPV) channels; activation of kinases such as protein kinase B (Akt), protein kinase C, tyrosine kinase, mitogen activated protein (MAP) kinases such as ERK 1/2, p38 MAP kinases and MAP kinase kinase (MEK 1) MMP. The present review discusses the role and mechanisms involved in adenosine preconditioning-induced cardioprotection.
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Affiliation(s)
- Lovedeep Singh
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala 147002, India
| | | | - Nirmal Singh
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala 147002, India
| | - Amteshwar Singh Jaggi
- Department of Pharmaceutical Sciences and Drug Research, Punjabi University, Patiala 147002, India
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Martikos G, Kapelouzou A, Peroulis M, Paspala A, Athanasiadis D, Machairas A, Liakakos T, Moulakakis K, Vasdekis S, Lazaris AM. Remote Ischemic Preconditioning Decreases the Magnitude of Hepatic Ischemia-Reperfusion Injury on a Swine Model of Supraceliac Aortic Cross-Clamping. Ann Vasc Surg 2018; 48:241-250. [DOI: 10.1016/j.avsg.2017.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/11/2017] [Accepted: 08/18/2017] [Indexed: 12/15/2022]
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Antoniou EA, Kairi E, Margonis GA, Andreatos N, Sasaki K, Damaskos C, Garmpis N, Samaha M, Argyra E, Polymeneas G, Weiss MJ, Pawlik TM, Voros D, Kouraklis G. Effect of Increased Intra-abdominal Pressure on Liver Histology and Hemodynamics: An Experimental Study. ACTA ACUST UNITED AC 2017; 32:85-91. [PMID: 29275303 DOI: 10.21873/invivo.11208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/16/2017] [Accepted: 09/19/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND While reduction of portal venous (PV) blood flow has been described in animal models of intra-abdominal hypertension, reports on compensatory changes in hepatic arterial (HA) flow, known as the hepatic arterial buffer response are controversial. MATERIALS AND METHODS Pneumoperitoneum with helium was induced in 13 piglets. Hemodynamic measurements and pathological assessment were conducted at baseline and during the three subsequent phases: Phase A: 45 minutes with a stable intra-abdominal pressure of 25 mmHg; phase B: 45 minutes with a stable intra-abdominal pressure of 40 mmHg; and phase C during which the abdomen was re-explored and reperfusion of the liver was allowed to take place. RESULTS Phase B pressure was significantly greater than phase A pressure in both the PV and the inferior vena cava, demonstrating a positive association between escalating intra-abdominal hypertension and the pressure in these two vessels (all p<0.001). In contrast, HA pressure was comparable between baseline and phase A, while it tended to decrease in phase B. Regarding histology, the most notable abnormality was the presence of inflammatory infiltrates and hepatocyte necrosis. CONCLUSION Helium-insufflation increased PV pressure with a partial compensatory decrease of HA pressure. Nonetheless, findings consistent with hepatic ischemia were observed on pathology.
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Affiliation(s)
- Efstathios A Antoniou
- Second Department of Propaedeutic Surgery, Laiko Hospital, University of Athens, Athens, Greece
| | - Evi Kairi
- Department of Pathology, Aretaieion Hospital, University of Athens School of Medicine, Athens, Greece
| | - Georgios A Margonis
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A
| | - Nikolaos Andreatos
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A
| | - Kazunari Sasaki
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A
| | - Christos Damaskos
- Second Department of Propaedeutic Surgery, Laiko Hospital, University of Athens, Athens, Greece
| | - Nikolaos Garmpis
- Second Department of Propaedeutic Surgery, Laiko Hospital, University of Athens, Athens, Greece
| | - Mario Samaha
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A
| | - Eriphyli Argyra
- First Department of Anesthesiology, Aretaieion Hospital, University of Athens School of Medicine, Athens, Greece
| | - George Polymeneas
- Second Department of Surgery, Aretaieion Hospital, University of Athens School of Medicine, Athens, Greece
| | - Matthew J Weiss
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A
| | - Timothy M Pawlik
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A
| | - Dionysios Voros
- Second Department of Surgery, Aretaieion Hospital, University of Athens School of Medicine, Athens, Greece
| | - Gregory Kouraklis
- Second Department of Propaedeutic Surgery, Laiko Hospital, University of Athens, Athens, Greece
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Wever KE, Bruintjes MHD, Warlé MC, Hooijmans CR. Renal Perfusion and Function during Pneumoperitoneum: A Systematic Review and Meta-Analysis of Animal Studies. PLoS One 2016; 11:e0163419. [PMID: 27657740 PMCID: PMC5033590 DOI: 10.1371/journal.pone.0163419] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/08/2016] [Indexed: 01/03/2023] Open
Abstract
Both preclinical and clinical studies indicate that raised intra-abdominal pressure (IAP) associated with pneumoperitoneum during laparoscopic surgical procedures can cause renal damage, the severity of which may be influenced by variables such as pressure level and duration. Several of these variables have been investigated in animal studies, but synthesis of all preclinical data has not been performed. This systematic review summarizes all available pre-clinical evidence on this topic, including an assessment of its quality and risk of bias. We performed meta-analysis to assess which aspects of the pneumoperitoneum determine the severity of its adverse effects. A systematic search in two databases identified 55 studies on the effect of pneumoperitoneum on renal function which met our inclusion criteria. There was high heterogeneity between the studies regarding study design, species, sex, pressure and duration of pneumoperitoneum, and type of gas used. Measures to reduce bias were poorly reported, leading to an unclear risk of bias in the majority of studies. Details on randomisation, blinding and a sample size calculation were not reported in ≥80% of the studies. Meta-analysis showed an overall increase in serum creatinine during pneumoperitoneum, and a decrease in urine output and renal blood flow. Subgroup analysis indicated that for serum creatinine, this effect differed between species. Subgroup analysis of pressure level indicated that urine output decreased as IAP level increased. No differences between types of gas were observed. Data were insufficient to reliably assess whether sex or IAP duration modulate the effect of pneumoperitoneum. Four studies assessing long-term effects indicated that serum creatinine normalized ≥24 hours after desufflation of pneumoperitoneum at 15mmHg. We conclude that harmful effects on renal function and perfusion during pneumoperitoneum appear to be robust, but evidence on long-term effects is very limited. The reliability and clinical relevance of these findings for healthy patients and patients at high risk of renal impairment remain uncertain. We emphasize the need for rigorous reporting of preclinical research methodology, which is of vital importance for clinical translation of preclinical data.
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Affiliation(s)
- Kimberley E. Wever
- Systematic Review Centre for Laboratory animal Experimentation (SYRCLE), Radboud university medical center, Nijmegen, The Netherlands
| | | | - Michiel C. Warlé
- Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands
| | - Carlijn R. Hooijmans
- Systematic Review Centre for Laboratory animal Experimentation (SYRCLE), Radboud university medical center, Nijmegen, The Netherlands
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Singal R, Singal RP, Sandhu K, Singh B, Bhatia G, Khatri A, Sharma BP. Evaluation and comparison of postoperative levels of serum bilirubin, serum transaminases and alkaline phosphatase in laparoscopic cholecystectomy versus open cholecystectomy. J Gastrointest Oncol 2015; 6:479-86. [PMID: 26487940 DOI: 10.3978/j.issn.2078-6891.2015.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) requires the creation of a pneumoperitoneum via insufflations of carbon dioxide; resulting in increased partial pressure of carbon dioxide (CO2) and intraperitoneal pressure which leads to the changes in pulmonary function and hemodynamic measurements. Hypercarbia leads to visceral organ ischemia including liver and venous stasis/thromboembolism or both due to impaired flow. The present study has been undertaken to see the changes in liver function tests (LFTs) after laparoscopic/open cholecystectomy (OC), the incidences of such change, their relation to age, sex, duration of surgery and to know the clinical significances of such disturbances. AIMS AND OBJECTIVES To compare and correlate the serum level of bilirubin, alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP) in patients who underwent LC to those who underwent OC. MATERIALS AND METHODS The present study was conducted in the Department of Surgery at MMIMSR, MM University, Mullana, Ambala. A total number of 200 patients diagnosed as cholelithiasis were included in the study from May 2012 to May 2014. These cases were randomly divided into two groups (A and B) consisting of 100 cases each. LC was performed in group A patients and OC was done in group B patients. Three blood samples were taken: (I) pre-operatively; (II) after 24 hours of surgery; and (III) after 72 hours of surgery for comparison of the enzyme level alterations. RESULTS In LC patients, there were rise in the levels of serum bilirubin, AST and ALT after 24 hrs of surgery from the preoperative value and then again fall was noted (near to normal value) after 72 hrs of surgery except in that of ALP. ALP levels showed slight fall after 24 hrs of surgery and then slight rise after 72 hrs which was within the normal limit. Whereas in OC patients, there were slight variations in the liver enzymes (which were within the normal range). CONCLUSIONS Transient elevation of serum bilirubin, AST and ALT occurs after LC or after OC. The alteration in the liver enzymes can be attributed to CO2 pneumoperitoneum, surgical manipulations, diathermy, patient position, and arterial injury may also other factors. These changes return to normal in 3-4 days after procedure and they have no clinical consequences in patients with normal hepatic function but they may still cause worry to the surgeon regarding the integrity of biliary tree.
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Affiliation(s)
- Rikki Singal
- 1 Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India ; 2 Department of Orthopaedics, Adesh Institute of Medical Sciences and Research, Bathinda, India
| | - Rajinder Pal Singal
- 1 Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India ; 2 Department of Orthopaedics, Adesh Institute of Medical Sciences and Research, Bathinda, India
| | - Karamjot Sandhu
- 1 Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India ; 2 Department of Orthopaedics, Adesh Institute of Medical Sciences and Research, Bathinda, India
| | - Bir Singh
- 1 Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India ; 2 Department of Orthopaedics, Adesh Institute of Medical Sciences and Research, Bathinda, India
| | - Gaurav Bhatia
- 1 Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India ; 2 Department of Orthopaedics, Adesh Institute of Medical Sciences and Research, Bathinda, India
| | - Abhishek Khatri
- 1 Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India ; 2 Department of Orthopaedics, Adesh Institute of Medical Sciences and Research, Bathinda, India
| | - Bhanu Pratap Sharma
- 1 Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, (Distt-Ambala), Haryana, India ; 2 Department of Orthopaedics, Adesh Institute of Medical Sciences and Research, Bathinda, India
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Athanasiadis D, Kapelouzou A, Martikos G, Katsimpoulas M, Schizas D, Vasdekis SN, Kostakis A, Liakakos TD, Lazaris AM. Remote Ischemic Preconditioning May Attenuate Renal Ischemia-Reperfusion Injury in a Porcine Model of Supraceliac Aortic Cross-Clamping. J Vasc Res 2015; 52:161-71. [PMID: 26745363 DOI: 10.1159/000439219] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/23/2015] [Indexed: 11/19/2022] Open
Abstract
AIM The effect of remote ischemic preconditioning (RIPC) in decreasing renal ischemia-reperfusion injury (IRI) during a suprarenal aortic cross-clamping was examined in a swine model. MATERIALS AND METHODS Four groups of pigs were examined: (a) ischemia-reperfusion (IR) group, renal IRI produced by 30 min of supraceliac aortic cross-clamping; (b) RIPC I group, the same renal IRI following RIPC by brief occlusion of the infrarenal aorta (15 min ischemia and 15 min reperfusion); (c) RIPC II group, the same renal IRI following RIPC by brief occlusion of the infrarenal aorta (3 cycles of 5 min ischemia and 5 min reperfusion); (d) sham group. Renal function was assessed before and after IRI by examining creatinine, neutrophil gelatinase-associated lipocalin (NGAL), TNF-α, malondialdehyde (MDA), cystatin C and C-reactive protein (CRP) from renal vein blood samples at specific time intervals. RESULTS Both RIPC groups presented significantly less impaired results compared to the IR group when considering MDA, cystatin C, CRP and creatinine. Between the two RIPC groups, RIPC II presented a better response with regard to CRP, NGAL, TNF-α, MDA and cystatin C. CONCLUSIONS Remote IR protocols and mainly repetitive short periods of cycles of IR ameliorate the biochemical kidney effects of IRI in a model of suprarenal aortic aneurysm repair.
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Affiliation(s)
- Dimitris Athanasiadis
- Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens (BRFAA), Athens, Greece
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Leventi A, Argyra E, Avraamidou A, Marinis A, Asonitis S, Perrea D, Voros D, Theodoraki K. Attenuation of Oxidative Stress by Ischemic Preconditioning in an Experimental Model of Intraabdominal Hypertension. J INVEST SURG 2015; 28:253-60. [PMID: 26305379 DOI: 10.3109/08941939.2015.1031922] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Increased intra-abdominal pressure, as used in laparoscopic surgery or seen in intraabdominal hypertension (IAH), is associated with tissue ischemia and oxidative stress. Ischemic preconditioning (IP) is a method successfully used in liver and transplant surgery, in order to attenuate the detrimental effects of ischemia and reperfusion. In this experimental study, we tested the ability of IP to modify oxidative stress induced by extremely high intraabdominal pressures. METHODS Twenty-five female pigs were studied and divided in three groups: a control group, a pneumoperitoneum group (with pressure of 30 mmHg), and an ischemic preconditioning group (initially subjected to preconditioning with pressure of 25 mmHg for 15 min and desufflation for 15 min and then to pneumoperitoneum as in pneumoperitoneum group). Blood samples were obtained at identical time intervals in the three groups. Total oxidative capacity, total antioxidative capacity and total nitric oxide (NO), nitrite and nitrate concentrations were measured and compared between groups. RESULTS IP increased total antioxidative capacity (p = .045) and protective mediators like nitrite (p = .022). It was also associated with a trend toward lower levels of total oxidative capacity at the end of the abdominal desufflation period but statistical significance was not met. CONCLUSIONS IP attenuated oxidative stress induced by IAH, mainly by increasing antioxidative capacity and the levels of protective mediators. The fact that IP was effective, even when used at extremely high levels of intraabdominal pressure, reinforces the interest on this method but further studies are needed to clarify its mechanism of action and potential clinical applications.
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Affiliation(s)
- Aikaterini Leventi
- a Department of Surgery, The Whittington Hospital, NHS Trust , London , UK
| | - Eriphylli Argyra
- b First Department of Anaesthesiology, Aretaieion University Hospital , Athens , Greece
| | - Alexandra Avraamidou
- b First Department of Anaesthesiology, Aretaieion University Hospital , Athens , Greece
| | - Athanasios Marinis
- c Second Department of Surgery, Aretaieion University Hospital , Athens , Greece
| | - Spyridon Asonitis
- c Second Department of Surgery, Aretaieion University Hospital , Athens , Greece
| | - Despoina Perrea
- d Laboratory of Experimental Surgery and Surgical Research "NS Christeas" (LESSR), Medical School of Athens, University of Athens , Athens , Greece
| | - Dionysios Voros
- c Second Department of Surgery, Aretaieion University Hospital , Athens , Greece
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Komori Y, Iwashita Y, Ohta M, Kawano Y, Inomata M, Kitano S. Effects of different pressure levels of CO2 pneumoperitoneum on liver regeneration after liver resection in a rat model. Surg Endosc 2014; 28:2466-73. [PMID: 24619333 DOI: 10.1007/s00464-014-3498-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 02/17/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND A recent study demonstrated that high pressure of carbon dioxide (CO2) pneumoperitoneum before liver resection impairs postoperative liver regeneration. This study was aimed to investigate effects of varying insufflation pressures of CO2 pneumoperitoneum on liver regeneration using a rat model. METHODS 180 male Wistar rats were randomly divided into three groups: control group (without preoperative pneumoperitoneum), low-pressure group (with preoperative pneumoperitoneum at 5 mmHg), and high-pressure group (with preoperative pneumoperitoneum at 10 mmHg). After pneumoperitoneum, all rats were subjected to 70% partial hepatic resection and then euthanized at 0 min, 12 h, and on postoperative days (PODs) 1, 2, 4, and 7. Following outcome parameters were used: liver regeneration (liver regeneration rate, mitotic count, Ki-67 labeling index), hepatocellular damage (serum aminotransferases), oxidative stress [serum malondialdehyde (MDA)], interleukin-6 (IL-6), and hepatocyte growth factor (HGF) expression in the liver tissue. RESULTS No significant differences were observed for all parameters between control and low-pressure groups. The liver regeneration rate and mitotic count were significantly decreased in the high-pressure group than in control and low-pressure groups on PODs 2 and 4. Postoperative hepatocellular damage was significantly greater in the high-pressure group on PODs 1, 2, 4, and 7 compared with control and/or low-pressure groups. Serum MDA levels were significantly higher in the high-pressure group on PODs 1 and 2, and serum IL-6 levels were significantly higher in the high-pressure group at 12 h and on POD 1, compared with control and/or low-pressure groups. The HGF tissue expression was significantly lower in the high-pressure group at 12 h and on PODs 1 and 4, compared with that in control and/or low-pressure groups. CONCLUSIONS High-pressure pneumoperitoneum before 70% liver resection impairs postoperative liver regeneration, but low-pressure pneumoperitoneum has no adverse effects. This study suggests that following laparoscopic liver resection using appropriate pneumoperitoneum pressure, no impairment of liver regeneration occurs.
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Affiliation(s)
- Yoko Komori
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan,
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Borchert D, Köhler P, Jäger T, Diederich M, Hüther L, Berk A, Lamade W. Prolonged capnoperitoneum does not cause postoperative ileus in pigs: safety of prolonged capnoperitoneum. MINIM INVASIV THER 2013; 23:157-64. [PMID: 24171454 DOI: 10.3109/13645706.2013.855234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Operative time is an accepted risk factor for the development of postoperative ileus (POI). Innovative surgical procedures such as robotic surgery and natural orifice transluminal endoscopic surgery (NOTES) will be associated with longer operative times. Although intraabdominal manipulation is a major factor for POI the impact of prolonged capnoperitoneum on postoperative gastrointestinal transit time (GIT-TT) has rarely been studied. MATERIAL AND METHODS IRB approved survival pilot study to assess postoperative GIT-TT using fecal collection and chromium-oxide (Cr2O3) labeling in pigs. Twelve female pigs were randomly assigned to three groups of four animals each. Group A received eight hours anesthesia and pressure-controlled high flow capnoperitoneum (15 mmHg), group B eight hours of anesthesia only and group C no intervention. No intraoperative manipulation. The pilot study was terminated after eight days. RESULTS None of the animals developed POI. In Group A one animal died after eight hours of general anesthesia. No differences in postoperative fecal output, Cr2O3 excretion rate or weight gain were found. CONCLUSION This study is the first to investigate eight hours of capnoperitoneum in a survival model. GIT-TT is not affected by prolonged capnoperitoneum in pigs. No POI occurred with prolonged capnoperitoneum. Prolonged capnoperitoneum is safe regarding postoperative gastrointestinal function in innovative surgical procedures.
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Affiliation(s)
- Dietmar Borchert
- Saarland University Hospitals, Department of Surgery , Homburg/Saar , Germany
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Maddison L, Karjagin J, Buldakov M, Mäll M, Kruusat R, Lillemäe K, Kirsimägi U, Starkopf J. Sublingual microcirculation in patients with intra-abdominal hypertension: a pilot study in 15 critically ill patients. J Crit Care 2013; 29:183.e1-6. [PMID: 24125769 DOI: 10.1016/j.jcrc.2013.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/07/2013] [Accepted: 08/27/2013] [Indexed: 01/18/2023]
Abstract
PURPOSE The purpose of the study is to clarify whether increased intra-abdominal pressure (IAP) is associated with sublingual microcirculatory alterations in intensive care patients. METHODS Fifteen adult, mechanically ventilated patients were included if their IAP was at least 12 mm Hg for at least 12 hours within the first 3 days after admission to the intensive care unit. Sublingual sidestream dark field (SDF) images were recorded twice a day for 7 days. RESULTS Median (interquartile range) IAP at inclusion was 14.5 (12.5-16.0) mm Hg. The total vascular density of small vessels at the sublingual area was 13.1 (10.6-14.3) per square millimeter at baseline; the proportion of perfused vessels, 78.9% (69.6%-86.2%); and perfused vessels density, 12.4 (10.8-13.8) per square millimeter. The calculated indices suggested relatively good blood flow in the capillaries, with a De Backer score of 9.0 (8.3-10.2) and a microvascular blood flow of 3.0 (2.9-3.0). Blood flow heterogeneity index was 0.3 (0.1-0.5) at study entry. Despite that IAP, vasopressors dose, and arterial lactate decreased significantly over time, no significant changes were observed in sublingual microvascular density or blood flow. Weak correlations of microvascular blood flow (positive) and heterogeneity index (negative) were detected with both mean arterial pressure and abdominal perfusion pressure. CONCLUSIONS Neither grade I or II intra-abdominal hypertension (IAP from 12 to 18 mm Hg) is associated with significant changes of sublingual microcirculation in intensive care patients. Correlation analysis indicates better microvascular blood flow at higher mean arterial pressure and abdominal perfusion pressure levels.
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Affiliation(s)
- Liivi Maddison
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu University Hospital, Puusepa 8, 51014 Tartu, Estonia.
| | - Juri Karjagin
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu University Hospital, Puusepa 8, 51014 Tartu, Estonia
| | - Maksim Buldakov
- University of Tartu, Medical Faculty, Ravila 19, Tartu, Estonia
| | - Merilin Mäll
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu University Hospital, Puusepa 8, 51014 Tartu, Estonia
| | - Rein Kruusat
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu University Hospital, Puusepa 8, 51014 Tartu, Estonia
| | - Kadri Lillemäe
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu University Hospital, Puusepa 8, 51014 Tartu, Estonia
| | - Ulle Kirsimägi
- Department of Surgery, University of Tartu, Tartu University Hospital, Puusepa 8, 51014 Tartu, Estonia
| | - Joel Starkopf
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu University Hospital, Puusepa 8, 51014 Tartu, Estonia
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Ribeiro CT, De Souza DB, Medeiros Jr. JL, Costa WS, Pereira-Sampaio MA, Sampaio FJB. Pneumoperitoneum induces morphological alterations in the rat testicle. Acta Cir Bras 2013; 28:419-22. [DOI: 10.1590/s0102-86502013000600003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 05/10/2013] [Indexed: 11/22/2022] Open
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