ANALYSIS OF THE IMMEDIATE RESULTS OF THE SURGICAL TREATMENTS OF FOCAL LIVER LESIONS
M. SEISEMBAYEV, M. RAMAZANOV, D. TOKSANBAYEV, E. ENIN, M. DOSKHANOV
National Scientific Center of Surgery n.a. A.N. Syzganov, Almaty, KAZAKHSTAN
Objective: To improve the immediate results of liver resections for patients with focal liver lesions.
Materials and methods: The results of hepatic resection for 193 patients with various focal liver lesions were analyzed. All patients were divided into two (2) groups depending on the time when the operation was performed. The Main Group included 81 patients (operations performed in 2004-2010); for the patients in this Group dissection of the liver pulp was made using the modern equipment and techniques, i.e. ultrasonic harmonic scalpel, argon plasma coagulation, and TachoComb adhesive materials.
The Control Group consisted of 112 patients (operations performed in 1980-2003); for the patients in this Group operations were performed using former common operative techniques in liver, applying diathermocoagulation and underruning of the liver pulp with P-shaped surgical sutures.
Results: 16 patients from the Main Group (19.7%) had various complications, the ratio of complications in patients with minor and major liver resections were little different: 3 (15.8%) and 13 persons (20.9%) respectively.
In the Control Group, 48 patients (42.9%) had various complications: 9 patients (21.9%) who got minor liver resection, and 39 persons (54.9%) for whom the major liver resections were performed. Moreover, 46 persons (41.1%) suffered from various postoperative specific complications: 19.5% of those who got minor liver resection, and 53.5% of patients who had major liver resections.
Conclusion: The number of various complications in patients from the Main Group was managed to be decreased more than twice, from 42.9% down to 19.7%. Analysis of the number of specific complications after major liver resections shows similar tendency, i.e. decreasing of cases of complications from 54.9% down to 20.9%.
EFFECTIVENESS OF THE METHODS OF LAPARASCOPIC CHOLECYSTOCTOMY IN ACUTE CHOLECYSTITIS
Rovno regional clinical hospital, Rovno, UKRAINE
The aim of the work. To compare effectiveness of laparoscopic cholecystectomy performed by American and own method in acute cholecystitis.
Materials and methods. The results of surgical interventions in 227 patients with acute cholecystitis treated from January 2005 to December 2008 were analyed. In all the observations diagnosis was confirmed morphologically. Patients were divided into two groups depending on the method of cholecystectomy. The first group - 115 patients, which underwent laparoscopic cholecystectomy by own method (an assistant carries out traction of the bottom of the gallbladder through a port located along the middle clavicular line 7-8 cm lower the costal arch, and traction of the gallbladder neck through the lateral port, located on anterior axillary line 2 cm lower the costal arch, the main stages of the operation are carried out by the surgeon through epigastric port). The second group - 112 patients were operated by the American method. The effectiveness of operations was evaluated by comparing the number of intra-and postoperative complications.
Results and discussion. Both groups of patients did not differ significantly as to age, sex, laboratory parameters, the thickness of the gallbladder wall and the distribution of morphological forms of acute cholecystitis. No fatal outcomes were observed in both groups. During the application of own method 1 (0.87%) conversion, and American method - 1 (0.89%) (p = 0.985) conversion was carried out. The number of bleedings with 50 ml and more of blood loss by own method of laparoscopic cholecystectomy constituted 51 (44.3%) cases and was significantly smaller as compared to the American method - 62 (55.4%) (p = 0.042). Statistically significant difference was revealed also in the number of perforations of gallbladder. Fewer perforations, as compared to the American method with 30 (27.0%) cases, were observed in laparoscopic cholecystectomy by own method: 18 (15.8%) observations (χ2 = 4,232, p = 0.040). The duration of the operation during laparoscopic cholecystectomy by own method constituted average of 80.03+27.66 minutes and was lower as compared to the American method - 93.48+32.57 (p = 0.001).
Conclusions. According to the results of study it was found that own method of laparoscopic cholecystectomy, taking into account the duration of the operation, has advantages over the American way, and involves smaller number of cases of bleeding and perforation of gallbladder.
IS PHARMACOLOGICAL PRETREATMENT AND ISCHEMIC PRECONDITIONING DECREASE ISCHEMIC REPERFUSION INJURY OF THE LIVER?
R. SHAHBAZOV, KARAKAYALI, N. HABERAL., S SEVMIS., N. BAYRAKTAR,
Scientific Research Surgical Center named after akad M. A. Topchubashov, Baku, AZERBAIJAN, Baskent University Medical Faculty, Ankara, TURKEY
Despite many advances in organ transplantation, ischemic-reperfusion injury of the liver remains major problem in liver transplantation.
Aim of this study was determination of the effectiveness of Essensiale-forte (EF) and ischemic preconditioning on ischemic-reperfusion injury of the liver.
Materials and methods. We have taken 10 weeks old,48 male Sprak-Dawi rats for study purpose. All rats were randomly divided into 6 groups. There were 8 rats in each group. Group 1 was control group. In group 2 rats were received 20mg/kg EF two days before test. In group 3, rats had ischemic-reperfusion assault. In group 4, rats were received 20mg/kg EF and I/R were created. In group5, after intermittent clamping of portal elements ischemic-reperfusion assault was created. In group 6 rats were received EF, ischemic preconditioning was created then I/R were done .Blood biochemical features (ALT, AST, ALP, MDA, NO, TNF-α, IL-6,Il-10) and morphological changes analyzed by hemotoxylin – eosin. Apoptosis were measured by TUNEL staining.
Results.ALT, AST, ALP, TNF α, MDA level were significantly lower in group1, 2, 4, 6 rats than those in 3 and 5 groups. However, NO level was higher in group 2, 4, 6.Histological examination showed amelioration of sinusoidal damage as well as decrease of necrotic areas and apoptotic sinusoidal endothelial cells in the pretreated rat groups.
Conclusion. Our study has shown that the pretreatment of EF with application of ischemic preconditioning decrease IR injury of the liver, therefore this method could be applied to clinical liver transplantation models.
REDUCTION OF THE BLOOD LOSS AND ISCHEMIC REPERFUSION INJURY IN THE MAJOR LIVER SURGERY
R.O. SHAHBAZOV, K.O. BEYDULLAYEV, E. AHMEDOV, M. SADIYEV, E. JABRAILOV,
C. MUSAYEV, H. ISAYEV
Scientific Center of Surgery named after akad. Topchubashov, Central Hospital for Neftchiler, Baku, AZERBAIJAN
Introduction: Extensive blood loss is still a major problem in major liver surgery, especially during partial liver resection and orthotropic liver transplantation. Major blood loss and transfusion requirements are still a concern during this type of operations. It is well known that peri-operative blood loss and transfusion of blood products are associated with increased rates of morbidity and mortality, both in non-cirrhotic and cirrhotic patients. Preoperative correction of coagulation tests with blood products has not been shown to reduce intraoperative bleeding and it may, in fact, enhance the bleeding risk. Blood loss can be minimized by surgical methods, including vascular clamping techniques, the use of dissection devices, and the use of topical haemostatic agents.
Materials and methods: To evaluate the effect of intermittent hepatic inflow occlusion (IHIO) during donor hepatectomy and liver resections for other causes, we performed a single centre, retrospective study. Patients who underwent liver resection between December 2009 and June 2011, using the Essencial phospholipids as a pharmacological pre-treatment medication as well as intermittent hepatic inflow occlusion manoeuvre were identified retrospectively. We use this manoeuvre routinely during hepatic resection.17 patients were male and 6 patients were female.All 23 patients (13 donor hepatectomy on normal liver, 5 right hepatoectomy and 1 left hepatectomy due to malignancy, 4 partial hepatectomy for Klatskin tumour) undergoing major liver resection were randomized to evaluate effectiveness of pharmacological pre-treatment and intermittent hepatic inflow occlusion (15 min ischemia, 5 min reperfusion) methodology. In overall 1.0±0.5 litre blood were transfused in perioperative period. Hospital stay in donor and other cases was a mean of 10.0 ± 6 days. There was no in-hospital mortality within 3 months, and no cases of primary non-function or initial poor function were identified
Conclusion: Although our series are small, but it shows that mechanical and pharmacological ischaemic preconditioning can reduce blood loss during major liver surgery without compromising remnant liver as well as graft liver functions.