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This experimental study compares the effects of early postoperative administration of three enteral diets of different compositions on the healing of colonic anastomoses. Sixty Wistar rats were subjected to colonic anastomoses. Following surgery, the rats were randomly allocated to four groups of 15 each. The rats in control group A received an electrolyte and glucose solution, the rats in group B received a complete balanced nutrition, in group C a complete balanced nutrition supplemented with fiber and in group D an isocaloric specialized elemental nutrition enriched with glutamine. The rats were sacrificed on day 7 following operation. Rupture of the anastomosis was higher in rats of the control group compared to the other three groups. Adhesion formation was more extensive in group A in comparison to the other three groups. The anastomotic bursting pressures were statistically significantly higher in groups C and D compared to the other two groups (p < 0.05). There was no statistically significant difference between group C and D (p > 0.05) while a statistically significant difference was noted between group B and group A (p < 0.05). Histological examination showed more profound inflammatory reaction in group A compared to the other three groups. There was also a statistically significant difference between group B and groups C and D while inflammatory reaction was of no statistically significant difference between group C and group D. Healing of the anastomoses was statistically significantly impaired in group A compared to the other three groups. There was no statistically significant difference between group C and group D while a statistically significant difference was found between group B and groups C and D. In conclusion, early postoperative enteral feeding improves healing of experimental colonic anastomoses in rats. This effect was more evident when fiber-supplemented diets or diets enriched with glutamine were administered. [ABSTRACT FROM AUTHOR]

Background: Experimental studies have shown that elevation of intraabdominal pressure by means of gas insufflation produces hemodynamic disturbances in the peritoneal viscera, leading to splanchnic ischemia. The purpose of this clinical investigation is to reproduce the experimental data in humans undergoing laparoscopic cholecystectomy.Methods: Sixteen females participated in this study. Eight of them (the control group) were subjected to open laparotomy for biliary surgery, while on the remaining eight laparoscopic cholecystectomy was performed. In all patients hepatic microcirculation was registered during the time of operation using the laser-Doppler technique. A single-fiber laser-Doppler microprobe was introduced transcutaneously within the hepatic parenchyma, through a Chiba needle, under direct or laparoscopic vision. Additionally, gastric intramucosal/intramural pH, a low level of which indicates tissue ischemia, was assessed by means of a tonometric nasogastric catheter. Hepatic microcirculation and gastric intramucosal/intramural pH were assessed between controls and pneumoperitoneum-subjected patients, and within the laparoscopic surgery group, i.e., during pneumoperitoneum and after abdominal deflation.Results: Hepatic microcirculation was found to be significantly decreased in laparoscopic surgery patients in relation to controls (22.21 +/- 5.48 vs 57.52 +/- 18.06 perfusion units of flow, P = 0.0001) as was gastric intramural pH (7.15 +/- 0.16 vs 7.37 +/- 0.02, P = 0.003). Similarly, immediately after abdominal deflation, hepatic microcirculation exhibited a sudden elevation (22.21 +/- 5.48 vs 67.49 +/- 7.93 perfusion units of flow, P = 0.0001), while gastric intramural pH return to its normal values (7.15 +/- 0.16 vs 7.43 +/- 0.07, P = 0.0001).Conclusions: It is concluded that during laparoscopic cholecystectomy abdominal organs are hypoperfused, leading to a splanchnic ischemia environment. The clinical significance of these events remains to be clarified. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the reliability of selective surveillance colonoscopy based on 6 specific perioperative risk factors in the early diagnosis of colonic ischemia (CI) after successful ruptured abdominal aortic aneurysm (rAAA) repair.Patients and Methods From 1999 to 2005, 62 consecutive patients underwent rAAA repair. In 59 of them, routine aggressive surveillance colonoscopy was offered every 12 hours within the first 48 hours, and CI was graded consistently. Patients with stage I or stage II CI were treated conservatively and were followed up with repeat colonoscopy, whereas patients with stage III CI underwent immediate laparotomy and colectomy. In parallel, 6 specific perioperative risk factors (PRFs) were retrospectively analyzed.Results Overall mortality was 33.9%. Nineteen patients (32.2%) developed CI and 12 (63.2%) of them survived.Thirteen (22%) had grade III CI and among these 6 survived. In patients with CI the mortality rate was 36.2%. Patients with less than 3 PRFs had no CI whereas all instances of CI could be diagnosed if colonoscopy was offered selectively in patients with more than 3 PRFs. The positive predictive value of CI increased with the number of PRFs. Patients with 5 or 6 PRFs were about 101 times more likely to develop CI compared with patients with 0 to 4 PRFs (P < .001).Conclusion Our study showed that CI is a frequent complication after successful rAAA repair and could reliably be early diagnosed if surveillance colonoscopy was offered selectively in patients with more than three PRFs. [ABSTRACT FROM AUTHOR]

Background: Endoscopic sphincterotomy (ES) is widely used for the treatment of residual bile duct stones in patients who had common bile duct (CBD) exploration and T-tube insertion. Method: in a 4-year period 45 patients were referred for endoscopic removal of residual bile duct stones. All patients had been operated 7–15 days earlier for choledocholithiasis and had a T-tube in the common bile dud (CBD), Results: Four patients were excluded. Three patients had a periampullary carcinoma and the fourth patient had no residual stone seen at cholangiography. All patients had a successful ES, conventional in 34, precut-knife in 3, and with the rendezvous technique in 4 patients. In 24 patients, all having stones distal to the T-tube, complete clearance of the CBD was achieved during one session and the T-tube was removed after 48 h. In the remaining 17 patients (15 having stones proximal to the T-tube). the T-tube had to be removed first and following stone extraction, a plastic stent was inserted in the CBD. Complete bile duct clearance and stent removal was achieved in a second session 3–4 weeks later. There were no serious complications or biliary related symptoms after the procedures and after a mean follow-up period of 18 months. Conclusion: The endoscopic technique is safe and efficient for the treatment of residual stones after CBD exploration with a T-tube insertion, offering immediate cure compared to the percutaneous techniques. It is also an ideal method for the diagnosis of periampullary carcinomas. [ABSTRACT FROM AUTHOR]

Background The aim of our study is to present our experience in the treatment of liver metastases in patients with colorectal cancer. Patients and methods Between 1997 and 2003 a total of 12 patients with liver metastases from a primary colorectal cancer were treated in our department. They were 8 males and 4 females with a median age of 64 years (range 56-70 years). Results Ten patients underwent liver resection. The surgical procedures were 4 major hepatectomies (3 right hepatectomies, 1 left lobectomy) and 9 wedge liver resections. In total, 16 metastatic lesions were resected. Already at the time of the primary tumour, 5 patients presented with a synchronous liver metastasis. In 3 of them, liver metastasis was resect- ed together with the primary tumour, and in the rest, resection was performed 1 month after the initial operation. In S patients liver metastases were metachronous and were diagnosed 3-14 months after the initial operation. The median survival of the patients was 39 months. Two patients (one with 2 metastatic lesions) underwent radiofrequency ablation (RFA) of the metachronous metastatic lesions and remain well 3-6 months postoperatively. Conclusions Hepatectomy is the treatment of choice for hepatic metastasis of colorectal cancer, whenever feasible. Recent promising treatments such as RFA can further improve the outcome of these patients. [ABSTRACT FROM AUTHOR]