Turkish Journal of Surgery - 2001; 17(2)

EFFECT OF DIFFERENT TYPES OF ENTERAL AND PARENTERAL NUTRITION ON FUNCTIONS AND REGENERATION OF THE LIVER AFTER PARTIAL HEPATECTOMY IN RATS

2001-03-01

The remnant liver has the capability of regeneration after massive hepatectomy. In order to document and compare the effect of different types of enteral and parenteral feeding forms on liver functions, hepatic regeneration and postoperotive mortality. 70 adult male Wistar-Albino rats (226.59 � 12.93g) after anesthetized with Diethyl ether (C2H5OC2H5) had 70% hepatic resection. The rats were divided randomly into seven groups; In control group, total hepatectomy was performed, in Group II; 80 kcal/kg/day standart oral feeding (SOF), in Group III; 115 kcal/kg/day ensure plus solution via gastrostomy tube, in Group IV; 110 kcal/kg/day 5% Dextrose, 0.9% NaCI and Hepatamine solution, in Group V; 190 kcal/kg/day 10% Dextrose, 10% Lipid and Hepatamine solution, in group VI; 216 kcal/kg/day 20% Dextrose, 20%Lipid and Hepatamin solution and in Group VII; 260kcal/kg/day 30% Dextrose, 30% Lipid and Hepatamin solution via juguler vein were given. On postoperative day seven, the rest of the liver was removed and blood samples were taken for Albumin, Total protein, and AST and ALT levels and tissue PCNA protein levels were compared. There were no differences between AST and ALT levels among all groups. In group 2 and 3 albumin levels and regeneration of the liver and percentage of hepotocyte nucleus were higher than the other groups (p<0.05). In conclusion, we recommend to return enteral feeding as soon as possible after major hepatic resections.

PATIENT'S RIGHT TO SELF-DETERM1NATION: INFORMED CONSENT

MURAT C�VANER, CEM TERZ� — 2001-03-01

We aimed to investigate the effect of informed consent on the patients' knowledge on his/her disease and satisfaction in this study. Moreover, the study was conducted to determine patients' attitude on the concept of informed consent. In routine practice, patients' consent which is a written agreement that gives the right to the health care provider to perform diagnostic and therapeutic procedures on the patient, has been taken on the hospital admission form as a small and compulsory legal detail at the turbulent environment of admission procedure. However, it has been understood and commonly accepted that having patients' consent via special structured form is very important. Between November 1 1999 and January31 2000, 142 patients who were admitted to the Dokuz Eyl�l University Hospital, Clinic of General Surgery were taken into the prospectively randomised study. In control group, patients' consent was taken via routine procedure. In study group, patients' consent was taken via informed consent form which was specially designed by the authors. Before discharge from the hospital, the patient information and satisfaction survey was performed to all patients. In statistical analysis, Pearson x2 test was used to compare the differences between the groups. The majority of patients in both groups (97.1%) wanted to know all facts of their disease and treatment, but they stated that the doctor could take the treatment decision on by her/his own (80.9%). Almost half of the patients stated that they would not refuse the treatment even it was not exactly the same with their consent (44.7%). In study group the patients pointed out that they had more information about the procedure (p<0.01), the side effects-possible harms (p<0.001), and alternatives of the treatment (p<0.001). In addition, we found that their understanding on what they have been told was better (p<0.001) and the informed consent increased patients' satisfaction (p<0.001).

SURGICALLY TREATED ACUTE PANCREATITIS: EVALUATION OF 51 PATIENTS

BURHAN KABAY, OSMAN ABBASO�LU, VOLKAN KAYNARO�LU, AHMET �ZEN�, �SKENDER SAYEK — 2001-03-01

This study was performed to determine the factors influencing the mortality and morbidity in surgically treated patients with acute pancreatitis. To know the risk factors and factors affecting mortality and morbidity is important for planning and evaluating the effectiveness of treatment, and determining prognosis. Hospital records of 51 patients, hospitalized between 1980-1998, with the operative diagnosis of acute pancreatitis were retrospectively investigated. Mortality and morbidity rates for all patients were %23.5 and 39.2 respectively. The most common operative indication was acute abdomen (%74.5) and deteriorating clinical condition (%19.6). Increased blood glucose and lactate dehydrogenase levels, decreased blood calcium and albumin levels, ileus and abdominal distension, diagnosis of hemorrhagic necrotizing pancreatitis were found to be the risk factors effecting mortality. Increased blood urea nitrogen (BUN), and decreased blood calcium level abdominal distension and infected necrotizing pancreatitis were the risk factors effecting morbidity. In case of interstisial pancreatitis mortality rate was decreasing (%15.2). We conclude that the most important factor determining mortality and morbidity was the presence of necrosis.

PATIENT SATISFACTION AND CHANGES IN COMMON BILE DUCT DIAMETER FOLLOWING CHOLECYSTECTOMY LONG TERM RESULTS

2001-03-01

The effect of cholecystectomy on common bile duet diameter remains controvertial, It has been shown that the diameter of common bile duet increases significantly in the early postoperative period, but in the long term studies such on evidence has not been shown. This study investigates the long term changes in the diameter of common bile duet ond its relationship with symptomatic relief following cholecystectomy. Twenty eight patients undergoing elective open or laparoscopic cholecystectomy due to symptomatic gall blodder stone were studied. The common bile duct diameter of these patients were measured by ultrasonography and compared with the preoperative values. Meanwhile the degree of symptomatic improvement was determined by a guestionnaire to compare the preoperative and postoperative symptoms. The median follow-up period was 98.5 (53-135) months. In the postoperative measurements, the diameter of common bile duet was found to be more than 7 mm in 29% of the patients (mean 6.1 mm) where as the corresponding figure was 43%, preoperotively (mean 7.4 mm). There was no statistically significant difference in measurements between two periods. Following cholecystectomy, 79% of patients had complete symptomatic relief. All patients were satisfied with the operation in various degrees. As the conclusion, cholecystectomy has no effect on changes of common bile duet diameter and clinical success as well as patient satisfaction can be achieved when patients with appropriate indication are chosen for surgery.

DELAY IN DIAGNOSIS AND TREATMENT OF ACUTE APPENDICITIS AND CLINICAL RESULTS

RAMAZAN ERYILMAZ, MUSTAFA �AH�N, ORHAN AL�MO�LU, G�RHAN BA� — 2001-03-01

In this prospective study, the association between delay in diagnosis and surgical treatment, and the stages and complications of acute appendicitis was investigated. Despite improvement in techniques, diagnosis of acute appendicitis still remains challenging and complications of disease and rate of negative laparotomy have not been reduced significantly. One hundred twenty-four patients with diagnosis of acute appendicitis underwent surgery between July 1999 and July 2000. Clinical and pathological findings, duration of symptoms, age, sex, postoperative complications and length of hospital stay were recorded and analyzed statistically. Among the patients,70 were males (56.5%), 54 were females (43.5%) and mean age was 24.7 years. Accurate diagnosis of acute appendicitis was 84.7%, negative appendectomy rate was 15.3% and negative exploration rate was 8.1%. The study results showed that delay in admission of patients to the hospital following onset of symptoms (55.7 � 26.5 h) results in complicated appendicitis. In patients with negative appendectomies, durations between admission to hospital-surgical consultation and surgical consultation-decision of operation was longer than complicated and noncomplicated appendicitis.

AGE AND SEX-SPECIFIC CHANGES IN PATIENTS WITH PERFORATED APPENDICITIS

G�NAY G�RLEY�K — 2001-03-01

The perforation of acutely inflamed appendicitis causing regional and systemic dissemination of a focal infection is a turning point negatively affecting clinical course, development of complications, and patient's outcome. To determine and to eliminate risk factors leading to perforation, and to be aware of and well-informed about the risk will be favourable for such patients. In this study we aimed to investigate age and sex-specific effects on the occurrence of perforation and intraabdominal sepsis due to acute appendicitis, and on the postoperative morbidity and mortality. We retrospectively reviewed hospital charts of patients with acute appendicitis who were subjected to appendectomy. 326 patients with perforated appendicitis were devided and analysed into three groups as the childhood, the adults and the elderly. We evaluated age and sex-specific effects on the incidence of appendicitis, perforation rate, postoperative complications and patient's outcome. Of 326 perforated cases 219 (67.2%) were male and 107 (32.8%) female with an average age of 27.8 years. The rate of perforation was 12.7%. This rate was 17.7% (p<0.001) and 38.5% (p<0.001) in groups of the childhood and the elderly respectively. The childhood and the elderly groups consisting 35.3% of all appendicitis cases, were 56.1% (p<0.0001) of perforated cases. Sex distribution did not significantly affected the occurrence of perforated appendicitis. The total morbidity was 32.8% in all cases, and 73.8% (p<0.0001)in the elderly. The number and severity of postoperative complications has increased with advancing age. The mortality in the early postoperative period was 1.5% (5 patients). All fatal outcomes were determined in patients older than 50 years of age (5/42; 11.9%). The mortality was related to pre-existing concomitant serious systemic diseases and disorders aggravated by intraabdominal sepsis. In conclusion, the gender is not an effective factor on the unfavourable progress of appendicitis, and on the undesirable outcomes of such patients. The age (younger age under 15 years, advanced age older than 50 years) is a significant risk factor on the occurrence of perforated appendicitis. According to age distribution, the perforation rate increases inversely proportional to decreasing incidence of acute appendicitis. By other words, in the childhood; lower incidence of appendicitis, higher perforation rate; in the elderly lowest incidence, highest rate are most prominent results. Advanced age (together with age-related concomitant diseases) is a significant risk factor on postoperative morbidity and mortality.

A SURVEILLANCE ABOUT INGUINAL HERNIA SURGERY IN THE CITY OF AYDIN

HEDEF �ZG�N, SERHAT REMZ� YARDIM, LEVENT �ANAKKALEL�O�LU, ��KR� BOYLU — 2001-03-01

We planned a study to investigate to what extent surgeons perform the popular techniques of groin hernia in the City of Ayd�n and the necessity of postgraduate courses. The serious developments like Lichtenstein repair or laparoscopic access to inguinal area has changed inguinal hernia surgery dramatically in the past ten years. In Ayd�n, the surgeons of University Hospital, Sosyal Sigortalar Kurumu Hospital, and State Hospital were given a questionnaire form asking about their choice of repair methods and the use of prophylactic antibiotics, mesh and suture materials. They were asked whether they would like to attend a panel about groin hernia surgery or not. Surgeons were grouped according to their experience. Obtaining their consent, their patients' operation records between October 1, 1997 and January 1, 2000 were reviewed. The ratio of mesh use was 39.9% and local anesthesia use was 4.8%. When compared with the recent literature, these values were significantly low. Laparoscopic hernioraphy method was used only in the University Hospital. We concluded that by organizing postgraduate courses, surgeons should be informed and trained for new techniques.