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Article
Preoperative Prediction of Difficult Laparoscopic Cholecystectomy by Clinical Assessment and Ultrasonagraphy

Author: Mohamed Salih Younis
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 2 Pages: 196-201
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT: BACKGROUND: Laparoscopic cholecystectomy(LC) has now replaced open cholecystectomy(OC) for the treatment ofgallbladder diseases. However, LC may be rendered difficult by various problems encountered duringsurgery, such as difficulties in accessing the peritoneal cavity, dissecting the Calot’s triangle and gallbladder, or extracting the excised gall bladder.OBJECTIVE:Of this prospective study: is to determine whether preoperative clinical parameter and Ultrasonagraphycan predict difficult LC. PATIENT AND METHODS: 100 patients underwent LC in Al-Jamhuri Teaching Hospital, all had gallstone disease. Prospectiveanalyses of different preoperative clinical and ultrasonic parameters contributing to difficult LC wereperformed. These included: age, gender, BMI (Body Mass Index), previous upper abdominal surgery,previous attack of acute cholecystitis , gall bladders size , gall stones size and numbers. The outcomesincluded the following operative parameters: access to peritoneal cavity, adhesion and difficultdissection, bleeding during surgery, bile leak, and conversion to OC. RESULTS: Of 100 patients with LC 41 patients (41%) developed difficulties during operation .Factors contributedto difficult LC were male sex, previous upper abdominal surgery ,previous attack of acute cholecystitis, BMI more than 35 and gall stones that were more than (1 cm) in diameters . The most common typeof difficulties was intraoperative bile leak (14%) and the least frequent difficulty was conversion to OC(1%).CONCLUSION: Clinical and ultrasonographic findings can help to predict difficult LC .This information may be usefulto both the patients and surgeons in being better prepared for the intra-operative risk includingconversion to OC


Article
The benefit and feasibility of early laparoscopic cholecystectomy

Author: Haqqi I. Razzouki
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2014 Volume: 13 Issue: 2 Pages: 40-45
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Acute cholecystitis is a common disease. The best managementin early cases is surgical, but the optimal timing for surgery remainscontroversial. With advances and increased experience in laparoscopicsurgery, laparoscopic cholecystectomy is increasingly being used in themanagement of acute cholecystitis.Aims: To determine the best time to operate in acute cholecytitis (early vs.delayed) and to compare the results of laparoscopic approach with those ofopen surgery in the treatment of acute cholecystitis .Patients and Methods: This was a prospective study done at al‐Yarmoukteaching hospital, Baghdad from Sep. 1st 2012 to Sep. 2nd 2013. All patientsadmitted with a proved diagnosis of acute cholecystitis were included. Thepatients were divided into two groups, the first group had earlycholecystectomy, laparoscopic (LC) or open (OC). The second group wastreated conservatively and delayed cholecystectomy was done. Detailedclinical, investigative and imaging data were recorded. The details of theoperative findings, procedures and early post‐operative complications, weredocumented.Results: There were 146 patients, 82.2% female and 17.8% male. The mean agewas 40±2 years. Early surgery was done for 32.8% of patients, 58.4% as alaparoscopic procedure, and 41.6% as an open procedure. Delayedcholecystectomy was done in 67.2% of cases. In the early group,the difficultywas minimal in 27.2%, moderate in 39.5%, marked in 25 % and very difficult withconversion done in 8.3%. Early complications were noticed in 4.2% in the earlyLC group, and 8.3% in the early OC. For delayed LC, 8.1% had earlycomplications vs. 6.1% for delayed OC.Conclusions: Early laparoscopic cholecystectomy is a safe and feasibleapproach to the management of acute cholecystitis.


Article
ATROPINE IN LAPAROSCOPIC CHOLECYSTECTOMY: IS IT SIGNIFICANT?

Authors: Mazin H AL-Hawaz --- Mohammed H AL-Hijaji --- Anna W Krikor
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2014 Volume: 20 Issue: 2 Pages: 75-80
Publisher: Basrah University جامعة البصرة

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Abstract

Bradycardia is a known problem in laparoscopic cholecystectomy especially during pneumoperitoneum and gall bladder dissection which might necessitate the use of intravenous atropine. The clinical significance of the latter as prophylactic issue in laparoscopic cholecystectomy has not been studied much to clarify its importance and to know how and when it could be used. We conducted a prospective study to evaluate the significance of preoperative intravenous atropine sulphate to reduce bradycardia during laparoscopic cholecystectomy. One hundred and forty patients were analyzed in a prospective study; seventy of them were atropine group and another seventy were non atropine group. Heart rate changes were studied in both groups in respect to preoperative, pneumoperitoneum and postoperative period. As well as the heart rate changes were evaluated separately in each group in concern of preoperative and pneumoperitoneum period. The results showed that age, sex, body mass index, duration of surgery and previous operations were comparable in both groups. Significant bradycardia was seen in non-atropine group during pneumoperitoneum as compared to atropine group (p<0.05), while insignificant heart rate changes were observed in both groups across preoperative and postoperative period (p>0.05). In conclusion, this work shows that a preoperative intravenous dose of atropine sulphate might be of value in preventing bradycardia during laparoscopic cholecystectomy.


Article
Predictive Factors For Conversion Of Laparoscopic Cholecystectomy To Open Procedure
العوامل التنبؤية لتحويل استئصال المرارة بالمنظار إلى طريقة الفتح

Authors: Zanko Sherko --- Sirwan Hama Shareef --- Taher Abdullah Hawrame
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2010 Volume: 14 Issue: 1 Pages: 1-8
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and Objectives: Laparoscopic cholecystectomy is the gold stander surgery for gallbladder diseases, especially symptomatic gall stone disease. to identify the factors that causes the conversion of planed laparoscopic cholecystectomy to an open procedure. Identifying these predictive factors will predict the conversion rate and eventually will help the surgeon, the patient and the hospital in planning the surgery.Methods: Retrospective study. Between October 2003 and December 2004 hundred and fifty patients with symptomatic gallstone underwent laparoscopic cholecystectomy in Department of Surgery, Sulaimaniyah Teaching HospitalResults: ages of the patients were between 11-70 years with a mean of 40, female to male were 5/1, and in 47% the symptoms were present for more than two years. Conversion incidence was 8.7.Conclusions: The predictive factors for conversion in our study accordingly were duration of the symptoms, abnormal intra-abdominal findings, concurrent illnesses, and intra-operative complications


Article
Morbidity and mortality Post laparoscopic Cholecystectomy in cirrhotic patients

Author: Hayder Al. Zobaidy
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2010 Volume: 52 Issue: 4 Pages: 385-387
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Cholecystectomy in cirrhotic patients is commonly followed by high morbidity and mortality, the incidence of hepatic cirrhosis has increased since last decade as well as the occurrence of complication such as liver failure, portal hypertension, and biliary disorders.Patients and methods: laparoscopic Cholecystectomy was performed in 24 cirrhotic patients (18 child A and 6 child B) in an effort to obtain lower complications and mortality rates. The mean age of the group was 51.8 years, ten of the 24 patients were men and 14 female.Results: intraoperative complications such as bleeding, dense adhesion and long operative time were recorded.Conclusion: laparoscopic Cholecystectomy was safe and will tolerated by selected cirrhotic patients (child A and B) with clear indication for surgery.


Article
Comparison of the Effect of Dexamethasone and Metoclopramide in Prevention of Post-Operative Nausea and Vomiting in Laparoscopic Cholecystectomy

Authors: Iyad Abbas Salman --- Redha Mohamed Abdul Hussien Alkabee
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 3 Pages: 443-448
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ACKGROUND: Postoperative Nausea and vomiting is Common complication depending on the type of surgery, technique and duration of anesthesia.OBJECTIVE: To evaluate the effect of Dexamethasone as antiemetic in comparison with Metoclopramide.METHODS: Is aprospective study carried on (100) patients undergone elective cholecystectomy in a periodfrom Jan. 2009 to April. 2010 in Baghdad Teaching Hospital / Medical city/Baghdad/Iraq. The patients were allocated into two groups of 50 patients each. Group A received 8mgDexamethasone, group B received 10mg metoclopramide intravenously, both groups monitoredpostoperatively for nausea and vomitting for 24 hours every 4 hours.RESULT:Regarding Nausea, for 24 hrs the results were not significant except at 24th hr., in which nauseamore significant in metoclopramide group.Regarding Vomiting, there was no significant from postoperative period to 12hr, while from 16 hr.to 24 hr. there were significant fewer incidences in dexamethasone group.CONCLUSION: A single dose of Dexamethasone is effective same as Metoclopramide in prevention of PONV ,and it is better in late prevention postoperativel


Article
Harmonic versus electrocautery in the dissection of gall bladder in laparoscopic cholecystectomy
دراسة مقارنة بين القاطع الصوتي والكهربائي في عملية رفع المرارة بالمنظار الجراحي

Authors: Muna M. Ahmad منى منير أحمد --- Samer Alsaffar سمير الصفار --- Emad Tahir عماد طاهر --- Nashwan K. Mahjob نشوان قحطان محجوب
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2013 Volume: 39 Issue: 2 Pages: 107-112
Publisher: Mosul University جامعة الموصل

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Abstract

ABSTRACTObjective: To demonstrate the efficiency and safety of Harmonic scalpel in comparison with electrocautery for gallbladder dissection and hemostasis in laparoscopic cholecystectomy. Patients and methods: A prospective comparative, study was done at Al-Jamhori Teaching Hospital in Mosul, during the period from 1st of January 2010 to 1st of January 2012. Three hundred and twenty patients underwent laparoscopic cholecystectomy, the following criteria were applied for selection: they had chronic cholecystitis, no complaint at time of operation, age between 25 to 50 years, normal body weight, with American Score of Anesthesia (ASA) of 1 or 2, no previous upper abdominal operation, no, or well controlled hypertension or diabetes, gall bladder wall thickness with less than 6 mm by preoperative ultrasonography and all the patients were operated by the authors. The patients were divided into two groups according to the instrument used for dissection of gall bladder from its bed, the first group with electrocautery and second group with harmonic scalpel. The time needed for complete dissection and hemostasis started from spreading of Calot’s triangle till removal of gall bladder totally from its bed, was recorded. Any intra operative complications: bleeding, gallbladder perforation, slipped stones, or conversion were recorded.Results: The study included 320 patients, 172 patients belonged to the first group (electrocautery) and 148 patients belonged to second group (harmonic). For the first group, the median time was 17 minutes, the mean time was 17.7 minutes and the mode was 13 minutes, while that for second group, the median time was 14 minutes, with a mean time of 16 minutes and a mode of 14 minutes. Intra-operative bleeding was recorded in 34 (20%) for the first group and 17 (11%) for the second one. Gallbladder perforation was recorded in 26 (15%) patients and slipped stone in 12 (7%) patients in the electrocautery group and 13(9%) and 5 (3%) respectively in the harmonic group. No common bile duct injury was recorded in either group. Conversion was needed in 4 patients (1.3%), 3 (2%) patients belonged to the first group and one (06%) to the second group. Conclusion: Harmonic scalpel is very safe and effective instrument for dissection of gall bladder and hemostasis in laparoscopic cholecystectomy and can replace electrocautery for this purpose if available at operative theater. Keywords: Laparoscopic cholecystectomy, harmonic scalpel, electrocautery.

الخلاصةالهدف: لتحديد مدى الفاعلية والأمان وترقية النزوفات لجهاز السكين الصوتي في عمليات رفع المرارة بالمنظار بالمقارنة مع جهاز الكيّ الكهربائي.التصميم والمشاركون: دراسة رجعية مقارنة، ضمّت 320 مريضا مصابا بإلتهاب المرارة الحصوي المزمن.زمان ومكان الدراسة: مستشفى الجمهوري التعليمي للفترة من 1-1-2009 لغاية 1-1-2012.القياسات الإجرائية: ضمّت الدراسة 320 مريضا أجريت لهم عملية رفع المرارة بالمنظار الجراحي من قبل الباحثين وقد تم اختيار المرضى وفق المعايير التالية: إن يتراوح عمر المريض من 25 إلى 50 سنة، ومصابا بالإلتهاب المزمن للمرارة، وبدون علامات سريرية قبل العملية مباشرة، وذو وزن طبيعي، وأن لا يتجاوز مؤشر التخدير للمريض عن نقطتين، ولم تجر له عملية فتح بطن سابقا. وأن لا يكون مصابا بمرض إرتفاع ضغط الدم أو التبول السكري، أو مسيطر على هذه الإمراض إن وجدت. وأن لا يتجاوز ثخن جدار المرارة 6ملم بالفحص بالأمواج فوق الصوتية قبل العملية. بالإعتماد على ملفات العمليات للمرضى تم تقسيمهم إلى مجموعتين. المجموعة الأولى ضمّت المرضى اللذين تم إستعمال جهاز الكي الكهربائي في التداخل الجراحي لرفع المرارة من الكبد. بينما ضمّت المجموعة الثانية المرضى اللذين تم إستخدام السكين الصوتي لذلك. تم إحتساب الوقت بالدقائق لإكمال عملية رقي النزوفات والسيطرة على شريان المرارة وقناتها ورفع المرارة كاملا من الكبد. كما تم تسجيل حالات النزوفات وطرق السيطرة عليها كذلك. تم تسجيل حالات إنثقاب المرارة وإنسكاب الحصيات إلى التجويف البطني. وتم تسجيل حالات التحويل إلى عملية فتح البطن والأسباب لذلك. وتم مقارنة النتائج. النتائج: ضمّت المجموعة الأولى 172 مريضا وكان معدل الوسط الزمني لعملية تشريح المرارة والسيطرة على القناة والشريان المراري 17,7 دقيقة. تم تسجيل نزوفات بسيطة في 19 مريضا ونزوفات كبيرة في 14 و واحدة خطيرة. حدث إنثقاب في جدار المرارة عند 26 مريضا مع إنسكاب الحصيات إلى التجويف البطني في 12 مريضا. إحتاج الجراح إلى تحويل العملية إلى فتح بطن في 3 حالات. بينما ضمّت المجموعة الثانية 148 مريضا وكان معدل الوسط الزمني لعملية تشريح المرارة والسيطرة على القناة والشريان المراري 16 دقيقة. تم تسجيل نزوفات بسيطة في 15مريضا و 4 نزوفات كبيرة ولم يسجل حالة نزف خطيرة. حدث إنثقاب في جدار المرارة عند 13 مريضا مع إنسكاب الحصيات إلى التجويف البطني في 5 مرضى. إحتاج الجراح إلى تحويل العملية إلى فتح بطن في حالة واحدة فقط.الإستنتاج: عملية رفع المرارة بالمنظار بإستخدام السكين الصوتي فعالة وأمينة بالمقارنة مع إستخدام جهاز الكي الكهربائي ونحن ننصح بإستخدامها في حالة توفرها في صالة العمليات. الكلمات الدليلية: رفع المرارة بالمنظار، جهاز الكي الكهربائي، جهاز السكين الصوتي.


Article
Changes of liver enzymes and serum bilirubin after laparoscopic cholecystectomy
تغيرات إنزيمات الكبد بعد عمليات رفع المرارة بالناظور

Authors: Salah O. Hamad صلاح عبيد حمد --- Khalaf R. Al-Luwaizi خلف رشيد اللويزي
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2013 Volume: 39 Issue: 2 Pages: 113-117
Publisher: Mosul University جامعة الموصل

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ABSTRACTBackground: Laparoscopic cholecystectomy (LC) has become the standard treatment of benign gallbladder diseases. However, it has been noticed that following LC, the serum level of certain liver enzyme rises markedly in patients who had preoperatively normal liver enzyme values.Objectives: The study is aimed to evaluate the effect of pneumoperitoneum in LC on liver enzymes and serum bilirubin in comparison with open cholecystectomy (OC).Patients and methods: A prospective case control study involved 74 patients treated by LC, and, 30 patients treated by OC as a control group, during the period from October 2010 to October 2011 at the Department of Surgery, Surgical Unit Number One, Al-Jumhori Teaching Hospital, Mosul, Iraq. Blood samples were taken 24 hours preoperatively and 24 hours after operation for biochemical tests.Results: There were significant increases in serum bilirubin, Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and Lactate dehydrogenase (LDH) levels in LC group postoperatively when compared with the OC group, while there were no significant changes in serum alkaline phosphatase (ALP).Conclusion: It has been concluded that, serum bilirubin and liver enzymes elevation could be attributed to the negative effects of the pneumoperitoneum on the hepatic blood flow. Although these changes seem to be of no clinical importance, care should be taken before deciding to perform LC in patients with hepatic insufficiency. Keywords: Laparoscopic cholecystectomy, pneumoperitoneum, liver enzymes.

الخلاصةالخلفية والأهداف: لوحظ إرتفاع بعض إنزيمات الكبد في المصل بعد عملية إستئصال المرارة بالمنظار لبعض المرضى الذين كانت إنزيمات الكبد لديهم طبيعية قبل العملية. الهدف هو دراسة التغيرات الحاصلة في مصل الدم لهذه الإنزيمات للمرضى الذين أجريت لهم عملية إستئصال المرارة بالمنظار ومقارنة هذه التغييرات مع تلك التي تحدث بعد إستئصال المرارة عن طريق فتح البطن.المرضى وطريقة العمل: أجريت هذه الدراسة المستقبلية في الردهة الجراحية الأولى في مستشفى الجمهوري التعليمي- الموصل خلال الفترة من تشرين الأول سنة 2010 الى تشرين الأول سنة 2011. وشملت 74 مريضا ممن أجريت لهم عملية إستئصال المرارة بالناظور، وكذلك 30 مريضا خضعوا لعملية إستئصال المرارة عن طريق فتح البطن خلال نفس الفترة للمقارنة. عينات الدم أخذت قبل 24 ساعة وبعد 24 ساعة من العملية لإجراء الفحص المختبري عليهما.النتائج: تبين التحاليل الإحصائية زيادة ملحوظة في مستويات الالانين اماينوترانسفريز, اسبارتيت اماينوترانسفريز, والاكتيت ديهايدروجينيز في المجموعة التي أجريت لهم عملية إستئصال المرارة بالمنظار مقارنة مع المجموعة التي أجريت لهم عملية إستئصال المرارة عن طريق فتح البطن.الاستنتاج: نستنتج بأن إرتفاع مستويات الإنزيمات في الدم قد يكون سببه التأثير السلبي للغاز داخل الصفاق على جريان الدم للكبد. وعلى الرغم من أن هذه التغييرات لا تبدو ذات أهمية سريرية, ولكن يجب أن نكون حذرين قبل إتخاذ القرار لإجراء عملية إستئصال المرارة بالمنظار للمرضى الذين يعانون من قصور الكبد.


Article
EARLY LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS AT AL-KADHIMIYA TEACHING HOSPITAL

Authors: Osama M. Alabid اسامه محمد علي العبد --- Hassan A. Hassan حسن احمد حسن
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2014 Volume: 12 Issue: 1 Pages: 37-43
Publisher: Al-Nahrain University جامعة النهرين

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Background:Despite the well-accepted success of laparoscopic cholecystectomy (LC) in the elective treatment of symptomatic gallstone, the safety and the efficacy of this technique has been subjected to some debate in the setting of acute cholecystitis (AC).Objective:To evaluate our institution’s experience with early LC and to evaluate the safety and effectiveness of LC in the treatment of AC.Methods:Eighty nine patients were diagnosed as having AC based on the clinical, laboratory and ultrasound findings; 80 patients were divided randomly into two equal groups.Group 1 included 40 patients who had early LC for AC within one week from onset of the symptoms and group 2 included 40 patients who had late LC around 6 weeks from onset of symptoms as interval LC after conservative treatment. Results:No significant difference in the conversion rate (in early group 8 patients (20%) versus delayed group 6 patients (15%). Complication rate was insignificant (in early group 4 patients (10%) versus delayed group 3 patients (7.5%). The delayed group had a significantly shorter operative time (early group = 128±53.5 min versus delayed group = 107±50.1 min) and significantly shorter postoperative stay (early = 2.4±3.2 days versus delay = 1.4±1.4 days). The early group had a significantly shorter total hospital stay (early = 5.5±3.1 days versus delay = 8.5±4.5 days). The male gender had a significant higher conversion rate in both groups.Conclusion:Early LC can be performed safely in most patients with AC and it is considered as effective treatment, allows significantly shorter total hospital stay with no significant differences in conversion rate or complications compared with delayed LC, in the hands of a safe and well trained surgeon.Keywords:Early laparoscopic cholecystectomy, acute cholecystitis.


Article
Physiological changes of pneumoperitoneum during laproscopic cholecystectomy

Authors: Mohammad O. AL-Muhammadi محمد عبيدالمحمدي --- Adel Mosa AL-Rekabi عادل موسى الركابي --- Hamida Salim AL-Mosayi حميدة سليم الموسوي
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2014 Volume: 10 Issue: 17 Pages: 162-175
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

Background: Recently, the frequency and indication for laparoscopic surgery have increased, and laparoscopic cholecystectomy has been widely accepted as an alternative to laparotomy.To carry out the laparoscopic procedure, a pressure gas, most commonly co2 is used. It is important to know the pathophysiological changes that are caused by an increase in intra-abdominal pressure and by the absorption of co2 from an co2 pneumoperitoneum. Aim this study; aims to estimate some physiological changes that caused by pneumoperitoneum during laparoscopic cholecystectomy.Patients and methods: one hundred patients were included in this study randomly selected and consisted of (80 females) and (20 males) their ages were between 19-65 years. Those patients were underwent elective laparoscopic cholecystectomy. we measured some clinical and biochamical parameters (pulmonary function tests, liver function tests, serum urea and creatinine) 24hr before operation as control and 24hr after operation , also we measured end tidal co2(ETCO2),serum aldosterone, potassium and sodium before insufflation of CO2(as control)and at the end of insufflation ,blood pressure and heart rate recorded at different time throughout the operation. Results: there is a statistically significant changes in haemodynamic responses (systolic, diastolic and heart rate) after pneumoperitoneum and changes in position; Pulmonary function tests (VC, FVC, FEV1, FEV1/FVC) show highly significant decrease (p<0.01) ,highly significant increase (p<0.01) in serum level of ALT and AST enzymes 24hrs post-operative . There was highly significant increase (p<0.01) in ETCO2, serum aldosterone and serum potassium level . Serum sodium, urea and creatinine show no significant changes. Conclusion: we concluded that laparoscopic cholecystectomy causes notable physiological alteration intraoperatively and postoperatively, caused mainly by pneumoperitoneum and change in position.

الخلفية العلمية: تزداد في هذه الأيام عمليات الناظور الجراحي بكثرة , حتى أصبحت عملية استئصال المرارة بوساطة الناظورهي الأكثر شيوعا واستخداما في التداخل الجراحي.ولإجراء هذه العملية لابد من استسقاء غشاء الصفاق(البرتون) بالغاز وغالبا ما يستخدم غاز ثاني اوكسيد الكربون في ذلك,ومن المهم جدا معرفة التغيرات الفسلجية والمرضية المصاحبة لعملية استسقاء البرتون الناتجة من ضغط الغاز المستخدم وامتصاصه ,لاتخاذ الإجراءات الاحترازية اللازمة .الهدف: أجريت هذه الدراسة لمعرفة بعض التغيرات الفسلجية التي من الممكن أن تطرأ على المرضى الذين تجرى لهم عملية استئصال المرارة بوساطة الناظور, بسبب استسقاء البرتون. المرضى والطرق: تضمنت نماذج البحث مئة مريض أجريت لهم عملية استئصال المرارة بالناظور تم اختيارهم بصورة عشوائية (80) و(20) من الذكور,كانت أعمارهم تقع بين (19 إلى60) سنة تم قياس بعض وظائف الرئة,بعض وظائف الكبد,مستوى اليوريا والكرياتنين في مصل الدم قبل إجراء العملية ب ( 24) ساعة وبعدها ب (24 ) ساعة.تم قياس مستوى ETCO2 ,هرمون الالدستيرون,البوتاسيوم والصوديوم قبل استسقاء البروتون وعند نهاية استسقاء البروتون.ايضا تم مراقبة وقياس ضغط الدم ودقات القلب خلال أوقات مختلفة اثناء العملية. النتائج: أظهرت النتائج أن ضغط الدم و عدد دقات القلب قد تغير تغيرا معنويا واضحا خلال أوقات مختلفة أثناء العملية,وظائف الرئة انخفظت أنخفاظا واضحا فيما أرتفع مستوى بعض انزيمات الكبد أرتفاعا معنويا واظحا بعد( 24) ساعة من اجراء العملية.اما بالنسبه لمستوى ETCO2,هرمون الالدستيرون و البوتاسيوم فقد أرتفع مستواها أرتفاعا معنويا واظحا عند نهاية استسقاء البروتون أما قيم اليوريا والكرياتين والصوديوم في مصل الدم, فلم تظهر النتائج أي تغير معنوي.الاستنتاج: وبناء على هذه النتائج ,فانه من الممكن أن نستنتج أن لعملية استئصال المرارة بوساطة (الناظور الجراحي )تأثيرات فلسجية واضحة في أثناء العملية وبعدها, وأن أغلب هذه التأثيرات ناتجة عن استسقاء البرتون بغاز ثاني أوكسيد الكربون وتغير وضعية المريض

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