Choledochotomy for calculous disease in the elderly

Article Abstract:

Patients who undergo cholecystectomy (gallbladder removal) due to gallstones may also have choledochotomy, or exploration of the common bile duct, which is performed in 15 to 22 percent of patients. This additional exploration is performed to avoid overlooking any residual stones in the duct, but results in an increased risk of 300 to 400 percent over that of cholecystectomy alone. A retrospective study of 313 patients who underwent choledochotomy was undertaken. There were 56 elderly patients (over the age of 80) in the group. Their outcomes were compared with those of the remainder of the group (257 patients) who were younger than 80 years. Fifty-four percent (30 of 56) of the elderly patients underwent urgent surgery for inflammation of the bile duct, acute cholecystitis (inflammation of the gallbladder), or obstructive jaundice, compared with 38 percent (97 of 257) of the younger patients. Common duct stones were found in 82 percent of the elderly patients, and in 62 percent of the younger group. The death rate in the elderly group was significantly higher (5 out of 56) compared with the younger group (6 out of 257). Overall, jaundiced patients had a higher mortality (9.4 percent for both groups). The elderly patients had a higher incidence of bactibilia (bacteria in the bile), than the younger patients; 93 percent versus 53 percent. Blood cultures were positive more often in the elderly than in the young; 63 percent versus 26 percent. Postoperative recovery in the elderly group was an average of 16.2 days, compared with 12.2 for the younger patients. It is concluded that elderly patients are at higher risk for developing gallbladder disease that requires duct exploration, appear to be more susceptible to both bactibilia and bacteremia, and require a longer recovery period. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Demographic aspects, Bacteremia, Bile, Common bile duct, Bile ducts, Common bile duct calculi

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Intraabdominal surgery during pregnancy

Article Abstract:

Emergency abdominal surgery during pregnancy is unusual, but when it does occur it presents a diagnostic and treatment challenge for both the obstetrician and surgeon. Not only must the mother be cared for, but it is important that complications to the fetus (unborn child) be avoided. A review was undertaken of 17 years experience in order to examine the complications of surgery for both mother and child and the consequences of delaying surgery. During this 17-year period there were 41,532 deliveries, and 90 women underwent abdominal surgery (a rate of 1 in 451 deliveries). Acute appendicitis was the most common reason for surgery (37 patients); in five cases there was perforation of the appendix. There were 20 operations for ovarian tumors, later found not to be malignant, and seven patients underwent gallbladder removal for acute inflammation and stones. There were two women who died, one of heart arrhythmia and one of liver failure. The most frequent complication was premature labor (in 19 patients, or 21 percent). Sixteen patients were able to have the premature labor stopped with medication. Five of the fetuses died. There was a correlation between delay of surgery and onset of premature labor; in 13 premature labor patients with acute appendicitis the time from onset of symptoms to surgery was longer than in other appendicitis patients. It is concluded that the risk to both mother and fetus from intraabdominal surgery is acceptable and that complications that do arise are related to the severity of the underlying disease and the delay before the operation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pregnant women, Abdomen, Laparotomy

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Antibiotic irrigation and the formation of intraabdominal adhesions

Article Abstract:

There is controversy over the usefulness of antibiotic lavage (washing out) of the peritoneal cavity (the space between the abdominal wall and the membrane covering the abdominal organs) in preventing infection following abdominal surgery. A study was undertaken on rats to determine if the use of antibiotic irrigation influenced the formation of intraabdominal adhesions. Adhesions are bands of scar tissue that hold together anatomic surfaces that are normally separate. Abdominal adhesions are the most common cause of intestinal obstruction; they may develop after surgery, inflammation or injury. In this study 32 rats underwent abdominal surgery. One group had normal saline solution instilled at the time of surgery; the second group had cefazolin instilled; the third group, tetracycline. The rats were killed after two weeks; intraabdominal adhesions were graded and tissue study was performed on the membrane lining the peritoneal cavity. Both groups of rats given antibiotics (cefazolin or tetracycline) had significantly higher adhesion scores than did the group of rats given only saline solution. Tissue obtained from the antibiotic-treated rats revealed thickening and the presence of fibroblasts and collagen, and evidence of damage to the peritoneum. This study has shown that peritoneal lavage with two widely used antibiotics produces tissue damage to the peritoneum and the formation of adhesions in rats. (Consumer Summary produced by Reliance Medical Information, Inc.)

Antibiotics, Irrigation (Medicine)

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