Postoperative Hepatic Catabolic Stress Response in Patients with Cirrhosis and Chronic Hepatitis

Lausten, Susanne B.; El-Sefi, Talaat; Marwan, Ibrahim; Ibrahim, T.; Jensen, Lone Susanne; Grøfte, Thorbjørn; Andreasen, F.; Vilstrup, Hendrik; Raouf, Ahmed A.; Helmy, Amr; Jensen, Steen Lund

doi:10.1007/s002689910058

Cited by 8 publications

(4 citation statements)

References 26 publications

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“…The result of their study showed an association of surgical severity and type of analgesic treatment on the level of corticosterone through surgery, but none of them have reached the objectives of this study. Lausten et al [ 6 ] demonstrated the result of open and laparoscopic cholecystectomy on hepatic stress response in patients with postnecrotic liver cirrhosis and chronic hepatitis. Besides other results, the changes of cortisol in both groups between pre- and postoperative time were not significant in this study.…”

Section: Discussionmentioning

confidence: 99%

“…The data from these studies suggest a positive correlation between the degrees of adrenal dysfunction with severity of liver disease [ 13 , 21 ]. Furthermore, other studies have reported the increased level of corticosterone throughout surgery, anesthesia, and postoperative course, but yet no studies have been able to investigate the changes in the function of the HPA axis before and after surgery in cirrhotic patients [ 1 , 6 – 8 , 13 , 14 , 24 , 25 ]. As a result, this study was designed to evaluate the function of HPA axis in response to surgical stress in cirrhotic rats compared with noncirrhotics by measuring corticosterone and blood sugar levels before and after surgery.…”

Section: Introductionmentioning

confidence: 99%

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An Analysis of the Hypothalamic-Pituitary-Adrenal Axis Functions in Cirrhotic Rats in Response to Surgical Stress

Yarigholi

Mehrjardi

Azizi

et al. 2018

Surgery Research and Practice

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Introduction The activation of hypothalamic-pituitary-adrenal (HPA) axis through severe diseases and stress courses leads to a rise in circulatory cortisol for an adequate response to stress. This axis is one of the important systems that involve in neuroendocrine response to the surgical stress. Hepatoadrenal syndrome that is a manifestation of adrenal insufficiency (AI) in the course of liver disease is described as insufficient production of steroid hormones mainly cortisol due to primary dysfunction of the adrenal gland or secondary malfunction of the HPA axis to provoke the adrenal gland leading to severe illness and increased mortality. Through this evidence, we presented this question as to whether cirrhotic patients have a greater mortality rate than other patients after surgery and if the HPA axis is partly responsible for this phenomenon. Also how the adrenal gland functions during surgery in cirrhotic rats. We conducted this study to assess the effect of cirrhosis on the HPA axis through surgery in cirrhotic rats by evaluating the changes in serum corticosterone level and blood sugar before, immediately, and 30 minutes after surgery. Method This study was performed in the animal lab approved by the Ethics Committee of Tehran University of Medical Sciences in 2014, on 25 male Wistar rats. Thioacetamide was used for induction of cirrhosis in rats with new method of monitoring weekly changes of rats' weight which had 100% success in procedure and reduction in mortality rate. Laparotomy was performed on all of the rats during 9–12 in the morning within 10–15 minutes. Laparotomy was chosen as surgical stress because of its simplicity and feasibility. Three blood samples were obtained from each rat immediately after inducing anesthesia, immediately after the conclusion of surgery, and 30 minutes after surgery. The plasma concentration of corticosterone was measured with enzyme-linked immunosorbent assay test. P value of 0.05 or less was considered as statistical significance. Result Cirrhotic rat group consisted of 15 rats and control group consisted of 10 rats. There was a significant difference in the mean level of corticosterone and blood sugar between the cirrhotic rat group and control group in the 3 time levels (P=0.044/P < 0.001). Pairwise comparison of mean corticosterone and blood sugar levels between case (mean: 249.359 ± 3.90) and control (mean: 262.40 ± 4.69) showed a significant difference (P=0.04, 95% CI = 0.30–25.79/P < 0.001, 95% CI = 129.62–233.96). Unlike the control group, the level of serum corticosterone was compared in the cirrhotic rat group (group 1) before, immediately, and 30 minutes after surgery, which showed a significant difference in our study (P value = 0.005). However, this result was also significant in comparing the blood sugar in 3 time levels of surgery in the control group (P value < 0.001) but not in the cirrhotic rat group (P value = 0.233). Conclusion There was a significant rise in corticosterone levels during 3 time levels of surgery in cirrhotic rats; nevertheless...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An Analysis of the Hypothalamic-Pituitary-Adrenal Axis Functions in Cirrhotic Rats in Response to Surgical Stress

Yarigholi

Mehrjardi

Azizi

et al. 2018

Surgery Research and Practice

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“…Surgery should be undertaken in cirrhotic patients with symptomatic gallstone disease at an optimal time; otherwise, there is a risk of functional decompensation of liver, which has dismal outcomes. Laparoscopic cholecystectomy should be the preferred option in cirrhotic patients because of advantages such as (1) minimally invasive procedure with less morbidity and quick recovery with high patients compliance [15], (2) better magnification of view, laparoscopy is helpful to observe minute vascular channels more clearly. Portal venous collaterals and congested gall bladder bed also handled properly to reduce hemorrhagic complications [16], (3) associated with less postoperative complications such as surgical site infections, incisional hernia, and post-operative pain [17].…”

Section: Discussionmentioning

confidence: 99%

Assessment of Feasibility and Complications of Laparoscopic Cholecystectomy in Cirrhotic Patients

Goyal

Pandey

Masood

et al. 2017

Asian J Pharm Clin Res

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:Introduction: From the era of absolute contraindication to the phase of preferred treatment, the technique of laparoscopic cholecystectomy advances with time. Here, we report our experience of laparoscopic cholecystectomy in 20 patients of liver cirrhosis. In our institute, laparoscopic cholecystectomy is the preferred choice for cholelithiasis in cirrhotic patient.Methods: In last 2 years, 180 laparoscopic cholecystectomies were performed and 20 patients were cirrhotic. Their data analyzed retrospectively in terms of preoperative optimization, operative technique and results.Results: Laparoscopic cholecystectomy was completed successfully in 19 patients and one was converted to open. Mean operative time was 54 minutes. No additional port was required in all cases. Calot’s first dissection was performed in 18 patients and fundus first technique was used in 2 patients due to unclear anatomy. Liver bed bleeding was present in 16 patients, which was controlled effectively. Subhepatic drain was placed in 12 patients. There was no mortality. Morbidity in two patients was worsening of ascites in one; and incisional hernia in other patient which was converted to open. Port site complications were not noted in any patient and there was no evidence of intraabdominal bleeding or bile leak postoperatively. Blood and component transfusion was required in 2 patients. Average length of hospital stay was 4.8 days.Conclusion: Though laparoscopic cholecystectomy may be difficult in cirrhotic patients but it is feasible and relatively safe. It offers many advantages in cirrhotic patients and associated with low morbidity when compared with open surgery.Keywords: cirrhosis, laparoscopic cholecystectomy, difficult cholecystectomy

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“…For data management reasons, we listed both groups as separate trials. 46,47 All other trials used a two-arm parallel-group design.…”

Section: Patient Characteristics and Trial Designsmentioning

confidence: 99%

Systematic review: open, small‐incision or laparoscopic cholecystectomy for symptomatic cholecystolithiasis

Keus

Gooszen

Laarhoven

2009

Aliment Pharmacol Ther

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Postoperative Hepatic Catabolic Stress Response in Patients with Cirrhosis and Chronic Hepatitis

Cited by 8 publications

References 26 publications

An Analysis of the Hypothalamic-Pituitary-Adrenal Axis Functions in Cirrhotic Rats in Response to Surgical Stress

An Analysis of the Hypothalamic-Pituitary-Adrenal Axis Functions in Cirrhotic Rats in Response to Surgical Stress

Assessment of Feasibility and Complications of Laparoscopic Cholecystectomy in Cirrhotic Patients

Systematic review: open, small‐incision or laparoscopic cholecystectomy for symptomatic cholecystolithiasis

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