Assessment of Ankaferd Blood Stopper in experimental liver ischemia reperfusion injury

Background/aim: To investigate possible protective effects of Ankaferd Blood Stopper® (ABS) in an experimental liver ischemia reperfusion injury (IRI) model. Materials and methods: The study was carried out on 30 female rats separated into 3 groups as sham, control (IRI), and treatment (IRI + ABS) groups. In the IRI + ABS group, 0.5 mL/day ABS was given for 7 days before surgery. In the IRI and IRI + ABS groups, the hepatic pedicle was clamped for 30 min to apply ischemia. Then, after opening the clamp, 90-min reperfusion of the liver was provided. Blood and liver tissue samples were taken for biochemical and histopathological analyses. Results: Compared to the sham group, the IRI group had significantly higher levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total oxidant status (TOS), malondialdehyde (MDA), fluorescent oxidant products (FOP) and lower expression of albumin and total antioxidant status (TAS) (P < 0.05). Compared to the IRI group, the IRI+ABS group showed lower expression of AST, ALT, TOS, MDA and FOP and higher expression of albumin and TAS (P < 0.05). In the histopathological analysis, congestion scores were statistically significantly lower in the IRI + ABS group than in the IRI group. Conclusions: ABS has a strong hepatoprotective effect due to its antioxidant and antiinflammatory effects and could therefore be used as a potential therapeutic agent for IRI.

Erdosteine ameliorates the harmful effects of ischemia-reperfusion injury on the liver of rats

Abstract Purpose: To investigate the potential protective effects of erdosteine against the harmful effects of ischemia-reperfusion injury on the liver in an experimental rat model. Methods: Forty rats were divided into 4 groups. In the sham group, only the hepatic pedicle was mobilized. No other manipulation or treatment was performed. In the other groups, ischemia was achieved by clamping the hepatic pedicle for 60 min. After that, 90 min reperfusion was provided. In the control group, no treatment was given. In the perioperative treatment group, 100 mg/kg erdosteine was administered 2 hours before ischemia induction. In the preoperative treatment group, 100 mg/kg/day erdosteine was administered daily for ten days before the operation. At the end of the procedures, blood and liver samples were obtained for biochemical and histopathological assessment. Results: Treatment with erdosteine ameliorated the histopathological abnormalities when compared with the control group. Furthermore, this treatment significantly decreased the serum liver function test values. It was also found that erdosteine ameliorated the oxidative stress parameters in both the perioperative and preoperative treatment groups. Conclusion: The current study is the first to have shown the favorable effects of erdosteine on the harmful effects of experimental hepatic ischemia-reperfusion injury.

Surgical treatment of liver metastases from colorectal cancer: experience of a single institution.

BACKGROUND: This report analyses an experience with 42 liver resections for metastatic colorectal carcinoma. METHODS: Forty-two patients underwent curative resection for liver metastasis from colorectal cancer between January 2004 and December 2007, with a follow up period that ranged from 3 to 66 months. In this retrospective study, early postoperative 30 day mortality and morbidity in addition to the effects of Dukes' stage, type of resection, number and size of the tumor, synchronous or metachronous metastases, resection margin, sex, age and chemotherapy protocol on three year survival were analyzed retrospectively. Univariate analyses of survival were estimated using the Kaplan-Meier method. Multivariate analysis was evaluated using Cox regression method. The value of P<0.05 was accepted as significant. RESULTS: Early postoperative morbidity and mortality rates were 7.14% and 0%, respectively. Fourteen patients died during the follow-up period of 3 to 66 months (mean, 40.40±12.87). Median survival was 56 months and three year survival rate was 71.30%. Recurrence occurred in 11 patients (26.00%) after liver resection and additional surgery was performed for two of them. At univariate analysis, the number of tumors (<4), tumor size (<4 cm), type of resection and negative resection margins were significantly correlated with three year survival. Sex, age, Dukes' stage, synchronous or metachronous metastasis, recurrence and chemotherapy protocol were not predictive of long-term prognosis. Multivariate analysis revealed that tumor size>4 cm and presence of more than four tumors before surgery were associated with a 5.89 and 2.18-fold increased risk of death, respectively. CONCLUSION: Curative resection is one of the most important treatment options that can demonstrate long-term survival for patients.

Clipless cholecystectomy: which sealer should be used?

BACKGROUND: The use of the Harmonic Scalpel (HS) for cystic duct ligation began with little data about its efficacy or safety. On the other hand, there is not any literature available about the use of PlasmaKinetic Sealer (PK) for closing the cystic duct in laparoscopic cholecystectomy (LC). Therefore, this study was designed to compare the efficacy and safety of HS and PK for achieving safe closure of the cystic ducts after LC. METHODS: Ninety patients with symptomatic gallstone disease were enrolled in this prospective case control study. The patients were operated with laparoscopic technic and divided into three groups (n = 30) randomly. After the dissection of Calot's triangle, proximal cystic ducts on common bile ducts were sealed with single surgical clips (SC) in all groups, and in the first group, distal of the cystic ducts also was sealed with single SC and the gallbladders were removed with SC. In the second and third groups, distal of the cystic ducts were sealed with HS and PK, respectively. The gallbladders were removed as sealed cystic ducts with HS and PK. Then, gallbladders were connected to a transducer set and increasing pressure with saline was applied. The bursting pressures of gallbladders were measured and differences between the groups were calculated by using Student's t test. The value of P < 0.05 was accepted as significant. RESULTS: In this study, the mean cystic duct bursting pressures were 332.46 ± 4.62 mmHg with SC, 326.56 ± 4.53 mmHg with PK, and 343.06 ± 4.28 mmHg with HS. Differences of the mean cystic duct bursting pressures between the groups were indicated the superior results of HS. CONCLUSIONS: The results of this study indicated that HS is more effective than PK and as safe and effective as SC for cystic duct closure.

Verification of clipless closure of cystic duct by harmonic scalpel.

INTRODUCTION: The excellent results of harmonic scalpel (HS) for closure of blood vessels encouraged surgeons to use these instruments for cystic ducts. The use of HS on tissues other than blood vessels was started with little data about its efficacy or safety. Therefore, this study was designed to verify the safety and efficacy of HS for achieving safe closure of the cystic ducts after laparoscopic cholecystectomy. MATERIALS AND METHODS: Sixty patients with symptomatic gallstone disease were enrolled in this prospective case control study. The patients were operated with laparoscopic technic and divided into two groups (n = 30). After the dissection of Calot's triangle, proximal cystic ducts on common bile ducts were sealed with single surgical clips (SC) in both groups. In the first group, distal of the cystic ducts was sealed with single SC and the gallbladders were removed with SC. In the second group, distal of the cystic ducts was sealed with HS and the gallbladders were removed as sealed cystic ducts with HS. Twenty-gauge catheters were inserted into the fundus of gallbladders in vitro and connected to the arterial line transducer set. A gradually increasing pressure was applied through a sphygmomanometer. The bursting pressures of the gallbladders were measured, and differences between HS and single SC groups were calculated with independent samples t-test. The value of P < 0.05 was accepted as significant. RESULTS: The mean cystic duct bursting pressures in single SC and HS groups were 332.46 +/- 4.62 and 343.06 +/-4.28 mmHg, respectively. The mean values between the groups were found significant and indicated the superior results of HS. CONCLUSIONS: HS sealer could be an alternative method for cystic duct closure, especially for avoiding the clip displacement and migration of the clip. Results of this study indicated that HS sealer was as reliable as single SC and it could be accepted as a standard closure technic.