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Background: Laparoscopic cholecystectomy since long time already has become the preferred method because laparoscopic cholecystectomy has many advantages compared to standard open cholecystectomy. However, since it has associated with a higher risk of complication, preoperative prediction of risk factors is needed to assess the intraoperative difficulties. Various scoring systems have a role in predicting intraoperative difficulties; however, there is a need to find a consistent and reliable predictive system. Aim: To validate a preoperative scoring system that will predict difficult laparoscopic cholecystectomy. Design of the Study. Nonrandomized retrospective descriptive study. Setting. Department of General Surgery, Lambung Mangkurat Univeristy Ulin Referral Hospital, Banjarmasin, Kalimantan Selatan, Indonesia. Methodology. A preoperative score was given to all the patients (134 patients from January 2015-December 2020) based on history, clinical examination, and sonographic findings. Using ROC curve, the cutoff for easy-difficult was 3.5 and difficult-very difficult was 7.5. The scores were compared in each patient to conclude the practicality of the preoperative predictive score. SPSS version 25 was used to analyze the data. Results: History of hospitalization for acute cholecystitis (p ≤ 0.001), high BMI (p=0.002), abdominal scar (p=0.005), palpable gallbladder (p ≤ 0.001), thick gallbladder wall (p ≤ 0.001), and leucocyte (p ≤ 0.001) were considered as the significant factors that predict difficult laparoscopic cholecystectomy. Sensitivity and specificity for easy-difficult cutoff of the scoring method were 72.6% and 87.5%, respectively, with the area under the ROC curve being 0.849. Sensitivity and specificity for difficult-very difficult cutoff of the scoring method were 70.0% and 84.5%, respectively, with the area under the ROC curve being 0.779. Conclusion: The preoperative scoring system evaluated in the study is reliable and beneficial in predicting the difficulty of laparoscopic cholecystectomy. However, further randomized prospective multicentric studies with large sample sizes are required to validate the efficiency of the scoring system.
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BACKGROUND: Laparoscopic procedures under certain pressure have the potential to cause intra-abdominal adhesions. However, the pathomechanism of this disorder is unknown. Release of mast cell mediators due to mast cell degranulation is thought to be the cause. MATERIALS AND METHODS: Thirty male Sprague-Dawley rats were grouped into five groups (n = 6 per group): one control group and four intervention groups to which 60 min insufflation was performed using carbon dioxide at 5, 8, 10 and 12 mmHg. Seven days after laparoscopy, we euthanized and evaluated the levels of histamine, tryptase, and chymase of peritoneal fluid, the thickness of ECM of peritoneal tissue, and intraabdominal adhesion scoring system. RESULTS: Histamine and tryptase levels in peritoneal fluid were significantly higher at the 10- and 12 mm Hg intervention compared to control (histamine: 0.50 ± 0.35 vs. 0.41 ± 0.41 vs. 0.04 ± 0.02 ng/mL, respectively; and tryptase: 0.69 ± 0.11 vs. 0.65 ± 0.05 vs. 0.48 ± 0.02 ng/ml respectively). The ECM was significantly thicker in the intervention groups at 10- and 12-mm Hg compared to control (71.3 [66.7-85.2] vs. 48.4 [34.5-50.3] vs. 10.25 [8.7-12.1] µm, respectively). Moreover, the intra-abdominal scoring was also significantly higher in the intervention groups at 10- and 12 mm Hg compared to control (4 [0-4] vs. 4.5 [4-5], vs. 0, respectively). CONCLUSIONS: Laparoscopic procedures increase the release of mast cell mediators in peritoneal fluid, the thickness of ECM and intraabdominal adhesion scoring in rats, implying that it might increase the possibility of intrabdominal adhesion in humans.
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BACKGROUND: Laparoscopy induces adhesion due to ischemia-reperfusion injury. However, the detail pathomechanism is poorly understood. This study aimed to investigate the impact of laparoscopy on mast cell and mesothelium morphological changes in the rat. METHODS: Forty-nine males of Sprague-Dawley Rattus norvegicus were divided into four groups: a) control and b) intervention groups P1, P2, and P3 that underwent 60 min laparoscopic using carbon dioxide (CO2) insufflation at 8, 10, and 12 mmHg groups, respectively. Serum hydrogen peroxide (H2O2), catalase (CAT), superoxide dismutase (SOD), malondialdehyde (MDA), and oxidative stress index (OSI) levels were determined 24 h after laparoscopy. Histopathological analyses of mast cell infiltration and degranulation and mesothelium thickness in the liver, greater omentum, mesenterium, small intestine, and peritoneum were performed 7 days after the procedure. RESULTS: H2O2, MDA, and OSI levels were significantly increased in the intervention groups compared with the control (p<0.05), while the SOD and CAT levels were decreased in the intervention groups compared with the control (p<0.05). Mast cell infiltration and degranulation were higher in the intervention groups than in control (p<0.05), while the mesothelium thickness was significantly lower in the laparoscopic groups than in control (p<0.05). Interestingly, the decrease in mesothelium thickness was strongly associated with the increase in mast cell infiltration and degranulation (p<0.01). CONCLUSIONS: Our study shows that laparoscopy in rats increases mast cell infiltration and degranulation, which also results in and correlates with a decrease in mesothelial thickness.