Cholecystectomy-Associated Complications in Kidney Transplant Recipients Compared With the General Population.

Cholelithiasis is one of the most prevalent diseases in the general population. Among kidney transplant (KT) recipients, atypical clinical presentation may delay the diagnosis and proper treatment. This single-center retrospective cohort study compared cholelithiasis clinical presentation and cholecystectomy-associated complications in 230 KT recipients and in 172 members of the general population. KT recipients had a higher proportion of men, comorbidities, biliary pancreatitis, choledocholithiasis, and acute cholecystitis clinical presentations than the general population. KT recipients presented higher American Society of Anesthesiologists scores and higher rates of emergency surgeries (15.7% vs 9.9%, P = .091), conversion (5.7% vs 1.2%, P = .019), drainage (7.8% vs 2.3%, P = .016), postoperative complications (10% vs 4.7%, P = .047), and longer hospital length of stay (1 vs 1 days, interquartile range, 2 vs 0 days; P < .001). There were 5 deaths, all of which occurred in KT recipients. History of diabetes mellitus, renal function, and surgical conversion were independent risk factors associated with postoperative complications. Male sex and level of renal function were independent risk factors associated with postoperative acute cholecystitis. KT was an independent risk factor associated with postoperative choledocholithiasis (adjusted odds ratio, 5.89; 95% confidence interval, 3.03-15.66) and pancreatitis (adjusted odds ratio, 6.89; 95% confidence interval, 2.99-11.61). In conclusion, KT recipients with cholelithiasis have an increased risk for clinical and surgical complications compared with the general population.

Modelo videolaparoscópico de condicionamento isquêmico do estômago em ratos / Videolaparoscopic model for the gastric ischemic conditioning in rats

OBJETIVO: Avaliar a exeqüibilidade do condicionamento isquêmico por videolaparoscopia e o seu efeito funcional, na parede gástrica de ratos. MÉTODOS: Vinte ratos machos, EPM-1 Wistar foram submetidos a desvascularização gástrica proximal, por videolaparoscopia, com pressão intra-abdominal de pneumoperitônio de 4mmHg através da colocação de três trocartes na parede abdominal. Os animais foram distribuídos em dois grupos de 10 animais cada de acordo com a data de sacrifício, ou seja, 7 (G7) e 14 (G14) dias para avaliação da perfusão da parede gástrica com fluxometria por laser-Doppler antes da desvascularização, 10 minutos após e 7 ou 14 dias de acordo com o grupo a que pertenciam. RESULTADOS: A fluxometria revelou melhora progressiva da perfusão gástrica principalmente no G14, após a desvascularização. CONCLUSÕES: O modelo de condicionamento isquêmico do estômago é exeqüível por videolaparoscopia. O condicionamento isquêmico permite o restabelecimento da perfusão sangüínea na parede gástrica.