RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES,KARNATAKA
BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
- Name of candidate and Address: Dr Anoop.M
S/O Dr.G.Mohan. ‘SAROVER’,Olai,
Kollam. Kerala. 691009
Address for correspondence Dept of Gen Surgery
M.S.RamaiahMedicalCollege and
Teaching Hospital. Bangalore.
2. Name of the Institution: M.S.RamaiahMedicalCollege and
Teaching Hospital.
Bangalore. Karnataka
3. Course of study and subject: M.S. General Surgery
4. Date of admission to course: 31.05.2007
5. Title of Topic: Effect of Carbondioxide
pneumoperitoneum on Liver function
following Laparoscopic Cholecystectomy
6.0 BRIEF RESUME OF THE INTENDED WORK
6.1 Need for the Study:
The advent of laparoscopic surgery has dramatically changed the management of gallbladder surgeries, establishing laparoscopic cholecystectomy as the treatment of choice in benign gallbladder diseases.
However recent studies have reported alterations in liver function parameters after laparoscopic cholecystectomy.
With this work, we intent to study further the incidence of these alterations in liver function parameters, their clinical significance and the safety of the procedure.
6.2 Review of Literature:
The introduction of laparoscopic surgery has changed dramatically the management of gallstone disease establishing laparoscopic cholecystectomy as the method of choice for treating uncomplicated cholelithiasis. Furthermore, the feasibility and safety of fluoroscopic intraoperative cholangiography and the laparoscopic common bile duct exploration have extended the role of laparoscopic techniques in the management of choledocholithiasis as well. However, the application of carbon dioxide pneumoperitoneum in high-risk patients may induce undesirable consequences in critically ill patients with cardiovascular, respiratory or renal insufficiency due to either hypercapnia or increased intra abdominal pressure (1,2,3).
Some recent trials have shown that the high intraabdominal pressure during laparoscopic cholecystectomy leads to reduced portal venous flow and compromised intra abdominal blood
flow (4). On the other hand, there are controversial studies showing that intra abdominal pressures ranging between 11 and 13 mm Hg are not associated with compromised splanchnic circulation (5). Furthermore, an elevation of serum liver enzymes after uncomplicated laparoscopic cholecystectomy has been reported (6,7) and that seems to be attributed to splanchnic ischemia (8).
This study was planned explore further the incidence and clinical significance of serum liver test changes after uneventful laparoscopic cholecystectomy.
6.3 Aim & Objective of the Study:
1.To study the incidence of alterations in liver function following laparoscopic cholecystectomy in the Indian population
2. To study the significance of these alterations in patients and the safety of the procedure
7.0 MATERIALS AND METHODS
7.1 Source of Data: A minimum of 50 patients undergoing Laparoscopic Cholecystectomy at M.S.Ramaiah Medical teaching Hospital and M.S.Ramaiah Memorial Hospital
7.2 Methods of Collection of Data:
We plan a study strength of a minimum of 50 patients, Liver Function Tests would be done preoperatively and 24 hrs later Liver Function Test would be repeated to monitor liver function.
7.3 Inclusion Criteria
All patients undergoing laparoscopic cholecystectomy at our hospital who have given written consent to be part of the study group
7.4 Exclusion Criteria
- Any patient with pre-operative abnormality in liver enzymes
- Suspected chronic liver diseases
- Common bile duct pathology
- Conversion to open cholecystectomy
-Haematological disorders
-Intra/post operative complications
-Incomplete data
7.5 Does this Study require any investigations or interventions to be conducted on patients or animals? If so describe.
Routine investigations would be done pre operative, this would include Complete blood picture- haemoglobin, total WBC count, differential count, ESR, Liver Function Test, serum electrolytes, random blood sugar
Special investigation that would be done would be a repeat Liver Function Test 24 hrs after surgery
No, this study does not involve testing on animals
7.6 Has ethical clearance been obtained from your institution?
Yes, certificate enclosed.
9. REFERENCES:
1. Hashikura Y, Kawasaki S, Munakata Y, Hashimoto S, Hayashi K, Makuuchi M. 1994 Effects of peritoneal insufflation on hepatic and renal blood flow. Surg Endosc; 8: 759-761.
2. Elefteriadis E, Kotzampassi K, Papanotas K, Heliadis N, Sarris K. 1996 Gut ischemia, oxidative stress, and bacterial translocation in elevated abdominal pressure in rats. World J Surg; 20: 11-16.
3. Gutt CN, Oniu T, Schemmer P, Kashfi A, Kraus T, Büchler MW. 2004 Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg; 21: 95-105.
4. Elefteriadis E, Kotzampassi K, Botsios D, Tzartinoglou E, Farmakis H, Dadoukis J. 1996 Splanchnic ischemia during laparoscopic cholecystectomy. Surg Endosc; 10: 324-326.
5. Odeberg S, Ljungqvist O, Sollevi A. 1998 Pneumoperitoneum for laparoscopic cholecystectomy is not associated with compromised splanchnic circulation. Eur J Surg; 164: 843-848.
6. Sakorafas G, Anagnostopoulos G, Stafyla V, Koletis T, Kotsifopoulos N, Tsiakos S, Kassaras G. 2005 laparoscopic cholecystectomy. N Z Med J; 118: U 1317.
7. Al-Jaberi TM, Tolba MF, Dwaba M, Hafiz M.2002 Liver function disturbances following laparoscopic cholecystectomy: incidence and significance. J Laparoendosc Adv Surg Tech A ; 12: 407-410.
8. Morino M, Giraudo G, Festa V.1998. Alterations in hepatic function during laparoscopic surgery. An experimental clinical study. Surg Endosc ; 12: 968-972
10. Signature of the Candidate:
11.Remarks of the Guide
This is a good study to know the effects of pneumoperitoneum on liver function post -operatively and subsequent mortality
11.1 Name and Designation of the Guide: Dr.H.K.Rudresh. M.S.
Associate Professor
Department of Surgery
M.S.RAMAIAHMEDICALCOLLEGE
BANGALORE
11.2 Signature
11.3 Name of Head of the Department Dr. M.R.Sreevathsa
Professor & HOD
Department of surgery
M.S.RAMAIAHMEDICALCOLLEGE
BANGALORE
11.4 Signature
12. Remarks of Chairman and Principal:
12.1 Signature: