A 1 2 4 8 S S A T A B S T R A C T S G A S T R O E N T E R O L O G Y , Vo l . 1 0 8 , N o . 4

OUTPATIENT LAPAROSCOPIC CHOLECYSTECTOMY: PATIENT & NURSING OPINION. M A Talamini, J .Coleman, P Sauter. Department of Surgery, Johns Hopkins School of Medicine. Baltimore, Maryland.

While laparoscopic cholecystectomy (LC) is much less disabling than open cholecystectomy, we have observed consid- erable patient variability following LC. This study was designed to determine the opinions of patients and their nurses regarding disability and pain following LC. 32 consecutive patients who underwent LC were surveyed the morning after surgery using a simple questionnaire. The nurse caring for each patient during the evening of surgery was also surveyed. Key results are summarized in the brief table below:

Question P.Ys P.No

Go to bathroom alone? 55% 45%

Ambulate alone? 58% 42%

Consume liquids? 53% 47%

Nausea? 55% 45%

Vomiting? 45% 55%

Could have gone home? 29% 71%

N.Ys N.No

82% 18%

41% 58%

42% 58%

68% 32%

33% 67%

19% 81% P.~'s=Patient yes, P.No=Patient no, N.Ys=Nurse yes, N.No=Nurse no

Also, 19% of patients rated their pain as a 9 (1-10 scale) the first postoperative night. Nurses felt that 56% of patients would not have been receptive to discharge teaching following surgery. Results did not differ between patients operated upon in the morning (16) versus the afternoon (16). We conclude that successful programs of outpatient LC should: 1) Ensure ade- quate home support since patient capability will be limited, 2) Optimize pain control, 3) Minimize nausea and vomiting, and 4) Deliver patient education pre-operatively, and reinforce it with repetition and detailed written material.

EMERGENCY RIGHT COLECTOMY. J.E. Thompson. R.S. Bennion, P.J. Schmit. S.G. swisher. L. Zuckerbraun. Department of Surgery, Olive View-UCLAMedical Center, Sylmar, California.

Primary repair or resection with anasto- mosis are accepted methods of management for traumatic injuries to the right colon without major contamination. However, there is lack of consensus regarding primary anastomosis following emergency right colectomy or cecec- tomy for inflammatory or obstructive condi- tions. Over a five-year period 57 patients (33 males, 24 females) with a mean age of 39.3 years (range 1-75) underwent an emergency right colectomy for the following conditions: perforated appendicitis (22), cecal diverti- culitis (12), malignancy (9), Crohn's disease (5), stricture (2), and other causes (7). An intraabdominal abscess was encountered in 21 patients (36.8%), bowel obstruction in ii (19.3%), and free perforation of the bowel with enteric soiling in 5 (8.8%). Primary anastomosis was performed in 50 patients (87.7%). Seven ileostomies were created, and four have subsequently been closed without incident. There were no deaths and 13 compli- cations developed in I0 patients. Two anasto- motic leaks occurred. One was contained and resolved spontaneously, and the other required reoperation and diversion. Other complications were: uninfected intraabdominal fluid collec- tion (3), intraabdominal abscess (2), wound infection (2), low output small bowel fistula (i), wound dehiscence (i), pneumonia (I), and pulmonary e~bolus (I). We conclude that emer- gency right colectomy with primary anastomosis for inflammatory and obstructive conditions is safe with low morbidity and a second operation to restore bowel continuity can be avoided.

• NEUROTENSIN STIMULATES PANCREATIC REGENERATION FOLLOWING EDEMATOUS PANCREATITIS. E.P. Tito, D.H. Jones, M.S. Gold, M. Rudnicki. The Mary Imogene Bassett Hospital, Cooperstown, N¥.

The pancreas regenerates after experimentally induced pancreatitis. Neurotensin (NT) is known to stimulate pancreatic growth. PURPOSE: The aim of this study was to determine the effects of exogenous NT on pancreatic regeneration following cerulein-induced acute pancreatitis (AP). METHODS: Sixty Sprague Dawley rats had AP induced by a single cerulein injection (ip, 20~g/kg). 48 hours later osmolar minipumps were placed subcutaneously to chronically deliver NT (282 pmol/kg/hr) in experimental animals. Rats in the control groups received no NT. Intact animals (n=10) served as baseline controls. Rats (n=10) were sacrificed at 48 hours after AP induction, and at 7 and 14 days after minipump placement. Pancreata were removed for weight, total protein, DNA, RNA, trypsinogen, chymotrypsinogen and amylase contents. RESULTS: Cerulein injections resulted in a significant decrease in pancreatic protein and trypsinogen content 48 hours later. The graph shows DNA data. Pancreatic weight, protein, trypsinogen, RNA and chymotrypsinogen concentrations were not affected by exogenous NT. CONCLUSIONS: Cerulein produced a mild pancreatitis depleting pancreatic protein

cz~ c~

• p < 005 v,. a~a,A~n hy ANOVA

and trypsinogen content at 48 hours. Fourteen days of treatment with NT induced pancreatic hyperplasia, as evidenced byan elevation in pancreatic DNA without changes in its protein or enzyme content. Exogenous NT may improve regeneration of the pancreas from cerulein-induced injury of its parenchyma.

• PANCREATIC DUCT DECOMPRESSION I N CHRONIC PANCREATITIS: EFFECTS ON PANCREATIC TISSUE OXYGENATION AND BLOOD FLOW IN CATS, MT Tovama. AM Kusske. AG Patel. PU Reber. SW Ashtev. HA Reber~ Depts of Surgery, UCLA and Sepulveda VAMC, LOS Angeles, CA.

It is unknown how duct decompression (DD) relieves pain in patients with chronic pancreatitLs (CP). Since CP is associated with low pancreatic blood flow (PBF) and tissue 02 (TPO2) levels which could cause pain, we studied the effects of DD on PBF and TPO2. Method: CP was created by narrowing the main pancreatic duct. PBF was measured by H2 gas clearance; TPO2 by fluorescence quenching probes. After 6 wks, PBF and TPO2 were measured before and after stimulation. The duct was then decompressed and measurements repeated. A separate group underwent DD 2 weeks after duct narrowing and were studied 4 wl<s later (PBF only, for technical reasons). Data: T_...~Q 2 PBF

(ram Hg) lml/min-100g) Control (6) Basal 53.6 _+ 10.8 118 _+ 20

Secretin (2U/kg) 50.2 ± 9.5 271 ± 52* CP (6.~ Basal 41.7 ± 1.4# 68.5 ± 8.9#

Secretin 37.3 ± 1.7* 42.8 _+ 6.6* CP post DD (6) Basal (10 rain p DD) 46.9 i 2.5@ 95.5 ± 6.6@

Secretin 49.6±2.4 145~6 ± 14" 60 min post DD 52.3 ± 1.4" 94 ± 8.6

CP 4wk o DD(6~ Basal not measured 111 _+ 10@ Secretin not measured 148 ± 21"

* p<e 05vs basa, I, # p.<0.05 vs c~ntro, @ p<o 05 vs CP Results: In controls, PBF increases with stimulation; TPO2 does not change. In CP, basal PBF and TPO2 are low; both decrease further with stimulation and return to basal levels by 60 min. DD restores both basal PBF and TPO2 toward normal and restores the normal increase in PBF with stimulation. TPO2 no longer decreases with stimulation and rises to normal levels. The PBF changes persist 4 wks after DD. Conclusions: The increase in PBF and TPO2 after DD suggest a possible mechanism by which DD in patients with CP relieves pain.