The Great Coffee Debate; Myth or Fact?

The Great Coffee Debate; Myth or Fact?

I. M. Kapuwa, MD. 

Coffee may taste good and get you going in the morning, but what will it do for your health? According to Frank Hu, MD, MPH, PhD, nutrition and epidemiology professor at the Harvard School of Public Health, there is certainly much more good news than bad news, in terms of coffee and health. A growing body of research shows that coffee drinkers, compared to nondrinkers, are less likely to have type 2 diabetes, Parkinson's disease, multiple sclerosis and dementia, have fewer cases of certain cancers (melanoma, prostate cancer), heart rhythm problems, strokes and computer-related back pain.

But (you knew there would be a “but,” didn’t you?) coffee isn't proven to prevent those conditions.

Caffeine myth or caffeine fact? It's not always easy to know. Chances are you have some real misperceptions about caffeine. For starters, do you know the most common sources of caffeine? Well, maybe two of the sources are not too hard to name -- coffee and tealeaves. However, did you know kola nuts and cocoa beans are also included among the most common caffeine sources? Caffeine contents can also vary from food to food depending on the type and serving size of a food or beverage and how it is prepared.                                                                                                                            

Caffeine content can range from as much as 160 milligrams in some energy drinks to as little as 4 milligrams in a 1-ounce serving of chocolate-flavored syrup. It is very important to note that even decaffeinated coffee is not completely free of caffeine. Caffeine is also present in some over-the-counter pain relievers, cold medications, and diet pills. These products can contain as little as 16 milligrams or as much as 200 milligrams of caffeine. In fact, caffeine itself is a mild painkiller and increases the effectiveness of other pain relievers.

It is worthy to note that people with sleep issues or uncontrolled diabetes should check with a doctor before adding caffeine to their diets, as should pregnant women, as there is some concern about caffeine's effect on fetal growth and miscarriage. In addition, some of the latest research seems to say that our genes may be responsible for how we react to coffee, explaining why some of us need several cups to get a boost while others get the jitters on only one.

According to CNN, the coffee debate is one of the age-old medical flip-flops: First coffee's good for you, then it's not, then it is – Now, you get the picture?

However, to stay completely healthy with your coffee consumption, it is advisable to avoid packing it with calorie-laden creams, sugars, and flavors. Also, how you brew it has health consequences. Unlike filtered (drip brewed) coffee, the French press, Turkish coffee or the boiled coffee popular in Scandinavian countries fail to catch a compound called cafestol in the oily part of coffee that can increase your bad cholesterol or LDL (low-density lipoprotein). Studies have shown that regular consumption of boiled coffee increases serum cholesterol by 8% in men and 10% in women. Moreover, be aware that a cup of coffee in most of these studies is only 8 ounces; the standard "grande" cup at the coffee shop is double that at 16 ounces.

Nevertheless, as you know, the news on coffee has not always been positive. The argument over the merits of your daily cup of favorite beverage dates back centuries. Let’s take a look at the timeline.

1500's headline: Coffee leads to illegal sex

Legend has it that Kaldi, an Ethiopian goatherd, discovered coffee after he caught his suddenly frisky goats eating glossy green leaves and red berries and then tried it for himself, but it was the Arabs who first started coffeehouses, and that's where coffee got its first black mark.     

Patrons of coffeehouses were said to be more likely to gamble and engage in "criminally unorthodox sexual situations," according to author Ralph Hattox. By 1511, the mayor of Mecca shut them down. He cited medical and religious reasons, saying coffee was an intoxicant and thus prohibited by Islamic law, even though scholars like Mark Pendergrast, believe it was more likely a reaction to the unpopular comments about his leadership. The ban didn't last long, says Pendergrast, adding that coffee became so important in Turkey that "a lack of sufficient coffee provided grounds for a woman to seek a divorce."

1600's headline: Coffee cures alcoholism but causes impotence

As the popularity of coffee grew and spread across the continent, the medical community began to extol its benefits. It was especially popular in England as a cure for alcoholism, one of the biggest medical problems of the time; after all, water wasn't always safe to drink, so most men, women, and even children drank the hard stuff.

Local ads such as one in 1652 by coffee shop owner Pasqua Rosée popularized coffee's healthy status, claiming coffee could aid digestion, prevent and cure gout and scurvy, help coughs, headaches, and stomachaches, even prevent miscarriages.

But in London, women were concerned that their men were becoming impotent, and in 1674 The Women's Petition Against Coffee asked for the closing of all coffeehouses, saying in part: "We find of late a very sensible Decay of that true Old English Vigour. ... Never did Men wear greater Breeches, or carry less in them..."

1700's headline: Coffee helps you work longer

By 1730, tea had replaced coffee in London as the daily drink of choice. That preference continued in the colonies until 1773, when the famous Boston Tea Party made it unpatriotic to drink tea. Coffeehouses popped up everywhere, and the marvelous stimulant qualities of the brew were said to contribute to the ability of the colonists to work longer hours.

1800's headline: Coffee will make you go blind. Have a cup of hot wheat-bran drink instead

In the mid-1800s, America was at war with itself and one side effect is that coffee supplies ran short. Enter toasted grain-based beverage substitutes such as Kellogg's "Caramel Coffee" and C.W. Post's "Postum" (still manufactured). They advertised with anti-coffee tirades to boost sales. C.W. Post's ads were especially vicious, says Pendergrast, claiming coffee was as bad as morphine, cocaine, nicotine or strychnine and could cause blindness.

1916 headline: Coffee stunts your growth

While inventions and improvements in coffee pots, filters, and processing advanced at a quick pace throughout the 1900s, so did medical concerns and negative public beliefs about the benefits of coffee.

Good Housekeeping magazine wrote about how coffee stunts growth. And concerns continued to grow about coffee's impact on common ailments of the era, such as nervousness, heart palpitations, indigestion, and insomnia.

1927 headline: Coffee will give you bad grades, kids

In Science Magazine, on September 2, 1927, 80,000 elementary and junior high kids were asked about their coffee drinking habits. Researchers found the "startling" fact that most of them drank more than a cup of coffee a day, which was then compared to scholarship with mostly negative results.

1970's and '80's headline: Coffee is as serious as a heart attack

A 1973 study in the New England Journal of Medicine of more than 12,000 patients found drinking one to five cups of coffee a day increased risk of heart attacks by 60% while drinking six or more cups a day doubled that risk to 120%.

Another New England Journal of Medicine study, in 1978, found a short-term rise in blood pressure after three cups of coffee. Authors called for further research into caffeine and hypertension.

A 38-year study by the Johns Hopkins Medical School of more than a 1,000 medical students found in 1985 that those who drank five or more cups of coffee a day were 2.8 times as likely to develop heart problems compared to those who don't consume coffee. But the study only asked questions every five years, and didn't isolate smoking behavior or many other negative behaviors that tend to go along with coffee, such as doughnuts. Or "Doooonuts," if you're Homer Simpson.

Millennium headline: Coffee goes meta

Now begins the era of the meta-analysis, where researchers look at hundreds of studies and apply scientific principles to find those that do the best job of randomizing and controlling for compounding factors, such as smoking, obesity, lack of exercise and many other lifestyles issues. That means that a specific study, which may or may not meet certain standards, can't "tip the balance" one way or another. We take a look at some of the years. The results for coffee? Mostly good.

2001 headline: Coffee increases risk of urinary tract cancer

But first, a negative: A 2001 study found a 20% increase in the risk of urinary tract cancer risk for coffee drinkers, but not tea drinkers. That finding was repeated in a 2015 meta-analysis. So, if this is a risk factor in your family history, you might want to switch to tea.

2007 headline: Coffee decreases risk of liver cancer

Some of these data analyses found preventive benefits for cancer from drinking coffee, most showed drinking two cups of black coffee a day could reduce the risk of liver cancer by 43%. Those findings were replicated in 2013 in two other studies.

2010 headline: Coffee and lung disease go together like coffee and smoking

A meta-analysis found a correlation between coffee consumption and lung disease, but the study found it impossible to completely eliminate the confounding effects of smoking.

2011 headline: Coffee reduces risk of stroke and prostate cancer

A meta-analysis of 11 studies on the link between stroke risk and coffee consumption between 1966 and 2011, with nearly a half a million participants, found no negative connection. In fact, there was a small benefit in moderate consumption, which is considered to be three to five cups of black coffee a day. Another meta-analysis of studies between 2001 and 2011 found four or more cups a day had a preventive effect on the risk of stroke.

As for prostate cancer, a 2011 study followed nearly 59,000 men from 1986 to 2006 and found drinking coffee to be highly associated with lower risk for the lethal form of the disease.

2012 headline: Coffee lowers risk of heart failure

More meta-analysis of studies on heart failure found four cups a day provided the lowest risk for heart failure, and you had to drink a whopping 10 cups a day to get a bad association.

2013 headline: Coffee lowers risk of heart disease and helps you live longer

For general heart disease a meta-analysis of 36 studies with more than 1.2 million participants found moderate coffee drinking seemed to be associated with a low risk for heart disease; plus, there wasn't a higher risk among those who drank more than five cups a day.

How about coffee's effects on your overall risk of death? One analysis of 20 studies, and another that included 17 studies, both of which included more than a million people, found drinking coffee reduced your total mortality risk slightly.

2015 headline: Coffee is practically a health food

As a sign of the times, the U.S. Department of Agriculture now agrees that "coffee can be incorporated into a healthy lifestyle," especially if you stay within three to five cups a day (a maximum of 400 mg of caffeine), and avoid fattening cream and sugar.

Nutritional benefits of coffee

Calorie count: Regular black coffee (without milk or cream) has a very low calorie count. A typical cup of black coffee only contains around 2 calories. However, if you add sugar and milk, the calorie count can shoot up.

Antioxidants: Coffee is the number one source of antioxidants in the U.S., according to researchers at the University of Scranton. Joe Vinson, Ph.D., lead author of the study, said that "Americans get more of their antioxidants from coffee than any other dietary source. Nothing else comes close."  Caffeinated and decaffeinated versions provided nearly the same levels of antioxidants.

However, there are some risks in consuming too much coffee. Drinking too much coffee can result in some very unpleasant adverse effects. According to a study by researchers at the University of Oklahoma, "caffeine can cause anxiety symptoms in normal individuals, especially in vulnerable patients, like those with pre-existing anxiety disorders." In addition, "caffeine use is also associated with symptoms of depression due to either a self-medication theory, or a theory that caffeine itself causes changes in mood."

Women who plan on becoming pregnant should be cautious. Researchers from the University Of Nevada School Of Medicine reported in the British Journal of Pharmacology that regular coffee may reduce a woman's chances of becoming pregnant.14

Once again, let’s go through the health benefits of coffee.

Coffee may protect against type 2 diabetes

Coffee may be protective against type 2 diabetes. Researchers at UCLA identified that drinking coffee increases plasma levels of the protein sex hormone-binding globulin (SHBG). SHBG controls the biological activity of the body's sex hormones (testosterone andestrogen) which play a role in the development of type 2 diabetes.

Coffee may help prevent Parkinson's disease

Researchers in the U.S. carried out a study that assessed the link between coffee consumption and Parkinson's disease risk. The authors of the study concluded that "higher coffee and caffeine intake is associated with a significantly lower incidence of Parkinson's disease".

Coffee may lower the risk of liver cancer

Italian researchers found that coffee consumption lowers the risk of liver cancer by about 40%. In addition, some of the results suggest that if you drink three cups a day, the risks are reduced by more than 50%.

Coffee may help prevent liver disease

Regular consumption of coffee is linked to a reduced risk of primary sclerosing cholangitis (PSC), a rare autoimmune disease of the bile ducts in the liver.

In addition, coffee consumption can lower the incidence of cirrhosis of the liver for alcohol drinkers by 22%, according to a study at the Kaiser Permanente Medical Care Program, California, USA.

Coffee may be good for the heart

Researchers at Beth Israel Deaconess Medical Center (BIDMC) and Harvard School of Public Health, concluded that drinking coffee in moderation protects against heart failure. They defined 'in moderation' as 2 European cups (equivalent to two 8-ounce American servings) per day.

So, is the great coffee debate ever going to be won?

Stay tuned. There's sure to be another meta-study, and another opinion. We'll keep you updated.

Source:

 - CNN - http://edition.cnn.com/2015/08/14/health/coffee-health/

- WebMD - http://www.webmd.com/default.htm

- MNT - http://www.medicalnewstoday.com/

Read More

Complications of Laparoscopic Surgery and Reasons for Conversion to "Open" Method of Operating

Complications and dangers in laparoscopic surgery and reasons for conversion to "open" (traditional) method of operating

I. M. Kapuwa, MD., M.A. Glushkov, MD., PhD.

(Department of Surgery. Central Clinical Hospital of the Russian Academy of Sciences, Moscow.)

Introduction

Over the recent years, a revolution has taken place in surgery requiring the retraining of tens of thousands of surgeons. This startling change has come about because of the rapid development of endovideosurgical (minimally invasive) technology and the expansion of its field of application. Many surgeons have rapidly adopted the laparoscopic technique in a wide range of operations. This has highlighted the principal advantages of the laparoscopic approach over “open” surgery, including reduced postoperative pain, shorter hospital stays and shorter periods of disability.

Naturally, the introduction of minimally invasive technology brings with it new challenges. The main one of them being the problem of safe and proper integration of laparoscopic operations in abdominal surgery.

Unfortunately, laparoscopic interventions are not without complications characteristic of "open surgery". Furthermore, there are specific complications. Complications, as well as complex anatomical situations encountered during laparoscopic surgery, can be the reason for transition/conversion to an open method of operating.

Material and methods

We are presenting the experience of complications and dangers encountered by Resident Surgeons when performing laparoscopic interventions carried out in our clinical hospital since 2013. During the period from September 2013 to April 2015, 1812 laparoscopic surgeries were performed, using the Karl Storz endoscopy.

           Table 1.              Laparoscopic interventions

Name of operation/ Diagnosis	Number of operations	Number of conversions	%
Laparoscopic cholecystectomy	1482	83	5.6
Laparoscopic appendectomy	27	7	25.9
Laparoscopic interventions in acute pancreatitis	30	4	13.3
Laparoscopic interventions in chronic pancreatitis	19	2	10.5
Viscerolisis- Adhesive disease of the abdominal cavity	26	4	15.4
Laparoscopic hernioplasty	124	2	1.6
Cyst resection- Kidney cysts -           Liver cysts	11 6	0
Adrenalectomy- Tumour of the suprarenal gland	4	2	50.0
Laparoscopic interventions in closed injury to the liver	5	0
Operations on the spleen	8	3	37.5
Laparoscopic interventions in dolichocolon	6	1	16.7
Re-laparoscopy	11	0
Diagnostic laparoscopy	53	8	15.1
Total	1812	116

Since the reasons for conversions differ for each pathology, we present below an analysis of the reasons for certain types of operations.

Conversion to laparotomy during laparoscopic cholecystectomy

Laparoscopic cholecystectomy has virtually replaced conventional open cholecystectomy as the gold standard for symptomatic cholelithiasis and inflammation of the gallbladder. The laparoscopic approach brings numerous advantages at the expense of higher complication rates, especially in training facilities; it has been adopted rapidly by most surgeons and embraced enthusiastically by the public.

In our hospital, there has been a reliably established decrease in the number of unsuccessful attempts at laparoscopic cholecystectomy due to the gaining of experience of each operating resident surgeon in particular and the operating room staff as a whole. The vast majority of failures accounted for surgery of a shrunken gallbladder and acute calculous cholecystitis.

Reasons for conversion during Laparoscopic cholecystectomy:

       I.            Inability to perform laparoscopic surgery due to morphological changes in organs and tissues.

1)      a dense infiltrate in the gallbladder.

In the case of laparoscopic division of the infiltrate, there is a big chance of damage to organs involved in it. Sometimes these damages go unnoticed during the operation. This was the reason for the conversion of 24 observations, which accounted for 53.4% of total conversions for acute calculous cholecystitis and 10 (26.3%) in chronic calculous cholecystitis. Dense infiltrate in chronic calculous cholecystitis is also observed in a certain percentage, when the clinical symptom is consistent with chronic inflammation of the gallbladder, dense infiltration is usually diagnosed in routine patients intraoperatively. In nine (20%) patients with acute calculous cholecystitis, the reason for conversion was the combination of dense infiltrate with pericholecystic abscess.

2)      Mirrizzi syndrome, internal biliary fistula.

We found Mirrizzi syndrome in 5.3% of all conversions in chronic calculous cholecystitis, in acute calculous cholecystitis, this pathology was not encountered.

3)      Massive adhesions in the abdominal cavity.

Visible adhesion in the area of the gallbladder was the reason for conversion in 5 (13.2%) patients with chronic calculous cholecystitis. In 2 (5.3%) cases, we could not perform laparoscopic viscerolysis due to an earlier abdominal surgery. The adhesive process was more intense in the projection of abdominal incisions and areas of great damage to the peritoneum. Widespread adhesions were observed in patients previously operated on for intra-abdominal hemorrhage, peritonitis and after gynecological operations.

4)      Evidence of sclerosis in the neck of the gallbladder with the inability to differentiate its structure.

In this case, we could not complete the operation laparoscopically in two (5.3%) cases with chronic calculous cholecystitis.

5)      Cancer of the gallbladder was diagnosed intraoperatively in two cases, consisting of 4.4% of all conversions in acute calculous cholecystitis.

6)      choledocholithiasis, including the  impaction of large stones in the distal common bile duct, which was not possible to remove laparoscopically, caused the conversion of 4 (10.5%) patients with chronic calculous cholecystitis.

7)      Gangrene of the gallbladder wall.

When there is gangrene of the gallbladder wall, it loses its strength, making it impossible for traction. This pathology was the cause of conversion in two (4.4%) cases with acute calculous cholecystitis due to inaccurate information of the preoperative ultrasound result.

8)      cholecystogastric, cholecysto-duodenal, cystocolic fistula: in two cases (4.4%) the cause of the conversion during laparoscopic cholecystectomy was cholecystogastric fistula in acute calculous cholecystitis; in another - cholecysto-duodenal fistula  in chronic calculous cholecystitis (2.6%).

    II.            Obscure anatomical relationships at the region of the neck of the gallbladder and the hepatoduodenal ligament - caused the conversion to open surgery in one (2.6%) case in chronic calculous cholecystitis.

 III.            Complications arising during surgery, winch were not possible to manage using the laparoscopic technique.

1.      Bleeding (a total of 12 cases):  

a.       From the cystic artery.  According to different authors, it occurs in 1.7-3.5% of cases, and the need to convert to laparotomy appears in 0.33-1.6% of cases. According to our data, this complication has led to the conversion of two (4.4%) patients with acute calculous cholecystitis and 2 (5.3%) with chronic calculous cholecystitis.

b.      From the gallbladder bed, (bleeding from the liver parenchyma and major damage to the hepatic veins that run close to the surface in the bed). In acute calculous cholecystitis - 2 (4.4%) observations, in chronic calculous cholecystitis - 3 (7.9%).

c.       From the hepatic arteries (right or left). There was one damage to the left hepatic artery in chronic calculous cholecystitis with the involvement of the hepatoduodenal ligament with massive bleeding that led to death on the operating table. The source of bleeding was found only during autopsy.

d.      Bleeding from a vein in the gallbladder wall, against the background of portal hypertension and accompanied by massive blood loss caused conversion in one case.

e.       Bleeding from injured hepatic hemangioma during surgery - 1.

f.       Bleeding from the common hepatic artery.

g.      From the retroperitoneal vessels (aorta, inferior vena cava).

h.      From the portal vein.

Ø  The last three options were not encountered in this observation. The only vascular formation, structure and topography that is always stable is the portal vein. However, its damage during laparoscopic cholecystitis is possible; it is usually the most dangerous and often leads to death on the operating table. This can happen only due to the erroneous mobilization of the hepaticocholedochus when it is mistaken for the cystic duct.

2.      Bile duct injury that required conversion in acute calculous cholecystitis was diagnosed in one case, in chronic calculous cholecystitis - 2. It should be noted that laparoscopic correction of the damage to the common bile duct was performed using endocorporal suturing.

3.      Damage to a hollow organ that cannot be corrected laparoscopically. Damage to hollow organs diagnosed intraoperatively during laparoscopic cholecystectomy was not observed in our hospital.

4.      Lost stones. In one observation, a large stone was lost during laparoscopic cholecystectomy, which could not be found laparoscopically. During laparotomy, after a long search, it was found in the omental bursa, where it got through the Winslow (epiploic) foramen.

  IV.             Technical problems in the equipment that might occur during the intervention that cannot be repaired immediately, irrational choice of operational positions, the type of optics, tools, and modes of electrocoagulation. 

                 

                  Table 2.           Reasons for conversion in acute calculous cholecystitis

Reason	# of observations		%
Dense infiltrate in the area of the gallbladder	24		53.4%
Pericholecystic abscess	9		20%
Cancer of the gallbladder	2		4.4%
Gangrene of the wall of the gallbladder	2		4.4%
Cholecystogastric fistula	2		4.4%
Stricture of vater papilla, cholangitis.	1		2.2%
Bleeding from cystic artery	2		4.4%
Bleeding from gallbladder bed.	2		4.4%
Damage to the choledochus	1		2.2%
Total	45
Table 3.                    Reasons for conversion in chronic cholecystitis
Reason		# of Observations	%
Dense infiltrate in the area of the gallbladder		10	26.3%
Mirizzi symdrome		2	5.3%
Adhesive process around the gallbladder		5	13.2%
Adhesive process in the abdominal cavity.		2	5.3%
Sclerotic gallbladder		2	5.3%
Choledocholithiasis		4	10.5%
Choledochoduodenal fistula		1	2.6%
Obscure anatomical relationships at the region of the neck of  GB		1	2.6%
Bleeding from the cystic artery		2	5.3%
Bleeding from the gallbladder bed		3	7.9%
Bleeding from the left hepatic artery		1	2.6%
Bleeding from a vein in the gallbladder wall		1	2.6%
Bleeding from hepatic hemangioma		1	2.6%
Injury to the choledochus		2	5.3%
Lost stones		1	2.6%
Total		38

As our resident surgeons gain experience of laparoscopic surgery and improve operating technique, the percentage of conversions gradually decreases. In 2013, the total number of laparoscopic surgery for acute calculous cholecystitis amounted to 15.6% of all laparoscopic cholecystectomies, in 2014 - 32%, and in 2015 - 47.7%. Total number of laparoscopically operated patients with acute calculous cholecystitis is about 78%. Given the complexity of the operated pathology and the increase in the number of surgeons that master the laparoscopic method of operation, the total number of conversions is stagnant. To date, laparoscopic surgery is performed by 90% of the general surgeons in the surgical department of our hospital.

Reasons for anatomical disorientation in laparoscopic cholecystectomy.

Due to the nature of the technology, surgeons do not immediately go on intersecting organs, but approach them slowly by dividing the tissue covering them in small portions. However, even minor bleeding from small blood vessels impairs visualization of the layers, walls of the gallbladder, vascular and ductal structures, which is one of the most frequent causes of disorientation of the Surgeon in anatomical proportions. Conditions such as excessive fat deposition, infiltrative processes and fibrosis, acute inflammation accompanied by increased tissue bleeding, making it difficult to differentiate boundaries and contours of anatomical elements degrade the outcome of the operation. Under these conditions, seeing only a part of the organ, the surgeon must constantly think of the ratio of limited surgical field area with a common position of all other organs and anatomical elements of the gallbladder, its form, location of the duct, vessels and the hepatoduodenal ligament involved in the operation.

In addition to these features of laparoscopic cholecystectomy, the other major cause of anatomical disorientation of the surgeon and possible severe complications are atypical forms of anatomical variants of the gallbladder, the cystic duct, the location and the branch of the cystic and right hepatic arteries, as well as general patterns and individual variants of transformation of these formations during inflammation.

 The most dangerous situation is with a short cystic duct, because, as often observed in practice insufficient mobilization of the gallbladder wall in the neck and vesico-ductal region, a short cystic duct can be masked or hidden in fat deposits and can be mistaken as the common bile duct. This is a common and very typical mistake. In inflammatory conditions, the danger increases dramatically. In the inflammatory infiltrate, the cystic duct approaches the hepaticocholedochus and along with the neck of the gallbladder, it is always shifted in the dense inflammatory tissues up toward the porta hepatis.

Regardless of the variants of the structure of the cystic duct as an extremely dangerous situation, the initially close adjacency of the common hepatic duct and right lobar duct to the rear wall of the gallbladder should also be considered. Due to inflammation, this adjacency is transformed into an intimate, dense fusion of the bile ducts and gallbladder that can lead to serious injuries to the ducts.

Conversion to laparotomy during laparoscopic appendectomy

With relatively little experience in laparoscopic appendectomy - 27 operations, which was started in 2013 by our resident surgeons, however, we encountered a number of difficulties that caused the conversion in 25.9% of cases. There were no complications observed during laparoscopic appendectomy and in the postoperative period.

Table 4.

Reasons for conversion	№ of observations	%
Appendicular infiltrate	3	42.8%
Retrocecal position of the appendix	1	14.3%
Gangrene with perforation of the appendix	1	14.3%
Impossibility to define the source of peritonitis	1	14.3%
Adhesive process around the appendix	1	14.3%
Total	7

Conversion to laparotomy during laparoscopic surgery for acute pancreatitis.

Laparoscopic technology in the surgery of acute pancreatitis was introduced in our study in 2014. In this sequence, we pursued three objectives: a) confirmation of the diagnosis of acute pancreatitis and presence of effusion in the free abdominal cavity; b) laparoscopic drainage of paracolic gutters and pelvis; c) inspection and laparoscopic drainage of omental bursa. The reasons for the conversions were:

Table 5.

Reasons for conversion	№ of conversions
Adhesive process in the abdominal cavity	2
Impossibility to define source of peritonitis	1
Infiltrate around the gastro-colic ligament	2
Bleeding from the vessels of the gastro-colic ligament	1
Total	6

Conversion to laparotomy during laparoscopic surgery for adhesive disease and adhesive intestinal obstruction.

Laparoscopic surgery for abdominal adhesive disease as an independent disease, rather than comorbidity, has been carried out in our hospital for quite some time now. The diagnosis is verified based on history, clinical symptoms, enterography, lower gastrointestinal series (barium enema) and ultrasound examinations of the abdomen. Laparoscopic adhesiolysis was performed by our resident surgeons in adhesive small bowel obstruction. In all the 26 operations performed, there were four (15.4%) conversions.

Table 6.

Reasons for conversion	№ of conversions
Adhesive process in the abdominal cavity	1
Injury to small intestine	1
Dense conglomerate of the loops of the small intestine	1
Tight fusion with anterior abdominal wall	1
Total	4

Surgical treatment of adhesive disease using laparoscopic method is more efficient because of less intraoperative tissue trauma, and is therefore associated with fewer recurrences and today it is the operation of choice in this pathology. In our opinion, adhesiolysis is most effective in the presence of individual adhesions. Preference must only be given to the traditional way of operation when the risk of laparoscopic adhesiolysis exceeds the risk of negative consequences of laparotomy.

Conclusion:

With the improvement of operating skills, development of new technological solutions, steadfastness and hard work of our surgeons, the emergence of new equipment and tools, improved anesthetic technique there is a reduction in the number of situations that were previously not allowing to complete the operation laparoscopically or a contraindication to this kind of intervention.

References:

1. NJ Soper, LM Brunt, K Kerbl. Laparoscopic general surgery. The New England Journal of Medicine. 1994. Medical progress 409-410
2. G. A. Bluvstein, S. V. Vertyankin, A.V. Vsemirov. Failures in laparoscopic surgery- Endoscopicheskaya Chirurgia 1998. - #.1. - P.5.
3.  M.P Zakharash, N.D KucherYu. M. Zakharash. Rational technique in laparoscopic surgery as a means of prophylaxis of intra- and postoperative complications. Endoscopicheskaya Chirurgia. - 1999.- #2.-P.22-23.
4.  Galimov O.V, SEnderovich E. I., et al. Ways of prophylaxis of complications in laparoscopic cholecystectomy. Endoscopicheskaya Chirurgia.- 2002.- #1.- P.45-47
5.  Ko S.T., Airan M.C. Review of 300 Conseactive Laparoscopic Cholecystectomies: Development, Evolution and Results. Surgical Endoscopy 1991. – vol. 3. – P. 701-706.
6. Reddick E.J. Laparoscopic Surgery: An Update. Overview of Recent Results. Endoscopy 1994. - vol. 26. -- № 5. – Р.433-501.
7. G. Berci, Complications of laparoscopic surgery. Surgical Endoscopy March 1994, Volume 8, Issue 3, pp 165-166

Article Source: http://EzineArticles.com/?expert=Mista_Kapus

Read More