Postoperative WBC Research Articles

Laparoscopic versus open appendectomy for complicated appendicitis in high risk patients.

Laparoscopic appendectomy is widely used for the treatment of complicated appendicitis. Its use in patients with high operative risk is still on debate. The aim of the presented study was to investigate the benefits of laparoscopic appendectomy in patients with high peri- and postoperative risk factors. We performed a retrospective analysis of all patients who underwent appendectomy in our center between 2006 and 2013. Patients were classified according to their preoperative risk (classification of the American Society of Anesthesia--ASA score). Only patients with ASA 3 and 4 were included and were divided into two groups--open appendectomy (OA group) and laparoscopic appendectomy (LA group). The operation time was slightly longer in the LA group (p = 0.05), but hospital stay was shorter (p = 0.05). Complications graded according to the Clavien Dindo classification were slightly more frequent in patients after LA, whereas severe complications occurred more frequently in patients after OA (p = 0.01). The postoperative WBC decreased steadily and significantly in patients after OA, whereas the decrease in patients after LA was delayed (p = 0.03). CRP slightly increased after OA and decreased thereafter, whereas it steadily decreased after LA (p = 0.05). Laparoscopic appendectomy can be recommended for patients with complicated appendicitis even with higher risk categories.

Acute-Phase Response in Monitoring Postoperative Recovery in Bitches After Ovariohysterectomy

Abstract An ovariohysterectomy is one of the most common procedures performed on bitches in everyday veterinary practice. As with any other surgery, it leads to a local inflammatory reaction, which is usually accompanied by a systemic reaction called the acute-phase response (APR). The aim of the study was to assess the changes of serum CRP concentration, WBC and rectal temperature during the postoperative period in bitches undergoing ovariohysterectomy and to establish the usefulness of such determinations after surgical trauma. The results showed increased levels of all the measured parameters 24 hours after surgery. During the course of a normal postoperative period, WBC count and rectal temperature return to values that are considered physiological norms for dogs. The subsequent decline in CRP during the postoperative course indicates the gradual subsidence of the inflammatory reaction to surgical trauma. CRP concentrations higher than the physiological norm noted 10 days after surgery indicate a persistent, although less severe inflammatory process. The serum concentration of CRP is a more sensitive and reliable parameter for an evaluation of the postoperative period in bitches than WBC count and rectal temperature

Safety of synchronous hepatectomy and splenectomy for patients with hepatocellular carcinoma and hypersplenism.

To assess the surgical safety of synchronous hepatic resection and splenectomy for patients with hepatocellular carcinoma (HCC) and hypersplenism. Patients with HCC and hypersplenism who underwent surgical treatment were included in this study. According to the difference of operations, patients were divided into two groups (group A, patients who underwent hepatic resection; group B, patients who underwent synchronous hepatic resection and hypersplenism). Pre- and intra-operative parameters were statistically analyzed. Postoperative outcomes including white blood cell and platelet count changes, surgical complications and long-term survival rates were compared. The pre- and intra-operative parameters of two groups were comparable except for preoperative white blood cell and platelet counts. The incidences of postoperative surgical complication were 53.33% for group A and 35.48% for group B (p=0.161). The 1- and 3-year survival rates of the two groups were 83%, 42% and 82%, 54%, respectively (p=0.313). Synchronous hepatic resection and splenectomy could increase the postoperative WBC and platelet level for patients with hepatocellular carcinoma and hypersplenism without increasing surgical risks.

Leukocytosis after robotic hysterectomy: commonly observed but clinically insignificant.

Laboratory studies are commonly performed after surgery, but with little evidence of clinical utility. We evaluated our experience with measuring a complete blood count (CBC) to determine peripheral blood leukocyte count (WBC) postoperatively following consecutive robotic hysterectomies. From January 2008 through November 2009, two surgeons (KM, HM) performed 204 robotic hysterectomies. Patient age, weight, height, indication for surgery, surgical procedure, operative time, estimated blood loss, hospital length of stay, postoperative fever, and complications were prospectively recorded and correlated with WBC measured on the day after surgery. The postoperative WBC was elevated (>11,000/μl) in 59/204 (29%) patients. Eight (4%) patients had marked leukocytosis (WBC >15,000/μl; maximum 16,600/μl). There was no correlation between postoperative leukocytosis and operative time, BMI, performance of lymphadenectomy, or length of hospitalization. The only factor significantly associated with elevated postoperative WBC was elevated preoperative WBC (P<.001). Also, there was no correlation between postoperative leukocytosis with fever or infectious complications. The mean T max was 37.1ºC and T max over 38ºC was seen in nine patients. Of the five women who developed infectious complications, only one (diagnosed with pneumonia) had a minimally elevated postoperative WBC (11,600/μl); the other four (pneumonia and pelvic abscess, two each) had normal postoperative WBC. Routine measurement of WBC after robotic hysterectomy is not useful. In about 25% of cases there will be a slight leukocytosis, and rarely (about 4%) will the WBC exceed 15,000/μl. In no case was measurement of postoperative WBC clinically relevant.

Varying Blood Monocyte and Dendritic Cell Responses after Laparoscopic Versus Open Gastric Bypass Surgery

Laparoscopy may activate innate immunity less than conventional open surgery. This may be important in obese patients who have pre-existing low-grade inflammation. This study examined phenotypic changes in blood monocytes (Mcs) and dendritic cells (DCs) from patients undergoing laparoscopic (L) or open (O) Roux-en-Y gastric bypass (RYGBP) surgery. 8 patients (3 male) had blood drawn before and after RYGBP, and on postoperative day (POD) 1, 3, and 28. Mc and DC quantity, phenotype, and activation status were determined by flow cytometry. Mean BMI was 53 +/- 4 and 46 +/- 1, and length of stay was 6.3 +/- 3.2 and 3.5 +/- 0.6 days, in the O (n=4) versus L (n=4) groups, respectively. Postoperative WBC count was 16 +/- 1 x 10(3)/mm3 after O and 10 +/- 1 x 10(3)/mm3 after LRYGBP (P<0.001). This was due to a greater rise in neutrophils and decline in lymphocytes after ORYGBP (P<0.001). Total Mcs increased in both groups at POD 1, but the number of CD18+ Mcs was reduced after ORYGBP (P=0.04). Mc human leukocyte antigen (HLA)-DR expression was lower in CD16+ Mcs after ORYGBP, suggesting decreased capacity to present antigen (P=0.002). Postoperatively, total DCs decreased in both groups, but recovered (P=0.04). The proportion and activation of the tolerogenic DC2 phenotype was lower, whereas the percentage of the ldDC phenotype was higher, in the O group (P=0.006). RYGBP changes the quantity and phenotype of circulating blood Mcs and DCs. Although there were overall similarities in the overall response to gastric surgery between open and laparoscopic, there were some notable differences, including a greater reduction in HLA-DR expression and increased number of immature DCs in the ORYGBP group. The findings suggest that RYGBP may have varying immunologic consequences depending upon the surgical procedure employed.

Evaluation of ameroid ring constrictors for treatment for single extrahepatic portosystemic shunts in dogs: 168 cases (1995–2001)

To evaluate use of an ameroid ring constrictor (ARC) for treatment for single extrahepatic portosystemic shunts (PSSs) and identify factors associated with postoperative death, continued portosystemic shunting, and long-term outcome in dogs. Retrospective study. 168 dogs with a single extrahepatic PSS. Medical records of dogs that had a single extrahepatic PSS and were treated with an ARC were reviewed. Signalment, history, clinical signs, results of preoperative blood analyses and portal pressure measurements, PSS location, ARC size, postoperative complications, and postoperative scintigraphy results were recorded. Owners were interviewed 6 months to 6 years after surgery. Results-Postoperative complications developed in 10% of dogs. Postoperative mortality rate was 7.1%. Predictive factors for postoperative death included high preoperative WBC count and postoperative complications. Twenty-one percent of dogs in which portal scintigraphy was performed 6 to 10 weeks after surgery had continued shunting. Predictive factors for persistent shunting included low preoperative plasma albumin concentration, high portal pressure after complete occlusion, and high portal pressure difference (postocclusion minus baseline). Clinical outcome in 108 dogs was classified as excellent (80%), good (14%), or poor (6%). Predictive factors for excellent long-term clinical outcome included high preoperative plasma albumin concentration, low preoperative leukocytosis, low portal pressure after complete occlusion, absence of postoperative seizures, and absence of continued shunting. Use of an ARC for treatment for a single extrahepatic PSS resulted in low morbidity and mortality rates. Certain preoperative factors were associated with increased risk of postoperative death, continued portosystemic shunting, and long-term outcome.

ANALYSES OF THE RISK AND OPERATIVE STRESS FOR DONORS IN LIVING-RELATED PARTIAL LIVER TRANSPLANTATION

Operative risk and stress were analyzed in 28 parent-donors whose children received partial liver transplantations at the Second Department of Surgery, Kyoto University Hospital between June 1990 and December 1991. Graft-harvesting operations were classified into three types: left lobectomy (group L, n = 12), left lateral segmentectomy (group S, n = 15), and right lobectomy (n = 1). Since donor safety is a primary concern, great care was taken to minimize potential damage to the remaining lobes of the donor liver as well as the graft liver by avoiding stressful maneuvers such as hepatic vascular clamping during the transection of the hepatic parenchyma. In all cases the arterial ketone body ratio, which reflects the hepatic mitochondrial redox potential, was maintained at over 0.7 throughout the donor operation as well as postoperatively. There was no significant difference in the postoperative RBC, WBC, serum GOT, and total bilirubin between groups L and S, although the abnormalities exhibited by the single right lobectomy case tended to be larger and more prolonged. All cases were within the range acceptable for immediate discharge, and all donors of groups L and S were subsequently discharged within 14 days without any postoperative complications. The single right lobectomy donor was discharged on POD17 because of transient slight icterus, which is the only postoperative complication encountered in this series thus far. The present analyses would indicate that the risk and operative stress to the donor in living-related partial liver transplantation can be minimal when the left lobe or left lateral segment of the liver is used for the graft.