title: Prevention of postoperative complications in jaundiced rats. Internal biliary drainage versus oral lactulose.
abstract: In an experiment mimicking a severe surgical trauma by deliberate renal ischemia, the postoperative outcome in jaundiced rats was studied. Intervention studies were performed with preoperative oral lactulose (to reduce endotoxin toxicity) or preoperative internal biliary drainage. Compared to control, obstructive jaundice in rats significantly reduced survival time (p less than 0.001) and enhanced renal impairment (p less than 0.001) after renal ischemia. Preoperative supportive therapy of jaundiced rats with oral lactulose increased survival time (p less than 0.01) but did not reduce deterioration of renal function. Preoperative internal biliary drainage proved to be superior, with a significant reduction of renal impairment (p less than 0.001) and an improved survival time (p less than 0.001). Our experiments provide further evidence that obstructive jaundice increases the complication rate following major surgical procedures. Based on our results in rats, we suggest that in obstructive jaundice preoperative internal biliary drainage is the supportive therapy of choice. However, if adequate drainage is not possible, oral treatment with lactulose may help reduce postoperative complications.
authors.affiliation: Department of Surgery, Academic Hospital Maastricht, State University of Limburg, The Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: Greve
authors.forename: J G
authors.initials: JG
authors.lastname: Maessen
authors.forename: T
authors.initials: T
authors.lastname: Tiebosch
authors.forename: W A
authors.initials: WA
authors.lastname: Buurman
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D000284:Administration, Oral; D000818:Animals; D001652:Bile Ducts / Q000601:surgery; D001663:Bilirubin / Q000097:blood; D001806:Blood Urea Nitrogen; D002779:Cholestasis / Q000097:blood / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D004187:Disaccharides / Q000008:administration & dosage*; D004322:Drainage / Q000379:methods; D004731:Endotoxins / Q000097:blood; D007511:Ischemia / Q000097:blood / Q000150:complications / Q000473:pathology; D007668:Kidney / Q000098:blood supply / Q000473:pathology; D007792:Lactulose / Q000008:administration & dosage* / Q000627:therapeutic use; D008026:Ligation; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care; D051381:Rats; D011919:Rats, Inbred Strains; D012709:Serum Albumin / Q000032:analysis; D015607:Stents; D014280:Triglycerides / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
chemical_list: D004187:Disaccharides; D004731:Endotoxins; D012709:Serum Albumin; D014280:Triglycerides; D014409:Tumor Necrosis Factor-alpha; D007792:Lactulose; D001663:Bilirubin