ABSTRACT Purpose: The aim of this randomized study was to compare the complications and perioperative outcome of three different techniques of laparoscopic cholecystectomy (LC). Changes in the liver function test after LC techniques were investigated. Also, we compared the degree of postoperative adhesions and histopathological changes of the liver bed. Methods: Thirty rabbits were divided into three groups: group A) Fundus-first technique by Hook dissecting instrument and Roeder Slipknot applied for cystic duct (CD) ligation; group B) conventional technique by Maryland dissecting forceps and electrothermal bipolar vessel sealing (EBVS) for CD seal; group C) conventional technique by EBVS for gallbladder (GB) dissection and CD seal. Results: Group A presented a longer GB dissection time than groups B and C. GB perforation and bleeding from tissues adjacent to GB were similar among tested groups. Gamma-glutamyl transferase and alkaline phosphatase levels increased (p ≤ 0.05) on day 3 postoperatively in group A. By the 15th postoperative day, the enzymes returned to the preoperative values. Transient elevation of hepatic transaminases occurred after LC in all groups. Group A had a higher adherence score than groups B and C and was associated with the least predictable technique. Conclusions: LC can be performed using different techniques, although the use of EBVS is highly recommended.

RESUMO: Os traumas ósseos desencadeiam resposta inflamatória aguda e consequentemente alteram a concentração sérica das proteínas de fase aguda (PFA), podendo essas representarem um parâmetro para avaliação da evolução do processo inflamatório relacionado à cicatrização óssea, assim como complicações. Objetivou-se avaliar a inter-relação da mensuração de PFAs com a repação óssea em coelhos submetidos à ostectomia parcial do rádio. Foram utilizados 22 coelhos, machos, jovens (160 a 180 dias) e peso médio (3,8 ± 0,3). Para acompanhamento da evolução do processo inflamatório foram realizados hemograma completo e mensuração de albumina, ceruloplasmina, haptoglobina, proteína C reativa e transferrina, além do acompanhamento radiológico. Foi observado a melhor correlação da haptoglobina e da transferrina junto ao processo inflamatório e achados radiológicos frente às demais PFAs mensuradas. A haptoglobina apresentou pico máximo 24 horas do pós-operatório e a transferrina após 36 horas, entretanto, essa última já mostrou indícios de diminuição nas primeiras 6 horas do pós-cirúrgico, antecipadamente à resposta leucocitária. Nas condições em que o presente estudo foi realizado, a mensuração das proteínas de fase aguda mostrou-se factível. Das proteínas estudadas, a haptoglobina e transferrina foram as que mostraram maior correlação com o processo inflamatório da cicatrização óssea. Estudos adicionais são necessários para determinar a sensibilidade das proteínas de fase aguda como previsores de complicações do tratamento das fraturas.

ABSTRACT: Bone trauma triggers an acute inflammatory response, which can alter the serum concentration of acute-phase proteins (PFA). We aimed to evaluate the effectiveness of PFA measurement as a laboratory biomarker for inflammation related to bone regeneration. A partial ostectomy of the right radius was performed on 22 young male rabbits. The complete blood count, albumin, ceruloplasmin, haptoglobin, C-reactive protein, and transferrin levels were recorded and correlated with the radiographic evolution of bone healing. Statistically the best correlations with the inflammatory process and radiological findings were reported with haptoglobin and transferrin compared to the other measured PFAs. Haptoglobin and transferrin showed a maximum peak 24 and 36 hours after surgery, respectively. Transferrin displayed signs of decrease in the first 6 hours after surgery, in advance of the leukocyte response. The measurement of acute-phase proteins proved to be viable, considering the conditions in which the present study was carried out. Among all variables studied, haptoglobin and transferrin showed best correlation with the inflammatory process of bone healing. Additional studies are needed to determine the sensitivity of acute-phase proteins as predictors of complications in the treatment of fractures.