mohsen najmadini

Adopting a suitable strategy to reduce the complications of cholecystectomy plays a significant role in the well-being of patients. We investigated the effects of atorvastatin on clinical symptoms, and inflammatory markers of patients undergoing cholecystectomy.

This double-blind randomized controlled trial was conducted in Imam Reza Hospital, Birjand in 2021. In this study, 47 patients received 40 mg atorvastatin (intervention group) and 47 patients received placebo both daily for 4 weeks (placebo group). Then, the frequency of fever, abdominal pain, and nausea before and after cholecystectomy, as well as peri-operative data (duration of operation, and intraoperative bleeding) and laboratory data [White Blood Count (WBC), C-Reactive Protein (CRP), Aspartate AminoTransferase (AST), and Alkaline Phosphatase (ALT)] was collected. The data was analyzed using (SPSS Version 22) based on chi-squared, and independent t-tests at the significance level of (P≤0.05).

The duration of hospitalization was not significantly different in both groups (P=0.26), however, the duration of operation was significantly longer in the intervention group (P<0.001). The frequency of fever, abdominal pain, and nausea after cholecystectomy was not statistically different (P>0.05). The volume of intraoperative bleeding in the placebo group was more than the intervention group (P=0.05). The decrease of WBC, CRP, and the ALT levels after cholecystectomy was not statistically different (P>0.05); however, AST level after cholecystectomy was higher in the intervention group (P=0.05).

The use of atorvastatin effectively reduced the volume of intraoperative bleeding. However, this intervention with this dose and duration could not have a significant role in reducing the duration of patients’ hospitalization, duration of operation, and levels of WBC, CRP, ALT, and AST.

Volvulus of the gallbladder or gallbladder torsion (GT), is a condition in which an organ twists along its long axis leading to the vascular source compromise. The GT was first diagnosed in 1898 as a rare cause of idiopathic cholecystitis. Some 500 cases have been reported ever since, and they account for 0.1% in acute cholecystitis cases. An 85-year-old male patient presented with epigastric abdominal pain that was referred to as the upper abdominal quadrant (UAQ). The pain did not radiate elsewhere but was constant and severe. Moreover, it did not change with eating; nonetheless, the patient had anorexia, nausea, and biliary vomiting that occur two times. Fever and chills, weight loss, and icterus were not observed. According to the ultrasound report, flat cholecystitiswas diagnosed, and the patient underwent cholecystectomy. During the operation, GT was confirmed. Diagnosis of GT in elderly patients without symptoms of acute abdomen and cholecystitis should be considered in differential diagnosis to prevent complications and mortality.

Hemorrhoids can be managed by means of several therapeutic options. Regarding this, it is of fundamental importance to identify the hemorrhoidectomy method with fewer complications (e.g., bleeding, pain, and postoperative infections) or beneficial outcomes (e.g., accelerated speed of wound healing and resumption of normal life activities). Such knowledge can play a significant role in the advancement of medical and educational goals. Therefore, the present study was conducted to compare the clinical results of Milligan-Morgan surgery and hemorapy device in the treatment of patients with hemorrhoids.

This prospective study was conducted on 60 patients aged over 20 years with hemorrhoids referring to Bahonar and Afzalipour hospitals of Kerman, Iran, and diagnosed to need surgery by a surgical specialist. The study population was selected using a simple randomization method and then allocated into two groups of A and B, regardless of gender. Group A was operated by open or Milligan-Morgan technique, while group B was subjected to the hemorapy method. After the surgery, the patients’ data were recorded in specific forms and analyzed by SPSS software (version 21).

Out of 60 patients with hemorrhoids, 37 (64%) cases were male. Regarding the severity of hemorrhoids, 19 (32%) and 41 (68%) patients had fourth-degree and third-degree hemorrhoids, respectively. The mean age of the patients was 35.86±12.84 years. Four weeks after the surgery, the mean pain scores of the patients in the Milligan-Morgan and hemorapy groups were 3.67±1.84 and 1.67±1.35, respectively, showing a statistically significant difference (P=0.001). However, 8 weeks post-surgery, no pain, bleeding events, urinary retention, or incontinence were observed in the patients, except for anal stenosis in two patients treated with the Milligan-Morgan method.

According to the results, the hemorapy method resulted in lower postoperative pain than the Milligan-Morgan method. In addition, the hemorapy technique was accompanied by considerably fewer complications, such as bleeding, urinary retention, gas incontinence, and stenosis, compared to the Milligan-Morgan method. Consequently, the hemorapy method can be recommended for hemorrhoidectomy.