An investigation into the clinical efficacy of thiol/disulfide hemostasis and ischemia-modified albumin in cases of gallbladder perforation

BACKGROUND: In the presence of advanced age and comorbidities, patients with gallstones may face gangrenous and perforated cholecystitis during their follow-up. In the literature, dynamic thiol/disulfide homeostasis has been shown to play an important role in detoxification, antioxidant protection, regulation of enzymatic reactions, and apoptosis and cellular signaling mechanisms. In this study, we aimed to evaluate the efficacy of IMA and thiol/disulfide homeostasis in the preoperative diagnosis of patients with cholelithiasis, acute/chronic cholecystitis, and perforated gallbladder.
METHODS: Sixty-six patients that presented to the General Surgery Clinic of Ankara City Hospital for a cholecystectomy operation between February 2019 and May 2020 were included in this study. The patients were divided into three groups depending on the condition for which they were scheduled for surgery: cholelithiasis, cholecystitis, and perforated gallbladder. The demographic data, history of cholecystitis, chronic disease, white blood cell (WBC), amylase, lipase and liver function tests (AST and ALT) were recorded before the operation. Gallbladder appearance was evaluated using hepatobiliary ultrasonography. The duration of surgery, pericholecystic adhesions, hospital stay, body mass index (BMI), postoperative complications, and pathology results of specimens were recorded. In addition, thiol/disulfide and IMA values were analyzed in the blood samples taken from the patients preoperatively.
RESULTS: The mean native thiol and total thiol values of the patients with an adhesion score of 0 were significantly higher than those with an adhesion score value of 1, 2 or 3. In addition, the disulfide, disulfide/native thiol, native thiol/total thiol and IMA values of the cases with an adhesion score of 2 or 3 were significantly higher than those with an adhesion score of 0. The native thiol and total thiol averages of the patients with normal cholecystectomy were higher than the others. The disulfide, native thiol/total thiol and IMA averages of those who underwent cholecystectomy due to a perforated gallbladder were also higher than the other groups. The mean preoperative WBC of the patients who underwent cholecystectomy due to a perforated gallbladder was also significantly higher than the other groups. Lastly, the native thiol and total thiol values had a statistically significant negative correlation with age, operation time, and hospital stay, and a statistically significant positive relationship with BMI.
CONCLUSION: We consider that in the preoperative diagnosis of the perforated gallbladder, the evaluation of thiol/disulfide hemostasis and IMA parameters can be used as an effective and reliable method to predict intraoperative difficulties.

Thiol/disülfid hemostazý ve iskemi modifiye albümin’in safra kesesi perforasyonu olgularýnda klinik etkinliðinin araþtýrýlmasý

AMAÇ: Safra kesesi taþý olan ileri yaþ ve ek hastalýða sahip hastalar, takiplerinde gangrenöz ve perfore kolesistit tablosu ile karþý karþýya kalabilmektedir. Literatürde dinamik thiol/disülfid homeostezisinin; detoksifikasyonda, antioksidan korumada, enzimatik reaksiyonlarýn düzenlemesinde, apoptoziste ve hücresel sinyal mekanizmalarýnda önemli rol oynadýðý gösterilmiþtir. Çalýþmamýzda, kolelityazis, akut/kronik kolesistit ve perfore kolesistit olgularýnda ÝMA ve thiol disülfit homeostazýnýn operasyon öncesi taný koymadaki etkinliðini deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Çalýþmaya Þubat 2019–Mayýs 2020 tarihleri arasýnda kolesistektomi operasyonu amaçlý Ankara Þehir Hastanesi Genel Cerrahi Kliniði’ne baþvuran 66 hasta dahil edildi. Hastalar, kolelityazis nedeniyle ameliyata alýnan (Grup 1), kolesistit nedeniyle ameliyata alýnan (Grup 2) ve perfore safra kesesi nedeniyle ameliyata alýnan (Grup 3) olmak üzere üç gruba ayrýldý. Hastalarýn demografik veriler, kolesistit öyküsü, kronik hastalýk öyküsü, ameliyat öncesi ve sonrasý çalýþýlan WBC, amilaz, lipaz ve karaciðer fonksiyon testleri (AST, ALT) kayýt edildi. Hepatobiliyer ultrasonografide safra kesesi görünümü deðerlendirildi. Ameliyat süresi, perikolesistik yapýþýklýklar, hastanede kalýþ süresi, vücut kitle indeksi (VKÝ), ameliyat sonrasý komplikasyonlar, spesimen patoloji sonuçlarý kayýt altýna alýndý. Ek olarak hastalardan ameliyat öncesi alýnan kanda thiol/disülfid ve ÝMA deðerleri çalýþýldý.
BULGULAR: Adezyon deðeri 0 olanlarýn native thiol ve total thiol ortalamalarý adezyon deðeri 1, 2 ya da 3 olanlara göre anlamlý derecede yüksek izlendi. Ayrýca adezyon deðeri 2 ya da 3 olanlarýn disülfid, disülfid/native thiol, native thiol/total thiol oranlarý ve ÝMA deðerleri adezyon deðeri 0 olanlara göre anlamlý derecede yüksekti. Normal kolesistektomi olanlarýn native thiol ve total thiol ortalamalarý diðerlerine göre daha yüksek iken, perfore safra kesesi nedeniyle kolesistektomi olanlarýn disülfid, native thiol/total thiol oraný ve ÝMA ortalamalarý da diðer gruplardan daha yüksek olarak izlendi. Perfore safra kesesi nedeniyle kolesistektomi olanlarýn ameliyat öncesi WBC ortalamasý da diðer gruplara göre anlamlý olarak daha yüksekti. Son olarak native thiol ve total thiol deðerleri ile yaþ, ameliyat süresi ve hastanede kalýþ süresi arasýnda negatif yönde, VKÝ ile pozitif yönde istatistiksel olarak anlamlý derecede bir iliþki bulunmakta idi.
TARTIÞMA: Ameliyat öncesi olarak perfore safra kesesi tanýsý koymada thiol/disülfid hemostazý ve ÝMA paremetrelerinin deðerlendirilmesinin intraoperatif olarak karþýlaþýlabilecek zorluklarý önceden tahmin etmede etkin ve güvenilir bir yöntem olarak kullanýlabileceði düþüncesindeyiz.