Influence on gallbladder volume of early postoperative gastric supply of nutrients

Background & Aim:The gallbladder volume is a predictor of biliary stasis an d the formation of biliary sludge. Biliary stasis and sludge have been rece ntly recognized as the precursors of acute acalculous cholecystitis, as wel l as 'idiopathid postoperative pancreatitis, rare but very serious complica tions after surgery. The aim of the study was to establish how early postop erative gastric supply of nutrients affects the gallbladder volume in patie nts after noncardiac and cardiac surgery Methods: In the two prospective, randomized studies 40 patients (study I - noncardiac surgery) treated at surgical ICU after major elective extrahepat obiliary and extragastrointestinal surgeries (7 thoracic, 19 vascular, 14 u rological) and 40 patients (study II - cardiac surgery) treated at cardiosu rgical ICU after CABG surgery were analyzed. In both studies the patients w ere divided into two groups: control group C (study 1: 20 patients, age 45 +/- 18 yrs, male 65%; study II: 20 patients age 58 +/- 7 yrs, male 60%) and group E (group of early postoperative gastric supply of nutrients) (study I: 20 patients, age 52 +/- 17 yrs, male 50%; study 11: 20 patients; age 59 +/- 8 yrs, male 65%). For the first 24 hours the patients in group C receiv ed only crystalloid solutions and the gallbladder volume was verified 24 ho urs after the surgery. In group E, postoperative gastric supply of nutrient s began 18 hours after surgery (Osmolite, Ross; first 3 hours 30 ml/h and s econd 3 hours 50 ml/h; total 240 ml after 6 hours). In all patients sonogra phic measurement of gallbladder volume was performed immediately before sur gery and 6 hours after the start of feeding (24 hours after surgery). The m easurement was done with ultrasonographic scanner Hitachi 405 EUB (convex p robe 3.5-5 MHz) by the same specialist, and the volume was calculated using the ellipsoid method. Results:The gallbladder volume measured by ultrasonography 24 hours after s urgery in study I (noncardiac surgery) in group E amounted to 43 +/- 25 ml while in control group C it was significantly higher, i.e. 67 +/- 30 ml (P < 0.05). In study II (cardiac surgery) in group E gallbladder volume amount ed to 59 +/- 15 ml while in control group C it was also significantly highe r, i.e. 71 +/- 11 ml (P < 0.05). Conclusion: An early postoperative gastric supply of nutrients after both n oncardiac and cardiac adult surgery diminishes the volume and probably stim ulates the motility of the gallbladder, thus preventing biliary stasis and the formation of biliary sludge. (C) 2000 Harcourt Publishers Ltd.