Prevention of Postoperative Complications in Jaundiced Rats

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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<0.001) and enhanced renal impairment (p 0.001 after renal ischemia. Preoperative supportive therapy of jaundiced rats with oral lactulose increased survival time (p<0.001) but did not reduce deterioration of renal function. Preoperative internal billiary drainage proved to be superior, with a significant reduction of renal impairment (p<0.001) and an improved survival time (p<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.