الفهرس 
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Abstract
The present study was carried out on 15 healthy mongrel dogs of both sexes, aging 10 - 24 months and weighing from 15 – 35 kg.
– Operations of the present study included:
1. Ligation of cystic duct
2. Ligation of common bile duct
3. Cholecystectomy
4. Cholecystoduodenostomy
5- Cholecystogastrostomy
- All operations in this study were performed under the effect of intravenous general anaesthesia using 4% thiopental sodium at a dose rate of 20–30 mg/Kg bwt. Preanaesthetic medication was performed using xylazine HCl at a dose of 1 mg/kg bwt. by IM route.
- Laparotomies in all operations were carried out by long midline celiotomy through incision of skin and abdominal muscles extending from xyphoid process to post–umbilical region.
The results of the present study showed that:
A) Surgical finding:
- Enlarged gallbladder, jaundice and dark liver surface were notices clearly in groups suffered from cystic duct & common bile duct ligations as well as liver adhesions between the liver surface and the surrounding peritoneum in different dogs from those two groups.
- Liver adhesions in cholecystogastrostomy & cholecystoduodenostomy group were uncommon complication.
- Necrotic gangrene of the gallbladder was a complication of pressure on the blood supply of the gallbladder.
- Normal liver surface was noticed in Cholecystoduodenostomy with normal healing found without any complications in all dogs.
- Bile was found as a remark in the small intestine at cholecystoduodenostomy & Cholecystogastrostomy.
- Cholecystogastrostomy had a complication due to closures of the fistula between the gallbladder and the stomach.
- All dogs remained a live till the end of the experiment except one dog, died post cholecystectomy operation by 36 hrs due to internal hemorrhage.
b) Biochemical findings:
- Blood samples were collected from dogs just before each operation by 5 min. as well as 24 hrs, 7, 14, 21 and 28 days post–operation for determination of serum activities of AST, ALT, ALP and GGT, and levels of serum glucose, cholesterol, total bilirubin, direct bilirubin, total protein, albumin, globulin and albumin/globulin ratio as well as the blood picture Hb, PCV%, RBCs and WBCs.
- The Hb in both CD and CBD ligation group showed a maximum level at 28 days post-operation and the lowest level observed after 24 hours post-operation. In general the level of Hb pre-operation is higher than post-operation by 24 hrs but at the end of the experiments the level of Hb is improved and became higher than that of the pre-operative value.
- The level of PCV % in CD group showed a higher level pre-operation, while the lower level of PCV % observed after 24 hrs post-operation and started to increase progressively toward the end of the experiment but didn’t reach the pre-operative value while in CBD group showed significant decrease post operation by 24hrs and start increase but didn’t reach its value pre operation.
- In cholecystectomy group both Hb & PCV% showed increase post operation by 24 hrs in its values then decreased by the end of the experiment at the 28th day but still higher than the pre operative value.
- Hb in cholecystoduodenostomy & Cholecystogastrostomy group showed decrease n their values post operative values by 24hrs and back to around the value pre operative at the 28th day while & PCV% in cholecystoduodenostomy showed decrease in its value post operation by 24 hr and returned near its value pre operation at the end of the experiment. But PCV% values at Cholecystogastrostomy group showed significant increase post operation by 24hrs & remained higher that its pre operative value tills the end of the experiment by the 28th day.
- RBCs level in both CD & CBD ligation showed gradual decreasing in their values to reach its lowest level at the end of the experiment compared with the pre operative values.
- While RBCs in cholecystectomy group showed no significant changes compared with the pre operative values.
- Cholecystoduodenostomy group showed significant decrease in RBCs value till the 7th day post operation then started to increase again to reach around the pre operative value from the day 14th till the 28th day.
- While RBCs in Cholecystogastrostomy group showed significant increase in its value post operation by 24 hrs then decreased slightly till the 14th day then increased again till the experiment end at the 28th faintly.
- The level of WBCs in CD ligation showed a gradual increase in its values to reach the higher level at 21 days of the experiment then DROPped to become 6.6 which is lower than the pre-operative value while the level of WBCs in CBD ligation showed significant increase post-operation by 24 hrs then decreased to reach its lowest value at the day 21 from the experiment compared with the pre-operative value. Then increased again at the 28th day from the experiment.
- WBCs in cholecystectomy showed significant changes as it increased after 24 hrs post operative and decreased at the 7th day post operation then increased again by the 14th day to decreased once more at the 21th days and increased again at the end of the experiment.
- Cholecystoduodenostomy showed significant decrease in WBCs after the 7th day of the operation then started to increase again at the 14th day then started to decrease significantly again till the end of the experiment.
- While in Cholecystogastrostomy WBCs showed non significant increase at the 7th day post operation then decreased till reach near the pre operative value at the 28th day from the experiment.
- Both glucose & cholesterol levels in CD and CBD groups showed a marked and significant increase during the time of the experiment, which didn’t return to the pre-operative base line value.
- In cholecystectomy group the glucose level showed significant increase post operation by 24 hrs and continued increase till the 14th day from experiment then at the 21th day it showed a non significant decrease then increased again at the 28th day from the experiment while Cholesterol showed significant increase post operation till the 7th day then decreased till the 21th day and followed by increase in its value at the experiment end by the 28th day.
- Glucose level in Cholecystoduodenostomy showed significant increase during the time of the experiment and didn’t return to its pre operative value at the end of the experiment. While cholesterol showed significant decrease till the 7th day post operation then started to increase again to reach nearly the pre operative value at the 14th day then decreased again from the 14th day till the end of the experiment.
- Cholecystogastrostomy group glucose level showed significant decrease post operation by 24 hrs then gradually increased significantly from the 7th day till the 28th day from the experiment. While cholesterol level showed significant decrease in its value post operation by 24 hrs then started to increase at the 7th day to reach higher than the pre operative value at the 14th day the decreased a little with no significant value till the experiment end.
- In CD and CBD ligation total protein, albumin, globulin and albumin/globulin ratio level showed significant decrease during the time of the experiment and didn’t return to its bas line pre-operative value.
- Cholecystectomy group showed slight increase in total protein post operation by 24 hrs then decreased in non significant form at the 14 days then increased slightly at the end of the experiment while albumen showed non significant changes in the parameter value as it decreased post operation by 24 hrs and started to increase again to be similar to the pre operative value at the 21th day the decreased at the end of the experiment as well as globulin showed a significant increase post operation by 24 hrs and decreased till the 14th day from the experiment the increased again till the 28th day post operation while Albumin/Globulin ratio showed a significant decrease in the value post operation by 24 hrs and started to increase gradually till the 14th day post operation the showed significant decrease till the end of the experiment at the 28th day.
- Cholecystoduodenostomy group total protein showed non significant changes all the time of the operation tll the 28th day which ranged around the pro operative value while albumin level showed significant decrease 24hrs post operation then started to increase again to reach its pre operative value at the 7th – 14th day then continued to increase till the end of the experiment at the 28th day. Globulin showed significant increase during the time of the experiment which didn’t returned to its pre operative value till the 28th day while Albumin/Globulin ratio showed significant decrease till the 14th day post operation then a significant increase was observed by the 21th day then decreased again at the 28th day at the experiment end.
- Total protein in Cholecystogastrostomy showed a significant decrease in its value post operation by 24 hrs then increased significantly at the 21th day post operation and continued increasing till the day 28th from the experiment while albumin showed significant decrease post operation by 24 hrs then started to increase till the 28th day but didn’t reach the pre operative value. Globulin showed non significant increase in its value post operation by 24 hrs then decreased slightly from the 7th day till the end of the experiment but results at the 28th day remained near the pre operative value while albumin/Globulin ratio showed significant decrease post operation by 24 hrs then started to increase significantly and gradually till the 28th day from the experiment to come close to the pre operative value.
- In both CD & CBD ligation groups the total bilirubin and direct bilirubin showed significant increase during the experiment time to reach its highest level at the 28th day post-operation.
- While in cholecystectomy total bilirubin showed significant increase till the 14th day 28th day post operation the decreased significantly at the 21th day the a slight increase in its value was noticed at the 28th day from the experiment as well as direct bilirubin showed significant increase post operative by 24 hrs and decreased at the 24th day from the experiment followed by increased value till the 28th day post operation.
- Cholecystoduodenostomy total bilirubin showed significant increase in its level post operation by 24 hrs the decreased gradually to reach the lowest value at the end of the experiment by the 28th day while direct bilirubin showed non significant value post operation by 24 hrs then decrease in its value at at the 7th day with non significant changes till the 28thday from the experiment.
- Cholecystogastrostomy total bilirubin showed slight decrease in its value post operation by 24 hrs then increased significantly at the 7th day then decreased again at the 21th day post operation and increased in the 28th day to be nearly higher than the pre operative value while direct bilirubin showed decreasing in its value post operation by 24 hrs then increased significantly till the 21th day post operation then decreased at the 28th day but still higher than the pre operative value.
- ALT, AST, ALP & GGT levels at CD and CBD ligation showed a significant increase in its value during the time of the experiment to reach its highest level at the 28th day post-operation.
- In cholecystectomy the ALT level showed significant decrease in its value post operation by 24 hrs the showed non significant increase till the end of the experiment at the 28th day while, AST level showed non significant value increase till the experiment end at the 28th day. The ALP level also showed significant increase in its value till 7th day post operation the decreased significantly and back to increase again till the experiment end. The GGT level showed similar value compared to the pre operative value till the 14th day post operation then started to increase insignificantly till the 28th day from the experiment.
- Cholecystoduodenostomy ALT showed significant increase in its value post operation by 24 hrs then started to decrease significantly till the end of the experiment by the 28th day to be below its pre operative value while AST showed significant increase post operation by 24 hrs then decreased gradually starting from the 7th day from the experiment till the 28th day to be nearly as its pre operative value. ALP showed significant increase in its value post operation by 24 hrs then decreased at the 7th day from the experiment and showed non significant increase at the 21th day the decreased below the pre operative value at the 28th day from the experiment. GGT showed significant decrease in its value post operation by 24 hrs the increased at the 7th day to be nearly as the pre operative value then showed non significant decrease till the end of the experiment.
- Cholecystogastrostomy AST showed significant increase in it value post operation by 24 hrs and continued till the 7th day then decreased non significantly from the 14th day till the end of the experiment but still higher than the pre operative value. ALT showed a significant increase in its value post operation by 24 hrs the decreased significantly till the 21th day from the experiment the increased slightly at the 28th day but still higher than the pre operative value. ALP showed a significant increase post operation by 24 hrs till the 7th day from the operation the decreased in the 14th day and remained till the end of the experiment at the 28th day with non significant changes. GGT Showed significant increase in its value post operation by 24 hrs and continued till the end of the experiment to be higher than the pre operative value.
C) Histo-pathological finding:
Samples were collected from liver tissue post ligation of cystic duct; Ligation of common bile duct; Cholecystectomy, cholecystoduodenostomy and cholecystogastrostomy by 28 days. Sections from formalin-fixed liver samples were stained for light microscopy using standard techniques and stained by hematoxylin and eosin.
In common bile duct ligation, Parenchymal changes were confined to periportal area, featuring scattered apoptosis and hyDROPic degeneration with cellular swelling (cholate stasis) as well as tubular rearrangement of the normally one-cell-thick hepatocytes plate.
Portal tract changes were present as expansion of portal tract with mixed inflammatory reaction mainly neutrophil with bile ductular proliferation extending to the periphery of the portal tract with or without inspissated bile.
Meanwhile, in cystic duct ligation, moderate parenchymal changes, featuring multifocal hyDROPic degeneration and dilated sinusoids ; mild expanded portal tract with neutrophils with or without mild ductular proliferation .
In Extra hepatic surgery
Cholestatic liver after cholecystectomy exhibited moderate parenchymal and portal tract change while cholecystoduodenostomy caused substantive reversal of the cholestatic liver to normal except mild cholate stasis. Cholecystogastrostomy alleviate cholestatic changes, the liver only exhibited mild parenchymal and portal changes.