Role of lactulose in preventing postoperative renal dysfunction in patients with obstructive jaundice.

Thesis Report.

SUMMARY: A prospective study was undertaken to assess postoperative renal dysfunction in patients with obstructive and to determine the effectiveness of lactulose in reducing its incidence. Forty-two patients undergoing surgery for obstructive jaundice ( bilirubin level >1000umol/l) were randomized in two groups. Those receiving preoperative lactulose (n=20), and a control group of patients receiving no specific treatment (n=22). All patients received intravenous fluid commencing 24 hours prior to surgery and all were given perioperative antibiotics. Blood urea, serum creatinine and creatinine clearance(C24) measurements were performed on 2 days before surgery and on the first 3 days after operation. None of the patients developed postoperative acute renal failure. In both groups there were rise in blood urea and serum creatinine values postoperatively, but the changes were not statistically significant. The C24 value in the control group dropped by 16 percent whereas in lactulose group it was 10 percent . It was statistically not significant (t= 0.11,d.f=40,p>0.05). Ten patients under control and six patient s receiving lactulose were found to show>20 percent fall in mean C24 following operation, which was statistically not significant (X2=1.1, d.f.=1,p>0.05). these findings suggest that, with preoperative hydration , electrolyte correction and perioperative antibiotics, the incidence of postoperative renal dysfunction in patients with obstructive jaundice can be reduced, and is not altered by the administration of preoperative oral lactulose.

Eng.