A1232 SSAT ABSTRACTS GASTROENTEROLOGY, Vol. 108, No. 4

LAPAROSCOPIC INGUINAL HERNIA REPAIR: A POOR CHOICE? J. C. MeAlhany Jr. and S. S. Cooper, Department of Surgical Education, Greenville Hospital System. Greenville, South Carolina.

The increased use of laparoscepy has resulted in the application of this technique for fntra- abdominal procedures other than cholecystectomy. The repair of inguinal hernias by a transabdominal pre-peritoneal approach has gained popularity. Seventy laparoscopic inguinal hernia repairs in 59 patients were performed by one surgeon. A transabdeminal pre-peritoneal insertion and stapling of prolene mesh was utilized for all hernia repairs. Forty-seven patients underwent repair as outpatients and 12 patients were hospitalized overnight. There were 56 male patients and 3 female patients and their mean age was 47.8 years. There was an operative morbidity of 19% which included 7 seromas, 1 hematoma, I ileus, 1 episode of hematuria, and 2 neuropathies. No patient required hospitalization after laparoscopic hernia repair and there were no mortalities. All patients were followed every 3-4 months for one year and were then asked to return for any symptoms referable to the groin. The mean follow up was II months with a range of 3-30 months. Thirty-six patients had unilateral hernia repairs, Ii had bilateral hernia repairs, i0 had recurrent hernia repairs and 2 had pantaloon hernia repairs. There were 9 recurrences (12.9%). Patients who undergo laparoscopic inguinal hernia repair have a low morbidity and an early return to full activity; however, patients who undergo a traditional hernia repair experience the same benefits. With morbidity and return to activity being similar between laparoscopic and traditional hernia repairs, an early recurrence rate of 12.9% is unacceptable. The use of laparoscopy for inguinal hernia repairs seems a poor choice for operative treatment.

SOMATOSTATIN (SMS) RECEPTOR AND ITS INTERACTION WITH INHIBITORY G PROTEIN IN RINm5F CELLS. Michael K. McLeod, Piyush C. Kotharv, Department of Surgery, Michigan State University-Kalamazoo Center for Medical Studies. Kalamazoo, Michigan; University of Michigan Medical Center. Ann Arbor, Michigan.

Previously, we have shown that SMS does not inhibit DNA synthesis in rat insulinoma (RINm5F) cells in culture unless pretreated with pertussis toxin (PT). This led us to study SMS receptors and the effect of SMS on inhibitory G protein (G) synthesis in RINm5F cells. 125I-tyrI1-sMS-14~SMS-14) was obtained from Amersham. The bind ng of SMS-14 to RINm5F (10Jce Is/ml) was performed at 24°C. SMS-[4 binding to RINmSF cells in the presence of lmM cold SMS-I4 was considered to be non-specific binding (NSB). NSB was <5%. SMS binding to its receptor in R1Nm5F cells was saturable and there was a dose dependent decrease in binding of SMS-14 to its receptor in the presence of cold SMS-14. Scatchard analysis showed a single class of receptor on RINm5F ceils with Kd=7.9nM and Smax=92I per ceil. SDS-PAGE gel electrophoresis showed a protein of the molecular weight=92,000. The binding of SMS-14 could be inhibited by a non- hydrolyzable analog of GTPTS, but not by ATP. In order to study the effect of SMS on the synthesis of G in RINm5F cells and isolated rat hepatocytes (control), we abe ed RINm5F ce s and hepatocytes with 3H-L-meth on ne (3mC/well) n the presence of 0.01% Tween-20. Labeled cells were then treated with TGFc~ (50ng/ml) in the presence and absence of SMS (I0nM). Cells were then washed and lysed with 0.i% zwittergem 3-12. The cell lysate was cemrifuged and divided into two parts. One part was incubated with G -antiserum specific for the alpha subunit of Gi,.and the second part was ncubated with 3% BSA to monitor non-specific precipuation. The resuhs obtained were as follows: (n=3), (#,*=p<0.05),(G i synthesis shown in cpm+SEM). TMU=tritiated methinnlne uptake.

G i synthesis (TMU)

Reagents Hepatocytes RINm5F

Control 4872 + 1760# 2751 _+596#

TGFc~(I0mM) 4255+1416. 1941+459

TGFa+SMS 2501+_708# 2405+356

SMS(10nM) 13311_2496# li328±363# Further, 10nM TGFe~ stimulated G i synthesis in PT (200n /ml/4 hrs) pretreated RINm5F cells. This effect on G i was inhibited by SMS (4753±372 vs 2986_+569 cpmiSEM, p<0.05). This data suggest: 1) There is a single class of SMS receptors in TINm5F cells. 2) SMS receptors (like other peptide receptors) are regulated bv guanine nucleotides. 3) SMS stimulated G i synthesi~ in cells in the unstimnlated state. 4) SMS inhibits G i synthesis in the presence of TGFc~ in isolated rat hepatoeytes and PT pretreated RINm5F cells. A defect at the transcription level may be responsible for the inability of SMS to inhibit cell growth in inanlinomas.

QUALITY OF LIFE (QL) AFTER THE PELVIC POUCH PROCEDURE (PP). R.S. McLeod, C.M. DeSouza, N. Baxter, B. O'Connor, E. Nq, Z. Cohen, Dept. of Surgery, University of Toronto. Toronto, Ontario.

The aim of this study was to assess QL and functional results of patients who underwent the PP and to determine factors affecting outcome. Of 653 patients who had a PP, 531 were mailed a 42 item questionnaire. Individuals were excluded if they had their PP removed, a defunctioning ileostomy, were lost to follow-up or deceased. Items concerned bowel function, diet, well being, daily activities and sexual function. A multivariate analysis was performed to assess the effect of various factors on outcome. Three hundred ninety five (74%) patients returned the questionnaire (210 males, 185 females; mean age 33 years). One hundred eight-eight patients had a handsewn and 207 a stapled IAA; 269 had a J and 124 had a S pouch; and iii were done without a covering ileostomy. The diagnosis was UC in 369 (93%). Mean follow-up was 4.8 years. Fifty-four per cent of patients had less than 6 BM/day; 66% were fully continent during the day and 50% during the night; less than 1% complained of significant incontinence; 62% rarely or never had urgency. Over 90% of patients always felt well, were able to do their normal activities, and were unrestricted in career and leisure activities° Stool frequency was significantly better in patients who were younger (p=.008), had a S pouch (p=.006) and had not had an IAA leak (p=.008). Furthermore, patients' ability to have a normal lifestyle was significantly correlated with their stool frequency (p=.O001), whether they experience urgency (p=.O001) and their nighttime (p=O.0009) and daytime (p=.O001) control. Results suggest functional results and QL following the PP are excellent in most patients. Bowel function does impact on QL. QL may be improved in younger patients who have a S pouch and had no IAA leak.

UTILITY OF CHOLECYSTOKININ-ASSISTED CHOLESCINTIGRAPHY IN ACALCULOUS BILIARY DISEASE. J.D. Mellinqer, D.P. McKellar, D.J. Lee, R. Black, and J.B. Peoples, Departments of Surgery and Radiology, Wright State University School of Medicine. Dayton, Ohio.

While gallbladder ejection fraction (GBEF) calculation via cholecystokinin-assisted cholescintigraphy has achieved some popularity in the assessment of patients with acalculous biliary symptomatology, its predictive utility to the surgeon remains controversial. We reviewed an experience with 29 consecutive patients who underwent cholecystectomy for acalculous biliary disease diagnosed by abnormal GBEF over a three year interval. All patients had biliary referable symptoms, absence of cholelithiasis by preoperative ultrasound and postsurgical pathology report, and GBEF values of less than 35%. Postsurgically, 28 patients (97%) had abnormal gallbladder histology, with chronic cholecystitis (n=27) with or without cholesterolosis (n=7) being the most frequent pathologic finding. Detailed telephone follow up by a physician not involved in the surgery was available in 22 patients (76%) at a mean of 16 months after cholecystectomy. All such patients reported at least partial symptom relief, and 12 (55%) had complete resolution of symptoms postsurgically. We conclude that abnormal GBEF correlates highly with gallbladder pathology and is a useful predictor of clinical response to cholecystectomy in patients with acalculous biliary symptomatology. These correlations suggest GBEF calculation may be of significant utility from a preoperative quality assurance standpoint in this era of increased cholecystectomy utilization.