ABSTRACT
Background: The difficult laparoscopic cholecystectomy is more likely to be converted to Open cholecystectomy with loss of the advantages of laparoscopic surgery and more complications. The main difficulty is in the dissection at Calot's triangle where inflammation, adhesions, and fibrosis make it unsafe, risking damage to important nearby structures. The alternative to conversion is laparoscopic subtotal cholecystectomy [LSC]
Objective: To assess the feasibility, safety. and efficiency of LSC. and to present our experience with this operation
Design: Prospective case series
Setting : Endoscopic Surgery Unit, Al-Zahrawi Teaching Hospital, Mosul
Patients and Methods: Thirty three patients who had [LSC] out of 3006 patients operated on for laparoscopic cholecystectomy [LC] by the authors in the period [from 1, January 1995 to1, July 2002]. Data were collected from the patients [by a pre-arranged form] regarding: history, examination, investigations, operative findings and technique, postoperative complications and follow up
Results: LSC was attempted in 39 patients [1.3% of the total LC]. but in 6 patients, it was converted to open subtotal cholecystectomy[OSC] [0.2% of the total LC and 15.4% of the LSC]in 33 patients LSC was successful [1.1%] of all LC. Acute laparoscopic cholecystectomy constituted 22.5% of the total, and included 23 attempted LSC, 6 of them converted to 08C. Non-acute cases were 77.5% and included 16 cases of LSC [0.7%]. LSC was 3.6 times frequent in acute cholecystitis, which was along with Mirizzis syndrome type I, the most common indications for LSC [23/33, 70%]. Anterior subtotal cholecystectomy was the commonest technique, leaving the posterior wall partially or completely in all patients. Minor wound sepsis was the commonest complication. Two patients with left stones had abdominal wall abscess 8 months, and subhepatic abscess 10 months after operation, both drained and stones removed. Operative time ranged 75-150 minutes, mean 105 minutes. Hospital stay W85 2-3 days, mean : 2 days
Conclusion : LSC is a safe, feasible, effective operation and may help prevent conversion to Open surgery in selected patients with difficult cholecystectomies
ABSTRACT
Background: Shortages of metallic clips for cystic artery occlusion [CAO] in laparoscopic cholecystectomy [LC] under the conditions of blockade imposed on Iraq; threatened to stop the performance of LC, with all its negative consequences both on patients and surgeons. We thought of an alternative: using monopolar diathermy coagulation [MDC] for occlusion of the cystic artery, to get on with laparoscopic surgery for the benefit of patients, surgeons, teaching and training programmes
Objective: To assess the efficiency, safety and feasibilityof MDC as a new method of cystic artery occlusion, and to compare it with the standard clip occlusion
Design: Prospective study
Setting: Endoscopic surgery unit, Al-Zahrawi Teaching Hospital, Mosul
Intervention: Laparoscopic cholecystectomy for chronic and acute cholecystitis
Main Outcome Measures: Bleeding at occlusion, bleeding after occlusion, time taken to occlude cystic artery, intra and postoperative complications. blood transfusion. conversion toopen cholecystectomy, and follow-up
Methods: Part 1: MDC for cystic artery occlusion used selectively in 50 patients out of 350 during a period of three years. Part ll: MDC used non-seiectively on patients presented to the authors [357] during a period of one year, and randomized to: group 1, 174 patients had MDC, and group 2, 183 had clips for CAO
Results: Part I : In 47 patients out of 50 [94%], LC was completed successfuliy using MDC technique. No intra or postoperative complications occurred after 12 months of follow-up. Part II: The average time to occlude the cystic artery and to complete LC did not differ much in the two groups: 30 sec and 38 minutes in group 1; 20 sec and 48.6 minutes in group 2.. Bleeding occurred in 14 patients [8%] while cauterising cystic artery, and in two patients [1.15%] in group 1; while there was no bleeding at clipping, and 2 after that [1.1%] in group 2. In one patient in group 1, LC had to be converted to open choiecystectomy [0.6%] due to uncontrolled bleeding from the cystic artery, in the rest [99.4%]MDC was completely successful in occluding the cystic artery
Conclusions: MDC for occlusion of the cystic artery is effective, safe, 13 nearly equal to clipping, and with less cost
ABSTRACT
One hundred patients who were symptomatic after peptic ulcer surgery were investigated by both barium meal radiography and Fibreoptic endoscopy. The diagnostic value of both methods were compared. Gastric mucosal congestion and bile-gastritis were common in the operated stomach, but the exact clinical significance of these changes remains obscure in the absence of a control series. Fibre-optic endoscopy is essential in the investigation of patients who are symptomatic after ulcer surgery