Efficacy and feasibility of laparoscopic subtotal cholecystectomy for acute cholecystitis

BACKGROUNDS/AIMS: For patients with acute cholecystitis, conversion from laparoscopic cholecystectomy to open surgery is not uncommon due to possibilities of serious hemorrhage at the liver bed and bile duct injury. Recent studies reported successful laparoscopic subtotal cholecystectomy for acute cholecystitis. The purpose of this study was to determine the efficacy and feasibility of such an operation based on the experience of surgeons at our facility. METHODS: In this study, we enrolled 144 patients who had received either laparoscopic subtotal cholecystectomy (LSC), laparoscopic cholecystectomy (LC), or open cholecystectomy (OC) for acute cholecystitis from January 2004 to December 2009 at the Department of Surgery of our hospital. Their symptoms, signs, operative findings, pathologic results and postoperative results were compared and analyzed. RESULTS: There were 26 patients in the LSC group 80 in the LC group and 38 in the OC group. There were no differences in mean age, sex, and symptoms of acute cholecystitis. The LSC group showed higher CRP levels (p<0.001) and a higher grade according to the Tokyo criteria (p=0.001). The mean operative time was 115.6 minutes and mean blood loss was 158.9 ml without intra-operative or postoperative transfusion. There weren't any bile duct injuries during the operation. No group suffered bile leakage. Drains were removed 3.3 days after the operation in the LC group, the shortest time compared to the other groups (p<0.001). LC and LSC groups demonstrated shorter postoperative hospital days and time to diet resumption than the OC group (p<0.001). CONCLUSIONS: LSC appears to be a safe and effective treatment in cases of severe acute cholecystitis that require consideration of conversion to open surgery.

Clinical Considerations of Intestinal Atresia

PURPOSE: The mortality of intestinal atresia has decreased remarkably owing to prenatal diagnosis, development of diagnosis method, neonatal intensive care, surgical technique, total parenteral nutrition and performing of early surgery. The clinical consideration of our experience about intestinal atresia would be helpful in the understanding of disease. METHODS: We reviewed the clinical presentation, hospital days, diagnosis method, surgical method, postoperative early complication and mortality based on medical records, retrospectively, in 32 cases of intestinal atresia encountered at Inha University Hospital between March 1997 and May 2009. RESULTS: The involved sites were; duodenum (n=11; 34.4%), jejunoileum (n=20; 62.5%), and colon (n=1; 3.1%). The mean postoperative fasting time was 6.38 days. The postoperative morbidity was 9.4% and mortality was 3.1%. CONCLUSION: Complete recovery from intestinal atresia can be insured by prompt diagnosis, early surgery and careful neonatal intensive care.