ABSTRACT
Aim: To describe a new technique in which laparoscopic cholecystectomy can be performed through trocar cannulas inserted directly through the same incision used for the cesarean section, without the need for additional incisions elsewhere. Presentation of Case: A 30-year-old pregnant woman presented with symptomatic cholelithiasis. Laboratory and radiological investigations revealed no signs of cholecystitis or pancreatitis. She had previously undergone cesarean section, so this was planned for the current birth as well, to be followed immediately by laparoscopic cholecystectomy. In week 38 of gestation, under general anesthesia and with a standard Pfannenstiel incision, a cesarean section was successfully performed. Thereafter, a laparoscopic cholecystectomy was performed through the same incision. The patient was discharged without any problem. Discussion: For patients with symptomatic gallbladder stones who undergo cesarean section, treatment options include laparoscopic cholecystectomy performed immediately after cesarean section during the same operative session, either with the standard technique or with the use of the cesarean incision in addition to other incisions. Technical difficulties of laparoscopic cholecystectomy performed through Pfannenstiel incision is the main concern of this method; however, the laxity of the abdominal wall due to enlarged uterus and hormonal changes during pregnancy facilitate laparoscopic maneuvers. Conclusion: Our technique, by making use of the cesarean incision alone, provides for easy gallbladder removal while also minimizing the risk of port related injury, reducing postoperative pain and providing better cosmetic results due to the absence of additional incisions; therefore can be considered in selected patients.
ABSTRACT
BACKGROUND: Failure of anastomotic healing is one of the major complications in colorectal surgery. Because histamine plays an important role in immune and inflammatory reactions, we demonstrate the effects of famotidine on the healing of colonic anastomosis in rats. METHODS: Twenty-eight Sprague-Dawley rats were used in the study. Excision and end-to-end anastomosis was performed in the distal colon of the rat. The Famotidine Group received 2 mg/kg/day famotidine; the Control Group received the same amount of saline. Bursting pressure of anastomoses and hydroxyproline content of perianastomotic tissues were evaluated on the third and seventh days following surgery. RESULTS: Bursting pressures and hydroxyproline contents for the Famotidine Group were significantly lower than the equivalent parameters for the Control Group on both the third and seventh days post-surgery. CONCLUSIONS: According to our findings, famotidine exerts detrimental effects on the anastomotic bursting pressure and hydroxyproline content of perianastomotic tissues in the colon of rats.