Clinical outcomes of subtotal cholecystectomy performed for difficult cholecystectomy

PURPOSE: Laparoscopic subtotal cholecystectomy (LSC) can be an alternative surgical technique for difficult cholecystectomies. Surgeons performing LSC sometimes leave the posterior wall of the gallbladder (GB) to shorten the operation time and avoid liver injury. However, leaving the inflamed posterior GB wall is a major concern. In this study, we evaluated the clinical outcomes of standard laparoscopic cholecystectomy (SLC), LSC, and LSC removing only anterior wall of the GB (LSCA). METHODS: We retrospectively reviewed the medical records of laparoscopic cholecystectomies performed between January 2006 to December 2015 and analyzed the outcomes of SLC, LSC, and LSCA. RESULTS: A total of 1,037 patients underwent SLC. 22 patients underwent LSC; and 27 patients underwent LSCA. The mean operating times of SLC, LSC, and LSCA were 41, 74, and 68 minutes, respectively (P < 0.01). Blood loss was 5, 45, and 33 mL (P < 0.05). The mean lengths of postoperative hospitalization were 3.4, 5.4, and 5.8 days. Complications occurred in 24 SLC patients (2.3%), 2 LSC patients (9%), and 1 LSCA patient (3.7%). There was no mortality among the LSC and LSCA patients. CONCLUSION: LSC and LSCA are safe and feasible alternatives for difficult cholecystectomies. These procedures help surgeons avoid bile duct injury and conversion to laparotomy. LSCA has the benefits of shorter operation time and less bleeding compared to LSC.

The advantages of early trauma team activation in the management of major trauma patients who underwent exploratory laparotomy

PURPOSE: Trauma team activation (TTA) has been shown to have fundamental impact on trauma patients' outcomes. The purpose of this study was to evaluate the short-term outcomes of use of a new TTA protocol in the management of major trauma patients who underwent exploratory laparotomy. METHODS: The medical records of trauma patients who had been treated by the new TTA protocol (NT) over 18 months were compared with those of trauma patients treated by the old TTA protocol (OT) over 18 months. Comparisons between the two groups in terms of the time interval between accident and emergency room (ER) arrival, between ER arrival and CT scanning, between ER arrival and operating room (OR) presentation, between accident and OR presentation, mean intensive care unit (ICU) stay, mean hospital stay, mortality within 24 hours, mean mortality within one month, and overall mortality were performed using the Pearson chi-squared test and Student t-test. RESULTS: The time interval between accident and ER arrival, between ER arrival and CT scanning, between ER arrival and OR presentation, and between accident and OR presentation was found to have decreased significantly with the use of NT compared to OT. However, the mean ICU stay, mean hospital stay, mortality within 24 hours, mortality within one month, and overall mortality were found not to have improved. CONCLUSION: While initiation of early TTA can shorten the time interval in the management of trauma patients, it may not improve patient outcomes.