Management of common bile duct stones in the laparoscopic era: an alternative pathway

The aim of this study was to evaluate a modified pathway of management of stones in the common bile duct. Twenty-five patients with gallstone disease were included in this study. All had clinical and/or chemical evidence of bile duct obstruction. For each patient, an abdominal ultrasound was done, followed by magnetic resonance cholangiography. The results were compared. Then, endoscopic retrograde cholangiography was performed, essentially for the removal of bile duct stones. Ultrasound revealed bile duct stones in 11 patients; while, in the rest of the patients, it was inconclusive. Magnetic resonance examination was normal in four patients [i.e. no obstruction found]; while it confirmed the presence of biliary obstruction in 21 patients; 17 due to stones and 2 due to other causes and in 2 patients, there was no obvious cause of obstruction. Endoscopic retrograde cholangiography was attempted in 23 patients. It was possible to insert endoscopic stents in two patients with malignant obstruction who needed no further surgery. The stones were endoscopically removed in 18 patients. Laparoscopic cholecystectomy was successfully performed in 20 patients. Open cholecystectomy and bile duct exploration were done in three patients

Laparoscopic cholecystectomy: modifications of the technique

Laparoscopic cholecystectomy has been rapidly replacing the traditional method of open cholecystectomy. With experience of the technique surgeons are adding and developing technical "tips" and modifying the procedure for better safety and convenience of the patients. This work presented the patients in whom minor modifications of the technique in special situations is made. Three parts only for easy cholecystectomy in 20 patients are used. The second modification is aspiration and retraction of the gallbladder while keeping the Veress needle inside the gallbladder dissection for acute cholecystitis in 10 patients. Modification of umbilical port closure is by the use of Vicryl stay sutures in 10 patients or the use of prolene plug in 10 patients. Laparoscopic cholecystectomy with modifications of the technique was attempted in 54 patients with symptomatic gallbladder disease during the period from January 1992 to January 1994. There was no mortality. The mean operative time was 105 minutes [60-150 minutes]. In 4 patients laparoscopic cholecystectomy was converted to open cholecystectomy. The average hospital stay was 3.6 days [2-8 days] and the mean time taken for return to normal activity was 12 days [7-35 days]

Ultrasonography in the diagnosis of acute appendicitis

During a 10 month period high resolution sonography was used in the evaluation of 80 patients with an equivocal clinical diagnosis of acute appendicitis. The sonographic findings were correlated with the surgical and pathological outcome in 53 cases and with clinical follow-up in the remainder. This technique was found to be accurate in the diagnosis of acute appeudicitis with a specificity of 95%, a sensitivity of 86% and accuracy of 91%. The predicitve value of a positive test was 93%, that of negative test was 89%. The results showed that high resoluion sonography is indicated to establish the diagnosis of acute appendicitis in patients with equivocal clinical findings