Primary closure versus T-tube drainage following laparoscopic common bile duct exploration in acute cholangitis cases / 国际外科学杂志

Objective To compare the clinical efficacy of primary closure versus T-tube drainage after laparoscopic common bile duct exploration in acute cholangitis cases.Methods The clinical data of 100 patients with acute cholangitis undergoing laparoscopic common bile duct exploration from January 2012 to December 2014 were reviewed.54patients received primary closure of the common bile duct and 46 patients were subjected to T-tube drainage after choledochotomy.Results One hundred patients underwent the surgery successfully.Compared with the T-tube group,the operation time(96.72 min vs 123.00 min,P =0.001),intraoperative blood loss(27.13 ml vs 38.48 ml,P =0.009),postoperative gastrointestinal function recovery time(1.57 d vs 2.33 d,P=0.003) and postoperative hospital stay(6.19 d vs 9.20 d,P=0.000) were significantly less in the primary closure group.There were no statistical differences in the incidence of postoperative drainage (309.22 ml vs 212.46 ml,P =0.070),drainage time (3.96 d vs 4.02 d,P =0.875),incidence of bile leakage(9.3％ vs 0,P =0.060) and postoperative bleeding rate(5.1％ vs 2.2％,P =0.622) between these two groups.Conclusion Laparoscopic common bile duct exploration with primary closure of the common bile duct is an effective and safe procedure in acute cholangitis cases compared with T-tube drainage.

Gasless single-incision laparoscopic cholecystectomy / 中华消化外科杂志

Laparo-endoscopic single site (LESS) surgery is in line with the development trend of minimally invasive surgery.Resolving the problems caused by the tiny single trocar is very important for the popularizing of LESS surgery.From February to September in 2012,34 patients with cholecystolithiasis or polypoid lesions of the gallbladder received gasless singleincision laparoscopic cholecystectomy at the Xuanwu Hospital.All the operations were successfully done,with no conversion to conventional laparoscopic surgery or open surgery.The mean operation time,intraoperative blood loss and duration of postoperative hospital stay were 70 minutes (range,45-135 minutes),18 ml (range,5-40 ml) and 3.4 days (range,3-4 days).There was no complication within the follow-up of 3 weeks,and all patients recovered well with satisfied cosmetic effect.Combination of gasless single-incision laparoscopic techniques could decrease the difficulty of LESS surgery and help to popularize LESS surgery.