Comparative evaluation of three laparoscopic cholecystectomy techniques in rabbit's model

Purpose: The aim of this randomized study was to compare the complications and perioperative outcome of three different techniques of laparoscopic cholecystectomy (LC). Changes in the liver function test after LC techniques were investigated. Also, we compared the degree of postoperative adhesions and histopathological changes of the liver bed. Methods: Thirty rabbits were divided into three groups: group A) Fundus-first technique by Hook dissecting instrument and Roeder Slipknot applied for cystic duct (CD) ligation; group B) conventional technique by Maryland dissecting forceps and electrothermal bipolar vessel sealing (EBVS) for CD seal; group C) conventional technique by EBVS for gallbladder (GB) dissection and CD seal. Results: Group A presented a longer GB dissection time than groups B and C. GB perforation and bleeding from tissues adjacent to GB were similar among tested groups. Gamma-glutamyl transferase and alkaline phosphatase levels increased (p ≤ 0.05) on day 3 postoperatively in group A. By the 15th postoperative day, the enzymes returned to the preoperative values. Transient elevation of hepatic transaminases occurred after LC in all groups. Group A had a higher adherence score than groups B and C and was associated with the least predictable technique. Conclusions: LC can be performed using different techniques, although the use of EBVS is highly recommended.

Estudio experimental de la anastomosis del colédoco con sutura contínua / Experimental study of the choledocal anastomosis with continuos suture

El amplio uso de sutura contínua en la cirugía digestiva nos indujo a emplearla en la anastomosis del colédoco. Con la hipótesis de que esta técnica no provoca estenosis efectuamos un experimento sucesional provocado. Se operaron 21 perros practicándoseles una anastomosis coledociana con sutura contínua de polipropileno 6-0. Seguimiento P.O. con G.O.T.. G.P.T.. Fosfatasa alcalina y Bilirrubina. Se efectuó además estudio bactereológico en bilis para aerobios y anaerobios, colangiografía y anatomía patológica. Los animales se sacrificaron a 7, 25 y 150 días. A los 7 días se encontró importante proceso inflamatorio pericoledociano que provocó una estenosis anastomótica incompleta y pasajera, que se tradujo en "pequeño síndrome de hipertensión biliar". Las alteraciones retroceden encontrando a los 150 días valores de laboratorio y dimensiones del colédoco normales. Concluímos que la anastomosis del colédoco con sutura contínua es segura y que en este modelo experimental no provocó estenosis postoperatoria