ABSTRACT
Limy bile syndrome is a rare entity in which there is an excessive precipitation of calcium salts, mainly calcium carbonate in the gallbladder (GB) and to a rare extent in the common bile duct (CBD), making it radiopaque in plain radiographs. Laparoscopic cholecystectomy is safe and effective in patients with limy bile confined to the GB. However, for patients with an extension to the CBD, bile duct exploration with a T-tube placement, endoscopic naso-billiary drainage or endoscopic sphincterotomy (EST) may be warranted. We report a case of limy bile syndrome associated with obstructive jaundice in a young female patient. She was managed successfully with EST followed by laparoscopic cholecystectomy.
Subject(s)
Cholecystectomy, Laparoscopic , Common Bile Duct/surgery , Gallbladder/surgery , Jaundice, Obstructive/surgery , Sphincterotomy, Endoscopic , Adult , Calcium Carbonate , Female , Humans , SyndromeABSTRACT
Non-alcoholic fatty liver disease and non-alcoholic steato-hepatitis are common in patients undergoing bariatric surgery. Non-alcoholic steato-hepatitis can progress to cirrhosis of the liver and hepatocellular carcinoma. Non-invasive methods of diagnosing non-alcoholic steato-hepatitis are not as accurate as liver biopsy, and bariatric surgery presents a unique opportunity to carry out a simultaneous liver biopsy. Routine liver biopsy can help early and accurate diagnosis of obesity-associated liver conditions. This has led some surgeons to argue for routine liver biopsy at the time of bariatric surgery. However, most bariatric surgeons remain unconvinced and liver biopsy is currently not routine practice with bariatric surgery. This review examines published scientific literature to ascertain the usefulness of routine liver biopsy at the time of bariatric surgery.
Subject(s)
Bariatric Surgery , Biopsy , Fatty Liver/diagnosis , Liver/pathology , Non-alcoholic Fatty Liver Disease/diagnosis , Fatty Liver/complications , Humans , Intraoperative Care , Non-alcoholic Fatty Liver Disease/complications , Obesity, Morbid/complicationsABSTRACT
AIM: To examine the change in practice from open to laparoscopic practice in our local trust, a national training colorectal unit. METHODS: Retrospective comprehensive review of clinical case notes of all colorectal resections between October 2007 and October 2009. Patients were identified through clinical coding and data were analyzed using SPSS. RESULTS: Comparison of 113 open versus 103 laparoscopic colorectal surgeries for various indications and short-term outcomes was made. There was an expected overall increase in the laparoscopic colorectal resections. The mean age was 73 years for open and 68 years for laparoscopic surgeries. There was no significant difference between the 2 groups with respect to age, sex, and the American Society of Anaesthesiologists. Of the 103 patients who were initially treated with laparoscopy-assisted colectomy, 12 (11.7%) were shifted to open procedures. Perioperative recovery was faster in the laparoscopic-surgery group than in the open-colectomy group, as reflected by a shorter hospital stay (median, 8 vs. 13 d). The overall complication rate was significantly less in the laparoscopy-assisted colectomy group than in the open-colectomy group (33% vs. 46%, P=0.05). CONCLUSIONS: Our local hospital practices support the many benefits of laparoscopic colorectal surgery. Substantial improvements in rates of hospital stay and wound infection were noted, hence shifting our practice safely in a district general hospital.
