The effect of morphometric and anatomic relationship of gallbladder to the liver on standard laparoscopic cholecystectomies and proposal of a new anatomical classification.

OBJECTIVE: Anatomical variations of the extrahepatic biliary tree are frequently seen and may cause challenging conditions for surgeons. We aimed to investigate the morphological variations of the gallbladder in patients who underwent cholecystectomy and their effects during and after the surgery, by using a new anatomical classification. PATIENTS AND METHODS: Dissection time, perioperative bleeding, perioperative/postoperative complication rates, the difference between preoperative/postoperative hematocrit and leukocyte levels of 164 symptomatic cholelithiasis patients who underwent laparoscopic cholecystectomy were evaluated. The patients' gallbladders were categorized in "seven" different types regarding their anatomical positions and morphometric relations with the liver's acute margin and fossa of the gallbladder. Relations between these gallbladders types and perioperative/postoperative parameters were also examined. RESULTS: The median time to complete the dissection of the gallbladder from the fossa was 375.5 seconds. The mean length of the fossa was 68.06 ± 15.08 mm, the average size of the gallbladder was 92.10 ± 18.79 mm. A positive correlation was found between dissection time and length of fossa vesica and also in the size of the gallbladder (p = 0.003, p = 0.034). Moreover, a positive correlation was found between the dissection time and the perioperative perforation risk of the gallbladder (p = 0.005). The most common type of gallbladder was type I and III (23.2%). The least common gallbladder type among the patients assessed as part of the study was type VI (6.7%). When the gallbladder types were compared, the perioperative perforation rate of the gallbladder wall was found to be significantly higher in morphological type V (p = 0.014). CONCLUSIONS: The perioperative perforation rate of the gallbladder wall was found significantly higher in morphological type V. To perform a safe cholecystectomy, surgeons should be aware of anatomical variations of the gallbladder and its relations with the liver parenchyma, which are important for surgical strategies.

Diagnostic value of preoperative serum carcinoembryonic antigen and carbohydrate antigen 19-9 in colorectal cancer.

BACKGROUND: Since the first introduction of tumour markers, their usefulness for diagnosis has been a challenging question. The aim of the present prospective study was to investigate, in colorectal cancer patients, the relationship between preoperative tumour marker concentrations and various clinical variables. METHODS: The study prospectively enrolled 131 consecutive patients with a confirmed diagnosis of colorectal carcinoma and 131 age- and sex-matched control subjects with no malignancy. The relationships of the tumour markers carcinoembryonic antigen (cea) and carbohydrate antigen (ca) 19-9 with disease stage, tumour differentiation (grade), mucus production, liver function tests, T stage, N stage, M stage were investigated. RESULTS: Serum concentrations of cea were significantly higher in the patient group than in the control group (p = 0.001); they were also significantly higher in stage iii (p = 0.018) and iv disease (p = 0.001) than in stage i. Serum concentrations of cea were significantly elevated in the presence of spread to lymph nodes (p = 0.005) in the patient group. Levels of both tumour markers were significantly elevated in the presence of distant metastasis in the patient group (p = 0.005 for cea; p = 0.004 for ca 19-9). CONCLUSIONS: Preoperative levels of cea and ca 19-9 might provide an estimate of lymph node invasion and distant metastasis in colorectal cancer patients.

Bidirectional Glenn shunt in an infant with prune-belly syndrome.

The prune-belly syndrome (PBS) usually is described as a deficiency of the anterior abdominal muscle involving bilateral cryptorchidism and urinary tract malformations. In this report, we will present an eleven-month-old boy with PBS associated with a complex cardiac anomaly. A bilateral bidirectional Glenn shunt was performed with the diagnosis of isolated dextrocardia, single ventricle, pulmonary atresia, incomplete A-V septal defect, hemiazygos continuity, persistent right superior vena cava, patent ductus arteriosus-dependent pulmonary blood flow. The patient required special consideration for postoperative pulmonary care.