Bile duct injuries in connection with 2500 laparoscopic cholecystectomies.

BACKGROUND: Laparoscopic cholecystectomy (LC) is taking the place of an effective and tested procedure in surgery, therefore it must not be inferior to the standard modality in any aspect. Some complications specific to the technique, however, are severe and complication rate seem to be higher than in standard open surgery. METHODS: In this paper the authors report their guiding principles in applying LC and methods of treatment, and describe the bile duct injuries of 2500 LCs accomplished during the past 4.5 years. RESULTS: Seventeen ductal injuries occurred in the whole series, which means an overall incidence rate of 0.68%. Data obtained in the last period, however, show a decrease down to 0.14%. Following ductal injuries six ductal strictures became clinically apparent. The various complications of these injuries caused the death of two patients. CONCLUSIONS: The great number of intraoperatively undetected injuries, many of them arising not due to technical difficulties, suggest the possibility of an injury caused by electric current. Depending on the type of injury direct suture, T-tube drainage or biliodigestive anastomosis can equally be effective. Long established practice and experience can help reduce the occurrence of complications to the level in standard open surgery.

Laparoscopic appendectomy (LA) with a new technique.

UNLABELLED: The technique of LA has evolved during the past decade. We describe a simplification using a scope with work channel. TECHNIQUE: A 1.2 cm paraumbilical trocar enters the CO2(-)-inflated peritoneum. The 1 cm scope with work channel is introduced. If the view confirms the diagnosis of appendicitis we place a 1-cm trocar in the midline 2 cm above the symphysis pubis. The scope is switched to the 1 cm trocar. The appendix is immobilized through the work channel. Through the paraumbilical site the appendiceal artery is clipped or coagulated as necessary. The stump is closed by Roeder loops or stapler. The specimen is removed through the larger site. The wounds are closed with single sutures. CONCLUSION: This technique has the advantage of being less invasive on the abdominal wall. The sum of the stab wounds is 2.2 cm, requires only one surgeon and the assistance of a scrub nurse. If necessary, the operation it can be converted to 3- or 4-trocar technique or an open one.

[Laparoscopic appendectomy]. / Laparoscopos appendectomia.

We have performed the first laparoscopic appendectomy in Hungary. Laparoscopic appendectomy is a new, minimally invasive method in abdominal surgery. We consider it a worthwhile alternative to classical appendectomy.

Follow-up examinations of laparoscopic cholecystectomies.

The postoperative complaints of patients having been subjected to laparoscopic cholecystectomy have been studied. Residual gallstones involving clinical symptoms have not been observed. Right subcostal pain, meteorism, and nausea due to faulty diet showed a slight difference in favour of the laparoscopic method when compared to traditional surgery. The laparoscopic method was qualified as excellent by over 95 per cent of the patients.

Laparoscopic appendectomy.

This study contains a brief review of the changes in the technique of laparoscopic appendectomy. The authors' experiences with the methods they applied are reported. The authors emphasize on the benefits of laparoscopic appendectomy as opposed to traditional appendectomy, and advocate its wide-range application.

Electrometric measurement of canine pancreatic tissue pH under conditions of preserved circulation and of ischaemia.

Canine pancreatic pH was measured by an electrometric method, which is described in detail. 60 measurements carried out in neuroleptanalgesia of the animals gave a mean figure of 7.29 +/- 0.10 for pancreatic pH in situ. For arterial blood pH in the same animals the mean value was 7.22 +/- 0.08. The difference between pancreatic and arterial blood pH is significant. Anaesthesia of 3 hr duration produced no significant change either in pancreatic pH or in arterial blood pH or in the serum amylase and serum lipase levels. Vascular isolation of the pancreas and adjoining duodenal segment was produced in 13 animals. In 10 of these ischaemia induced by clamping of the arterial pathways for 1 hr resulted in a fall of pH by 0.65 +/- 0.21. Restoration of blood-flow at the end of the first hour was followed by a return of pH to the original values. The 3 control animals revealed no significant changes in the pH and enzyme values.