3D reconstruction of a gallbladder duplication to guide LC: A case report and literature review.

RATIONALE: Gallbladder duplication is a congenital aberration of the biliary tree, which is rarely encountered in the abdomen. It is a challenge that can be encountered by surgeons and is associated with an increased risk of complications after cholecystectomy. More than 50% of gallbladder duplication cases were undetected on preoperative traditional imaging. In this study, a case of gallbladder duplication in a patient with mild abdominal pain detected using preoperative 3-dimensional (3D) reconstruction of the gallbladder was described for the first time. PATIENT CONCERNS AND DIAGNOSIS: We present a case of gallbladder duplication in a 32-year-old man who was referred to our hospital for recurrent right upper quadrant abdominal pain without any other significant history. INTERVENTIONS AND OUTCOMES: He underwent a 3D reconstruction technique as a supplement for gallbladder duplication that could not be diagnosed using magnetic resonance cholangiopancreatography or other traditional tools. Compared with other diagnostic tools, 3D reconstruction is more visual and accurate for diagnosing gallbladder duplication and guiding laparoscopic cholecystectomy without ductal injuries or other complications. CONCLUSION: Gallbladder duplication is an extremely rare biliary anatomical anomaly; failure to recognize it perioperatively exposes the patient to an increased risk of bile duct injuries. We review 28 cases of missed gallbladder duplication and conclude that less 50% of gallbladder duplication cases were detected via preoperative traditional imaging. We present a case and find that the 3D reconstruction technique can be used as a supplement for gallbladder duplication that could not be diagnosed by using magnetic resonance cholangiopancreatography or other tools. The value of using 3D reconstruction of gallbladder duplication is feasible and innovative, and facilitates guiding to laparoscopic cholecystectomy.

Efficacy comparison between primary total laryngectomy and nonsurgical organ-preservation strategies in treatment of advanced stage laryngeal cancer: A meta-analysis.

BACKGROUND: We aimed to provide a pooled analysis of controlled trials comparing long-term survival after primary laryngectomy and primary organ preservation methods in patients with T3-4 laryngeal cancer. METHODS: We performed random-effects meta-analyses on overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), and locoregional control (LRC). RESULTS: Fifteen studies met the selection criteria including 6288 patients (2696 patients who underwent primary laryngectomy and 3592 patients who underwent primary nonsurgical organ preservation therapy). There was a significant difference between the groups with respect to OS (HR 0.71, 95% CI 0.57-0.89, P = .003). However, a subgroup analysis found OS was not significantly worse for patients with T3 laryngeal cancer who received primary organ preservation compared with patients who underwent primary laryngectomy (HR 0.96, 95% CI 0.45-2.03, P = .91). There was no significant difference for DFS (HR 0.63, 95% CI 0.39-1.04, P = .07) in two groups. Patients with laryngeal cancer who underwent primary laryngectomy had a better DSS (HR 0.47, 95% CI 0.25-0.88, P = .02) and LRC (HR 0.56, 95% CI 0.390.80, P = .001) than patients who underwent primary nonsurgical organ preservation therapy. CONCLUSION: Our results support total laryngectomy for patients with T4 laryngeal cancer and show that primary organ preservation for laryngeal cancer has no advantage and also did not decrease the rate of OS in patients with T3 laryngeal cancer when compared with primary total laryngectomy.