Laparoscopic cholecystectomy: technical compromise between French and American approach. Presentation of an original technique.

INTRODUCTION: Laparoscopic cholecystectomy (LC) is a well standardized technique. There are two main approaches, proposed by French and American Schools. They have similar operative times, but different arrangements for site ports insertions and for patients and operators' position at operative bed. Although we can foresee new scenarios for the next future (robotics, SILS, NOTES, minilaparoscopy), it seemed interesting to describe a simple variation to LC introduced in the last years in our experience relative to the positioning of operators and patient during standard American technique. METHODS: In a retrospective analysis of 140 patients operated on for LC in the last two years (70 with French technique and 70 with "American modified" technique) we compared the following parameters: laparotomic conversion, duration of operation, hospital stay, morbidity and mortality rates. RESULTS: Conversion to laparotomy, length of operative time and hospital stay were similar. Morbidity rates were slightly different, but it did not show statistically significant differences between the two groups. Mortality was nil. CONSIDERATIONS: Our variant to LC seems to be almost a compromise between the two main techniques. Our operators' arrangement gave a greater comfort for surgeons during LC and our results were similar to those reported with adoption of French and American approaches. These considerations led us to judge our variation safe and reliable.

Intraluminal migration of a surgical drain. Report of a very rare complication and literature review.

INTRODUCTION: Gastric or intestinal foreign bodies may cause heterogeneous symptoms ranging from asymptomatic conditions to chronic pain and, in some cases, occlusion and/or perforation. There are sporadic reports of intraluminal migration of medical devices. Most commonly they are sponges, hernia meshes, gastrotomy tubes, while surgical drains are very rarely reported. METHODS: A 79 year-old female who consulted our department in May 2009 for abdominal pain and constipation. Her symptomatology started in 2006 some months after an anterior resection for sigmoid diverticulitis associated to obstructed incisional hernia. The symptoms had begun a few months after the operation and were progressively increased month by month. An abdominal CT- scan showed the presence of an intra-peritoneal foreign body and at laparotomy a drain fragment was found inside a small bowel loop and pulled out through a small enterotomy. RESULTS: Post-operative course was regular and the patient was discharged at 7th day. DISCUSSION: The observation of this case and a literature review led us to analyze the origin and the clinical problems of this very rare complication. Incidence, symptomatology, diagnosis and treatment were analysed. CONCLUSIONS: The intraluminal migration of a surgical drain is very rare. The diagnosis is easy by abdominal plan radiogram or CT-scan, but it is casually achieved, because, as it almost always occurs in case of intra-peritoneal foreign bodies, the clinical suspicion is focused on other conditions that most frequently cause abdominal symptoms. When a foreign body is found in intraluminal position and its endoscopic removal is not feasible, then surgery is mandatory and resolutive.

Laparoscopic retrieval of retained intraperitoneal drain in the immediate postoperative period Report of two cases.

AIM: The purpose of this study is to analyze a "rare" complication on the management of abdominal surgical drains: abdominal drainage's retention. Starting from our experience we reviewed literature on this topic MATERIAL OF STUDY: We report two cases (occurred on 2004 and 2010) of retained intraperitoneal drain occurred in the immediate postoperative period after laparoscopic cholecystectomy. RESULTS: Both patients were successfully treated by early laparoscopic removal. DISCUSSION: We compared our experience with literature. Incidence, ethiology, prevention, diagnosis and treatment of this rare complication are analysed. We also considered the guidelines in the placement of intraperitoneal drains, the different fixation techniques, the causes of fragmentation of the drainage and removal techniques. CONCLUSIONS: Retained intraperitoneal drain secondary to fracture and adhesion in the immediate postoperative period is rare but probably underestimated surgical complication. It is impossible to know its real incidence. The role of laparoscopy is emphasized because this approach is cosmetically acceptable, contributes to early recovery and discharge of the patient, and helps to lessen the friction in worsening doctor-patient relationship. KEY WORDS: Abdominal drainage, Drain-related complications, Laparoscopy, Retained intraperitoneal drain.