The utility of the CADISS® system in laparoscopic cholecystectomy for acute cholecystitis.

BACKGROUND: The CADISS® system combines the use of a topical formulation of mesna (sodium 2-Mercaptoethane sulfonate) to facilitate selective dissection of pathological and fibrotic tissues with a non-cutting instrument for a safer dissection. A prospective, multi-site, clinical trial was performed to explore the use of the CADISS® system in laparoscopic cholecystectomy for acute cholecystitis. METHODS: A total of 15 patients were enrolled at different severity stages of pathology according to Tokyo classification. They were operated on prior to, or after 72 h of, the onset of symptoms. The primary measure was the number of critical dissection steps successfully achieved using the CADISS® system without cutting instruments. RESULTS: Five patients were operated on before 72 h of symptom onset and ten after. All the dissections were successfully achieved using the CADISS® method. No mortality was recorded. No conversion to open surgery was performed. No bile duct injury was observed. Other endpoints (facilitation of dissection of critical structures, identification of cleavage planes and reduction of risk) had scores of above nine on our Likert scale. Four postoperative serious adverse events including cholangitis, fever, pulmonary embolism and right hepatic artery pseudoaneurysm were reported. However, they seemed to be more related to cholecystitis or local conditions rather than the use of the CADISS® method. CONCLUSION: This is the first study to investigate the use of the CADISS® System in cholecystectomy. The CADISS® system seemed to facilitate dissection in acute cholecystitis. Encouraging results are reported independently of the severity grade of cholecystitis and the delay in performing the surgery. Even now, laparoscopic cholecystectomy for acute cholecystitis remains a surgical challenge. Techniques that could facilitate this operation and reduce surgical complications may be helpful. Further studies should be conducted to confirm our preliminary results. Trial registration Clinical trials.gov NCT05041686.

Comparison between single-incision and conventional laparoscopic cholecystectomy: a prospective trial of the Club Coelio.

BACKGROUND: The aim of this study was to compare the outcomes of single-incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC). METHOD: Patients' inclusion criteria were uncomplicated gallstones, BMI ≤30, ASA score ≤2, and no past surgery in the upper abdomen. Five surgeons performed only SILC and seven only CLC. Data analyzed included operative time, morbidity, quality of life (QOL), cosmetic result, and global patient satisfaction. The last three parameters were evaluated 3 months after surgery. QOL was assessed with the Gastrointestinal Quality of Life Index (GIQLI) questionnaire. Cosmetic result and patient satisfaction were rated using a 5-grade Likert scale. RESULTS: This study included 104 patients operated on between April and June 2010. A SILC was performed in 35 patients and a CLC in 69. The preoperative characteristics of the two groups were similar. Median operative time for SILC was higher than that for CLC: 55 versus 40 min (p < 0.001). Postoperative complications (0 vs. 2) and postoperative GIQLI scores (123 ± 13 vs. 121 ± 18) were not significantly different between groups. Cosmetic result and patient satisfaction were better for SILC than for CLC. The percentages of results rated as excellent were 68 versus 37 % (p < 0.006) and 80 versus 57 % (p < 0.039), respectively. For the whole group, multivariate statistical analysis revealed that postoperative GIQLI score and cosmetic result were independent predictive factors of patient satisfaction. The percentages of satisfaction rated as excellent were greater in patients who had a postoperative GIQLI score ≥130 (92 vs. 49 %, odds ratio [OR] = 4, p < 0.001) and in patients who had an excellent cosmetic result (82 vs. 47 %, OR = 7, p < 0.001). CONCLUSIONS: Compared to CLC, SILC is associated with a longer operative time, an equivalent morbidity and QOL, and a better cosmetic result. The improved aesthetic result also leads to a better global patient satisfaction.

Nodular sclerosing Hodgkin's disease mimicking Riedel's invasive fibrous thyroiditis.

Riedel's thyroiditis appears in the form of a hard cervical mass with rapid onset, and it is associated with extensive fibrosis that compresses nearby structures, such as the trachea and supra-aortic vessels; its diagnosis is essentially histopathological. Although its histological characteristics have been well established, there are some diagnostic pitfalls. We report here the case of a 37-year-old woman, with clinical and histopathological data suggesting Riedel's disease. Fibrosis regressed after treatment with corticosteroids, relieving the compressed airways. However, in contrast with the latest knowledge on this disease, the IgG4 serum levels were consistently normal, and positron emission tomography in search of extensive fibrosis revealed an abnormal metabolic activity of the bone marrow. The final diagnosis revised by the histopathologist was that of nodular sclerosing Hodgkin's lymphoma. This case allows us to review the diagnostic approach when facing a thyroid mass with extremely rapid evolution.

[Value of endoscopic ultrasonography and somatostatin receptor scintigraphy in the preoperative localization of insulinomas and gastrinomas. Experience of 54 cases]. / Valeurs de l'échoendoscopie et de la scintigraphie des récepteurs de la somatostatine dans la localisation pré-opératoire des insulinomes et gastrinomes.

AIM: The classic morphological techniques for the localization of insulinomas and gastrinomas are of limited value. Endoscopic ultrasonography and somatostatin receptor scintigraphy have shown high sensitivity for the detection of gastroenteropancreatic endocrine tumors. The aim of the study was to evaluate the sensitivity of endoscopic ultrasonography and that of somatostatin receptor scintigraphy in the localization of insulinomas and gastrinomas. PATIENTS AND METHODS: This retrospective study concerned 54 patients with insulinoma (n=29) or gastrinoma (n=26) operated on between March 1991 and March 2000 and who had at least one among the two tested examinations. Forty-two patients had scintigraphy (17 with insulinoma, 25 with gastrinoma), 47 had endoscopic ultrasonography (28 with insulinoma, 17 with gastrinoma). One of the ten patients with MEN 1 had both tumors. All diagnosis were confirmed by histologic examination. RESULTS: The sensitivity of scintigraphy for the localization of insulinomas was 47%. There was one false positive. Sensitivity of endoscopic ultrasonography for insulinomas was 85%. The sensitivity of scintigraphy in the detection of gastrinomas was 65% for the tumors in the duodenopancreatic area, 20% for the tumors in the pancreatic tail and 71% for metastasis. The sensitivity of endoscopic ultrasonography was 46% for duodenal tumors, 75% for pancreatic tumors and 57% for lymph node metastasis. The combination of both localization studies increased sensitivity to 94%. CONCLUSION: Endoscopic ultrasonography and somatostatin receptor scintigraphy are the gold standard for localization of gastrinomas. Association of both examinations increases the sensitivity. Scintigraphy for the detection of insulinomas should be performed when endoscopic ultrasonography is negative.