Single-incision laparoscopic cholecystectomy at community hospitals in Honolulu, Hawai'i: a case series.

This study aims to demonstrate the feasibility of implementing single-incision laparoscopic cholecystectomy in a community hospital setting. Minimally invasive surgical approaches for cholecystectomy achieve equivalent outcomes to the open surgical approach with less post-operative pain, improved cosmesis, shorter hospital stays, and decreased complications. Surgeons are attempting to reduce incisional trauma further by decreasing the number of incisions. A retrospective chart review was conducted for demographics, operating time, blood loss, conversion rate, length of stay, and presence of operative complications on patients undergoing single-incision laparoscopic cholecystectomy at two community hospitals between 2008 and 2011. One hundred and three patients (79 females and 24 males) underwent single-incision laparoscopic cholecystectomy. The mean age was 49.8 years (range 18-88). Ninety-six patients (93.2%) underwent elective procedures while 7 patients (6.8%) underwent urgent procedures. The mean operating time was 89.7 (± 28.3) minutes and the average blood loss was 33.7 (± 27.4) milliliters. Ninety-five (92.2%) of the procedures were successfully completed with a single-incision approach and 8 (7.8%) were converted to a multi-incisional approach, while none were converted to an open approach. The median length of stay was 4.75 hours. The post-operative complication rate was 7.4% (7/95) and included four superficial wound infections, one bile leak, one acute renal failure, and one urinary tract infection. These outcomes for single-incision laparoscopic cholecystectomy are comparable to other case series reported in the literature, and this retrospective review illustrates that single-incision laparoscopic cholecystectomy is feasible in a community setting.

Treatment of median arcuate ligament syndrome via traditional and robotic techniques.

Median arcuate ligament syndrome (MALS) is a rare entity characterized by extrinsic compression of the celiac artery and symptoms of postprandial epigastric pain, nausea, vomiting, and weight loss mimicking mesenteric ischemia. We present two patients diagnosed with MALS, the first treated with an open laparotomy by a vascular surgeon and the second using a robot assisted laparoscopic approach by a general surgeon with a vascular surgeon on standby. This is the second ever report of this approach. Both patients recovered without complications and experienced resolution of their symptoms. A discussion of the pathophysiology, literature review, and multispecialty treatment approach are presented.

Oriental cholangiohepatitis from outside of Asia.

Oriental cholangiohepatitis, also known as recurrent cholangitis is exclusively endemic in Asian countries. Sporadic cases have been reported in the United States, however almost all cases have been seen in the Asian immigrants to the United States. We report a 31-year-old male from outside of Asia who developed oriental cholangiohepatitis.