Laparoscopic transfistulous bile duct exploration for Mirizzi syndrome type II: a simplified standardized technique.

BACKGROUND: Laparoscopic treatment is a viable option for Mirizzi syndrome (MS) type I, but it is not recommended for MS type II (McSherry classification). We introduce laparoscopic transfistulous bile duct exploration (LTBDE) as a simplified standardized technique for MS type II. METHODS: Eleven consecutive LTBDEs performed by a surgeon for MS type II were analyzed retrospectively, including three successful single-incision LTBDEs (SILTBDEs). Transfistulous stone removal followed by primary closure of gallbladder remnant and partial cholecystectomy was performed. An additional choledochotomy was required in one patient. RESULTS: Preoperative endoscopic retrograde cholangiopancreatography and operative findings confirmed the diagnosis of MS in five and five patients, respectively. Preoperative ultrasound implied the remaining diagnosis. The operative time was 270.5 ± 65.5 min. The stone clearance rate was 100 %. The postoperative length of hospital stay was 5.1 ± 2.2 days. There was no open conversion. Overall complications comprised two postoperative transient hyperamylasemia (18.2 %) and one superficial wound infection (9.1 %). Compared with the other group of 92 patients who underwent laparoscopic bile duct exploration, the MS type II group had a significantly younger age, a higher jaundice rate, a lower single-incision laparoscopic approach rate, a lower choledochotomy rate, longer operative time, a lower postoperative pethidine dose, and a longer total length of hospital stay. The average follow-up period was 12.1 months. CONCLUSIONS: LTBDE is safe and efficacious for MS type II including Csendes type IV. A high suspicion of MS is critical. SILTBDE is feasible in selected cases. Long-term follow-up is mandatory.

Is routine single-incision laparoscopic cholecystectomy feasible? A retrospective observational study.

BACKGROUND: Single-incision laparoscopic cholecystectomy (SILC) has been shown to be safe for uncomplicated gallbladder diseases. Routinely applying SILC is debatable. METHODS: Two hundred SILCs were performed with single-incision multiple-port longitudinal-array and self-camera techniques. RESULTS: Eighty-eight (44%) procedures were scheduled for complicated diseases. The routine group had a higher comorbidity rate, a lower preoperative endoscopic retrograde cholangiopancreatography rate, a higher intraoperative cholangiography rate, a higher proportion of complicated gallbladder diseases, shorter operative time, more intraoperative blood loss, and lower postoperative pethidine dose than the selective group (the first 73 patients). The conversion and complication rates showed no statistical difference. It took fewer cases but longer time to pass the learning phase of SILC for complicated gallbladder diseases. The multivariate analysis showed that male sex and complicated gallbladder diseases were associated with a higher procedure conversion rate, and increased patient age was related to a higher complication rate. CONCLUSIONS: Routine SILC for benign gallbladder diseases is feasible in the experienced phase. Practicing SILC for uncomplicated gallbladder diseases helps to achieve competence in this technique for complicated diseases.

Signals for increase of µ-opioid receptor expression in muscle by hyperglycemia.

Increase of µ-opioid receptor (MOR) expression in liver of diabetic rats has been mentioned to associate with hyperglycemia that can activate the signal transducer and activator of transcription 3 (STAT3) pathway. Additionally, STAT3 may regulate the expression of MOR genes. In the present study, role of STAT3 in the regulation of increased MOR expression was investigated in diabetic rats and cultured rat skeletal myoblast (L6) cells. Streptozotocin-induced type 1-like diabetic rats (STZ rats) were used to estimate the response to MOR agonist (loperamide) and the changes in MOR expression. Then, cultured L6 cells incubated in high glucose (HG) medium were used to mimic the in vivo changes. Loperamide-induced hypoglycemia was more pronounced in STZ rats. The increased MOR expression in skeletal muscle of STZ rats was reversed by the reduction of hyperglycemia. Increased MOR expression and the enhanced expression of STAT3 observed in HG-exposed cultured L6 cells. Treatment with siRNA specific to STAT3 reversed the increased expression of MOR in this cell model. Treatment with stattic at a dose sufficient to inhibit STAT3 reversed MOR expression in STZ rats. We identified that hyperglycemia induces a greater expression of STAT3 to result in the increased expression of MOR, both in vivo and in vitro.