Single-incision laparoscopic cholecystectomy (SILC) using harmonic scalpel.

BACKGROUND: Single-incision laparoscopic cholecystectomy (SILC) is emerging as a potentially less invasive alternative to standard laparoscopic cholecystectomy (LC). However, this procedure is technically more complex and time consuming. We present our initial experience with SILC using harmonic ACE (HS-SILC) in an attempt to simplify the procedure. METHODS: We collected concurrent data on 67 consecutive patients undergoing HS-SILC by a single surgeon in a university-affiliated hospital over a period of 9 mo. RESULTS: From May 2010 to February 2011, 67 consecutive patients underwent an attempted HS-SILC for symptomatic cholelithiasis by a single surgeon, with a success rate of 95.5%. Conversion to a standard LC was necessary in two patients (2.9%), and conversion to an open cholecystectomy was necessary in one patient (1.6%). The average operative time was 36.2 min. No injuries to the common bile duct occurred. Postoperative port site infection occurred in one patient (1.5%). No perioperative deaths occurred. CONCLUSIONS: HS-SILC is safe and feasible. It simplifies the procedure and makes operative time less with better cosmetic results and lower rate of conversion to multi-incision LC or open cholecystectomy.

Laparoendoscopic management of concomitant gallbladder stones and common bile duct stones: what is the best technique?

BACKGROUND AND STUDY AIMS: The intraoperative use of endoscopic retrograde cholangiopancreatography (ERCP) during laparoscopic cholecystectomy (LC) is a safe, single-stage option for the management of concomitant gallstones (GS) and common bile duct stones (CBDS). This study aims to compare between 2 techniques of combined laparoendoscopic management, which are laparoendoscopic Rendez-vous (LC/LERV) technique and standard ERCP after the completion of LC intraoperative endoscopic sphincterotomy (IOES). PATIENTS AND METHODS: Patients with GS and suspected CBDS were included. They were divided into 2 groups; LC/LERV and LC/IOES. Both groups were compared for failure of endoscopic sphincterotomy/stone extraction, operative time, conversion rate, mortality/morbidity, and length of hospital stay. RESULTS: Between October 2007 and February 2010, 98 patients with GS and CBDS were eligible for inclusion in the study. They were prospectively randomized into 2 groups; LC/LERV (N=45) and LC/IOES (N=53). There were no differences in preoperative parameters between both groups. There was a significant difference in operative time (shorter for LC/IOES). No difference was noted in success/failure rate, post-ERCP pancreatitis. CONCLUSIONS: Both Standard ERCP after the completion of LC and LC/LERV are valid single-session management for CBD stones, but LC-ERCP may be preferred.

Is the use of T-tube necessary after laparoscopic choledochotomy?

BACKGROUND: Traditionally, the common bile duct (CBD) is closed with T-tube drainage after choledochotomy and removal of CBD stones. However, the insertion of a T-tube is not without complication. AIM OF WORK: This randomized study was designed to compare the use of T-tube and primary closure of choledochotomy after laparoscopic choledochotomy to determine whether primary closure can be as safe as closure with T-tube drainage. METHODS: Between February 2006 and June 2009, 122 consecutive patients with proven choledocholithiasis had laparoscopic choledochotomy. They were randomized into two equal groups: T-tube (n = 61) and primary closure (n = 61). Demographic data, intraoperative findings, postoperative complications, and postoperative stay were recorded. RESULTS: There was no mortality in both groups. There were no differences in the demographic characteristics or clinical presentations between the two groups. Compared with the T-tube group, the operative time and postoperative stay were significantly shorter and the incidences of overall postoperative complications and biliary complications were statistically and significantly lower in the primary closure group. CONCLUSION: Laparoscopic common bile duct exploration with primary closure without external drainage after laparoscopic choledochotomy is feasible, safe, and cost-effective. After verification of ductal clearance, the CBD could be closed primarily without T-tube insertion.