Is monopolar electrocautery safe and effective for control of the cystic artery during laparoscopic cholecystectomy?

BACKGROUND: Laparoscopic cholecystectomy is one of the most common surgical procedures. Here we report our experience with the use of monopolar electrocautery to control the cystic artery during laparoscopic cholecystectomy. SUBJECTS AND METHODS: Data regarding the site, number, size, and method of control of the cystic artery during laparoscopic cholecystectomy were prospectively collected. Other data collected included the operative time, intraoperative difficulties, and postoperative complications. RESULTS: The study included 158 laparoscopic cholecystectomies. Two arteries were controlled in 25 patients (15.8%) and one artery in 122 patients (77.2%), while the cystic artery was not identified in 11 patients (7%). The artery was graded as small, medium, and large in 43, 72, and 32 patients, respectively. Patients with unidentified cystic artery were excluded from our data analysis. The artery was controlled using monopolar electrocautery in 114 patients (77.5%) and by metal clips in 33 patients (22.5%). The cystic artery was controlled lateral to the cystic lymph node in the majority of patients (68%). Neither bleeding nor bile duct injury was encountered throughout the study period. CONCLUSIONS: Electrocautery is safe and effective for control of the cystic artery during laparoscopic cholecystectomy. A future randomized study is needed to confirm the findings of the present study.

Spinal versus general anesthesia for day-case laparoscopic cholecystectomy: a prospective randomized study.

BACKGROUND: The aim of this study was to compare the surgical outcome of day-case laparoscopic cholecystectomy (DCLC) performed with the patient under spinal anesthesia with that performed with the patients under general anesthesia in the management of symptomatic uncomplicated gallstone disease. PATIENTS AND METHODS: One hundred eighty patients were prospectively randomized to either the spinal anesthesia DCLC group (SA-DCLC group) or the general anesthesia DCLC group (GA-DCLC group). Intraoperative events related to spinal anesthesia, postoperative complications, and pain scores were recorded. The incidences of both overnight stay and readmissions were also recorded. Patient satisfaction values as to the anesthetic technique and same-day discharge were assessed by direct questionnaire at the end of the first postoperative week. RESULTS: In both groups, all procedures were completed laparoscopically. In the SA-DCLC group, there were 4 (4.4%) anesthetic conversions due to intolerable right shoulder pain, and those 4 patients were excluded from further analysis. In the SA-DCLC group, all patients were discharged on the same day. Overnight stay was required in 8 patients (8.9%) in the GA-DCLC group (P<.001). The cause of overnight stay was nausea and vomiting in 4 patients (4.4%), inadequate pain control in 3 patients (3.3%), and unexplained hypotension in 1 patient (1.1%). Readmission was required in 1 patient (1.1%) in the GA-DCLC group. The difference in patient satisfaction scores with regard to both anesthetic technique and same-day discharge was not statistically significant between the two groups studied. CONCLUSIONS: DCLC performed with the patient under spinal anesthesia is feasible and safe and is associated with less postoperative pain and lower incidence of postoperative nausea and vomiting and therefore a lower incidence of overnight stay compared with that performed with the patient under general anesthesia.

Laparoscopic cholecystectomy in cirrhotics: a prospective randomized study comparing the conventional diathermy and the harmonic scalpel for gallbladder dissection.

BACKGROUND: Ultrasonically activated devices have been used for gallbladder dissection in laparoscopic cholecystectomy (LC) with encouraging results. The aim of the present study was to compare the surgical outcome of LC performed by the harmonic shears to that performed by the conventional diathermy in patients with cirrhosis. METHODS: In this prospective randomized study, 40 cirrhotic Child-Pugh's classes A and B patients with symptomatic uncomplicated gallstones disease were randomly assigned to either the Harmonic scalpel LC group (20 patients) or the conventional diathermy LC group (20 patients). RESULTS: The use of the harmonic shears was associated with a statistically significant shorter median operative time (55 vs. 82.5 minutes, P = .000), less median estimated intraoperative blood loss (50 vs. 120 mL, P = .000), and lower incidence of gallbladder perforation (10% vs. 70%, P = .000). In the Harmonic scalpel LC group, Laparoscopic subtotal cholecystectomy was resorted to in eight patients (40%) compared with six patients (30%) in the conventional diathermy LC group. No statistically significant difference was found between both groups as regards the conversion rate, the median hospital stay, and the incidence of postoperative complications. Neither bile leaks nor Bile duct injuries were encountered in either group. Similarly, no mortalities were encountered in the present study. CONCLUSIONS: The Harmonic shears achieved complete hemobiliary stasis. Further, it provided a superior alternative to the conventional diathermy in terms of shorter operative time, less intraoperative blood loss, and lower incidence of gallbladder perforation partly through facilitating the performance of laparoscopic subtotal cholecystectomy.

Laparoscopic-assisted truncal vagotomy and gastro-jejunostomy: trial of simplification.

BACKGROUND: Truncal vagotomy and gastro-jejunostomy is an effective procedure for Gastric Outlet Obstruction. The authors' experience with the procedure is presented and an alternative technique for creating the gastro-jejunostomy is described. METHODS: From January 2005 through June 2007, 18 patients with gastric outlet obstruction secondary to a cicatrizing peptic duodenal ulcer underwent laparoscopic truncal vagotomy and an ante-colic laparoscopic-assisted stapled gastro-jejunostomy. RESULTS: All procedures were completed laparoscopically with a mean operative time of 81.2 +/- 11.1 minutes. Anastomotic leak was encountered in 1 (5.5%) patient and bile vomiting in 2 patients (11%). The mean follow-up duration was 22.8 +/- 9.8 months. None of the patients developed recurrent obstruction. CONCLUSIONS: The procedure is feasible, safe, and provides an effective cure for gastric outlet obstruction. The laparoscopic-assisted stapled gastro-jejunostomy reduces the operative time and may reduce the cost of the procedure.