[Complications due to mechanical sutures in laparoscopic surgery: bowel obstruction caused by staple. Case report and literature review]. / Complicanze da suture meccaniche in chirurgia laparoscopica: occlusione intestinale da clip. Segnalazione di un caso clinico e revisione della letteratura.

Bowel obstruction after laparoscopic surgical operation is reported only in few cases. The incarceration of bowel loop occurs into the port site more frequently. The case of a young woman, subjected to laparoscopic appendectomy is reported: bowel obstruction occurs on the third postoperative day caused by a staple of the mechanical suture on the caecum, hooked to bowel mesentery. This complication can occur for staples partially formed, spilled in the peritoneum or put to the extremity of mechanical sutures: they can hook to fixed structures and strangle a bowel loop. It may occur in 1.8% of surgical laparoscopic procedures. It can be solved by the simple laparoscopic lysis, above all if an early diagnosis and surgical operation are performed. It is recommendable to remove all the free spilled staples in the peritoneum and close or remove those partially formed to the extremities of the suture.

[A modified technique of gallbladder dissection from the liver during laparoscopic cholecystectomy. Personal technique]. / La dissociazione della colecisti dal letto epatico durante colecistectomia laparoscopica. Tecnica personale.

BACKGROUND: Gallbladder injures during cholecystectomy happens more frequently when surgical operation is conduced under laparoscopic (16%) rather than laparotomic (8%) access. A modification of the technique of dissection of the gallbladder from the liver is presented, suggesting a progression from the medium to the lateral side. This technique should facilitate the division of the organs and, above all, limit the gallbladder iatrogenic injures. METHODS: During 1995-2000 we have employed our technique in 637 patients, 89 (14%) affected by acute cholecystytis, subjected to laparoscopic cholecystectomy. RESULTS: Gallbladder injures occurred in 38 cases (6%), with stones liberation 12 (1,9%): 11 had been submitted to surgery in emergency. All patients have been subjected to follow-up from 12 to 30 months. No intraperitoneal abscess was observed, while suppuration of the umbilical port occurred in 12 patients (1,9%): 6 were affected by systemic illnesses. CONCLUSIONS: Our technique can limit the incidence of iatrogenic gallbladder injuries during laparoscopic cholecystectomies, reducing surgical times, antibiotics administration, incidence of perioperative complications. Besides, this technique may facilitate the gallbladder dissection from the liver in case of infundibular stones.