Outcome evaluation of 10,317 laparoscopic cholecystectomies: a 17-year experience at a single center.

BACKGROUND/AIMS: This study is an analysis of the large series of laparoscopic cholecystectomies and compare our results with those reported in the literature concerning complications. METHODOLOGY: From December 1993 to September 2010, 10,317 patients with gallstone disease underwent laparoscopic cholecystectomy. Previously operated patients were also included in the study. We analyzed the successfulness of the results, intraoperative and postoperative complications, conversions in open cholecystectomy, mortality and reoperation rate. RESULTS: We registered 23.28% complications. Intraoperative complications were bleeding in 9.84%, gallbladder perforation in 8.63%, stone loss in 1.37%, common bile duct injury in 0.24% and injury of intraabdominal organs in 0.07% of cases. Postoperative complications were bleeding in 1.12%, wound infection in 0.59%, bile leakage in 0.5%, incisional umbilical hernias in 0.37%, subhepatal collection in 0.33%, residual gallstones in choledocus in 0.09%, urine retention in 0.08% and biliary peritonitis in 0.01% of patients. Conversion to open cholecystectomy was necessary in 2.13%. Reoperation was performed in 0.27%. The mortality rate was 0.019%. CONCLUSIONS: Our results on large number of patients are similar to other series in the newer literature but the rate of complications should be decreased. The incidence of complications decreases with growing laparoscopic experience.

Effect of pyloric dilatation on gastric emptying after pylorus-preserving pancreaticoduodenectomy.

BACKGROUND/AIMS: Pylorus-preserving pancreaticoduodenectomy (PPPD) is the standard treatment for periampullary and pancreatic head tumors. Delayed gastric emptying (DGE) is the most common (ranging from 15-45%) but not life threatening complication and impairs patient recovery and prolongs the hospital stay after PPPD. The precise pathomechanism of DGE is still unclear. The aim of this study was to evaluate whether the method of pyloric dilatation performed at the time of PPPD could improve gastric emptying. METHODOLOGY: Forty patients underwent PPPD for pancreatic or periampullary lesions from January 1999 to July 2004 were included in this study. In twenty patients mechanical dilatation of the pylorus after duodenal transaction was performed (PPPD+PD group) while in other twenty PPPD was not followed with pyloric dilatation (PPPD group). The incidence of DGE as well as other complications was analyzed. Delayed gastric emptying was defined as gastric stasis requiring nasogastric intubation for more than 4 postoperative days (POD), or the inability to tolerate a regular diet on the 8th POD. RESULTS: Delayed gastric emptying occurred in seven (35%) out of the 20 patients in the PPPD group, while none of the 20 patients in the PPPD+PD group developed DGE. CONCLUSIONS: Pyloric dilatation reduces DGE after PPPD enabling patients to return sooner to a normal diet.

Double transection of complete duodenal circumference after blunt abdominal trauma without other intra-abdominal injuries.

We report a case of a 20-year-old male with isolated complete duodenal transection at two duodenal segments after blunt abdominal trauma. On admission, the patient underwent physical examination, laboratory analysis, abdominal ultrasound and plain abdominal x-ray. Physical examination revealed diffuse and rebound tenderness and extreme rigidity of the abdomen, guarding and decreased bowel sounds. Standard surgical techniques were used (median laparotomy, primary anastomosis, nasojejunal three-luminal tube for feeding and gastric decompression). At exploration, we found complete transection of the duodenum just below the pylorus and between the second and third part of the duodenum. We performed primary anastomosis of both transections with interrupted sutures in two layers. Prior to discharge magnetic resonance imaging (MRI) was performed. Early diagnosis of duodenal rupture is important. When dealing with trauma patients with pain greater than local findings, the mechanism of injury should always be taken into account.