A 42-Year-Old Woman with Recurrent Pancreatitis Associated with Gallstones and Phrygian Cap Gallbladder.

BACKGROUND Gallbladder anomalies are rare congenital defects with an incidence rate of approximately 2% in the general population. Phrygian cap gallbladder is a common anatomical variant in which the fundus of the gallbladder folds on itself. Gallstone impaction is rare, and it can be associated with acute pancreatitis. This report describes a 42-year-old woman with recurrent pancreatitis associated with gallstones and Phrygian cap gallbladder. CASE REPORT We report the case of a 42-year-old woman with acute biliary pancreatitis and a history of repeated hospitalizations for episodes of pancreatitis. A preoperative MRI was conducted, which revealed the presence of a Phrygian cap gallbladder that had not been previously reported in imaging studies. The patient underwent cholecystectomy surgery with a laparo-endoscopic approach (rendezvous technique). No intra- or postoperative complications occurred. CONCLUSIONS We report a case of acute biliary pancreatitis caused by stone migration and describe the anatomical variant of the Phrygian cap gallbladder with its clinical implications. The literature contains very few reports of cholecystitis or pancreatitis in patients with a gallbladder anomaly. Continuous reporting of anatomical variations of the gallbladder and biliary tract improves clinical knowledge, and knowledge of gallbladder anomalies is crucial to avoid injury to the biliary tract during laparoscopic cholecystectomy. This case emphasizes the importance of accurate preoperative evaluation to prevent serious surgical complications.

Totally laparoscopic right hemicolectomy with up-down approach. A single institution experience.

AIM: Many laparoscopic techniques have been described for the treatment of right colon cancer. The purpose of this study is to communicate our experience in the totally laparoscopic treatment of right colon cancer and to report our short-term results in order to confirm the feasibility and safeness of this demanding procedure. MATERIAL OF STUDY: From November 2017 to April 2020, we performed 384 surgical operations for colorectal cancers, of these 81 have involved tumors of the right colon in urgent and elective conditions. Right hemicolectomies with a totally laparoscopic approach were performed, by the same surgical team, in 55 patients in elective surgery. RESULTS: During the study period we evaluated intra and postoperative complications in terms of: demographic data and preoperative clinical characteristics, intraoperative and postoperative outcomes (operative time, blood loss, conversion rate, surgical complications, hospitalization, readmission, and mortality), pathological outcomes. DISCUSSION: Our experience confirms that totally laparoscopic approach, with up to down dissection, for the treatment of right colon cancer, performed by expert surgeons is a safe and feasible technique. CONCLUSION: This procedure allows the mesocolon excision with outstanding number of harvested lymph nodes ensuring low complications and better oncological cleaning. KEY WORDS: Central Vascular Ligation, Colorectal Cancer, Fluorescence GLaparoscopy, Right Hemicolectomy, Complete Mesocolic Excision, Surgery.

Management of cholelithiasis with choledocholithiasis: Endoscopic and surgical approaches.

Gallstone disease and complications from gallstones are a common clinical problem. The clinical presentation ranges between being asymptomatic and recurrent attacks of biliary pain requiring elective or emergency treatment. Bile duct stones are a frequent condition associated with cholelithiasis. Amidst the total cholecystectomies performed every year for cholelithiasis, the presence of bile duct stones is 5%-15%; another small percentage of these will develop common bile duct stones after intervention. To avoid serious complications that can occur in choledocholithiasis, these stones should be removed. Unfortunately, there is no consensus on the ideal management strategy to perform such. For a long time, a direct open surgical approach to the bile duct was the only unique approach. With the advent of advanced endoscopic, radiologic, and minimally invasive surgical techniques, however, therapeutic choices have increased in number, and the management of this pathological situation has become multidisciplinary. To date, there is agreement on preoperative management and the need to treat cholelithiasis with choledocholithiasis, but a debate still exists on how to cure the two diseases at the same time. In the era of laparoscopy and mini-invasiveness, we can say that therapeutic approaches can be performed in two sessions or in one session. Comparison of these two approaches showed equivalent success rates, postoperative morbidity, stone clearance, mortality, conversion to other procedures, total surgery time, and failure rate, but the one-session treatment is characterized by a shorter hospital stay, and more cost benefits. The aim of this review article is to provide the reader with a general summary of gallbladder stone disease in association with the presence of common bile duct stones by discussing their epidemiology, clinical and diagnostic aspects, and possible treatments and their advantages and limitations.