Open conversion for laparoscopically difficult cholecystectomy is still a valid solution with unsolved aspects
The difficult laparoscopic cholecystectomy remains a surgical challenge for surgeons who must decide between laparoscopic continuation and open conversion. The balance between the lack of open surgery training...
ConclusionsThis series represents six cases of subtotal reconstituting cholecystectomy with no recurrent gallbladder symptoms on long-term follow-up. This may encourage surgeons who feel that subtotal reconstituting cholecystectomy is the safest way to proceed with cholecystectomy in the setting of severe inflammation.
CONCLUSIONS: The application of Hem-o-Lok clip during laparoscopic surgery is safe and effective. Postoperative Hem-o-Lok migration into the duodenum is rare. The treatment could be conservative in the majority of cases. PMID: 31958943 [PubMed - in process]
Subtotal cholecystectomy, where the gallbladder infundibulum is transected to avoid dissecting within the triangle of Calot, has been suggested to conclude laparoscopic cholecystectomy while avoiding common bile duct injury. However, some reports suggest the possibility of recurrent symptoms from a remnant gallbladder.
ConclusionDIC ‐CT is useful for predicting the surgical difficulty of LC.
One of the early meta-analyses on the timing of laparoscopic cholecystectomy after an episode of acute cholecystitis, published in 2006, included 4 studies with a cumulative number of 504 participants randomized to early or delayed laparoscopic cholecystectomy.1 The authors found similar perioperative outcomes and a shorter hospital stay in patients undergoing early cholecystectomy. Since this publication, a number of cohort studies, randomized controlled trials (RCTs) and meta-analyses have found similar results and, additionally, have demonstrated a lower risk of wound infection following early cholecystectomy.
Conclusion: LC can be safely performed in cirrhotic patients. However, higher CTP and MELD scores, operative bleeding, more blood and plasma transfusion units, longer operative time, lower platelet count, and higher INR values are predictors of poor outcome that can be improved by proper patient selection and meticulous peri-operative care and by using Harmonic scalpel shears.
Conclusionsthe absence of high ‐level evidences precludes the possibility to draw definitive conclusions. However, the available data derived from a growing number of centers demonstrates that minimally invasive surgery may offer its well‐known advantages on postoperative outcomes also in the setting of severe iatrogenic inju ry to the bile ducts.
Journal of Laparoendoscopic&Advanced Surgical Techniques, Ahead of Print.
Condition: Cholelithiasis Intervention: Diagnostic Test: Fluorescence Cholangiography Sponsors: University of Malaya; Ummi Surgical Sdn Bhd Completed
Conclusions: We identified a lack of quality and thorough educational surgical videos appropriate for third year medical students and a need for improved online video based instruction. Our checklist can be utilized as a guide for anyone creating surgical videos for medical student education in the future. PMID: 31920174 [PubMed - in process]