Bile duct stone formation around migrated surgical clip 17 years after laparoscopic cholecystectomy
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Carl Langenbuch (1846-1901) has been appropriately designated the 'creator' of surgery of the gallbladder. In the surgical treatment of gallstone disease, Langenbuch advocated cholecystectomy in favour of cholecystostomy since he realised that the gallbladder should be removed not because it contained stones but because it originated the stones. In 1882, he successfully performed the first cholecystectomy in a 43-year-old patient. The new operation gave rise to a vehement, international discussion questioning the dispensability of the gallbladder in view of its alleged role in bile physiology. The famous abdominal surgeon Lawson Tait appeared to be a strong opponent of cholecystectomy, maintaining cholecystostomy as the procedure of choice. In the medical journals, he rejected cholecystectomy in unequivocal terms. The controversy about cholecystectomy persisted for several decades, delaying its wide acceptance.
Cholecystostomy
Gallbladder disease
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Objective To analyse the adva nt ages and disadvantages of minilap cholecystectomy and laparospic cholecystectomy .Methods We compared and analysed minilap cholecystectomy in 53 4 cases and laparoscopic cholecytectomy in 225 cases.Results Bo th minilap cholecystectomy and laparoscopic cholecystectomy had the features of less injury and early recovery,but minilap cholecystectomy also had the advantag es of flexibility of manipulating,fewer complications,lower expense,and generali zing easily.Conclusion Less injury operation will act a very im portant role in surgery of 21 centure.Minilap cholecystectomy can popularize eas ily in some primary hospitals.However innovation of equipment and skillful opera tion,laparoscpic cholecystectomy will possess bright tomorrow.
Open cholecystectomy
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Aims Cholecystectomy after endoscopic removal of the common bile duct stones is generally recommended to prevent recurrence of biliary complications. The rate of following these recommendation is low. The aim of this study was to evaluate the need for laparoscopic cholecystectomy in the patient without GB stone after CBD stone clearance.
Gallbladder Stone
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A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In patients undergoing cholecystectomy is the clipless laparoscopic cholecystectomy is associated with higher risk of bile leak compared to conventional cholecystectomy? The search has been devised and 6 studies were deemed to be suitable to answer the question. The outcome assessed was the rate of bile leak in clipless cholecystectomy compared to conventional laparoscopic cholecystectomy. Authors found that the rates of bile leak in clipless laparoscopic cholecystectomy is comparable to conventional technique. Clipless cholecystectomy is feasible and safe.
Bile leak
Open cholecystectomy
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The operation of cholecystectomy has been accepted by experienced surgeons as the one of choice for most cases of gallbladder disease that in former years were simply drained. The literature of late has been filled with articles by many surgeons, the enthusiastic advocating cholecystectomy for all cases, the conservative decrying its general adoption. Believing it would be of interest and profit to find out the profession's attitude in regard to the indications for cholecystectomy, I have reviewed the literature extensively and have been in correspondence with forty-five experienced abdominal surgeons. In the letters sent out the following information was asked: What percentage of cases of cholecystostomy have had a recurrence of trouble following operation? Are you performing cholecystectomy more frequently than in the past? Have the results been better than when simple drainage was used? In what cases do you consider cholecystectomy the operation of choice? What are the contraindications
Cholecystostomy
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Objective To analyze the high risk factors likely causing injury of bile duct during laparoscopic cholecystectomy(LC) and to discuss the causes of the injury and the precautions against such injuries. Methods A retrospective study was made on 13 cases of iatrogenic bile duct injury in LC at three hospitals in China in the past ten years. Results Iatrogenic bile duct injury often resulted from LC, the causes of which were mainly anatomic variation of the bile duct, pathological changes around the bile duct and irregular or wrong operation in LC. Conclusion For LC performers, clear understanding of all these high risk factors and the Calot′s triangle, careful dissection and regular operation in LC help reduce the incidence of bile duct injuries.
Iatrogenic injury
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Objective To explore the preventive and therapeutic strategy of bile duct injury caused by laparoscopic cholecystectomy(LC).Methods We retrospectively analyzed 12 cases of bile duct injury in 1033 cases of laparoscopic cholecystectomy performed.Results According to Strasberg classification,10 cases with diameter=3mm were cured by sewing up the wound of bile duct and placing T type tube to drain bile,while the other two cases were cured by cholangioplasty and cholangiojejunum Roux-en-Y anastomosis.Through 6 months to 1 years follow-up,no such complications as bile duct stricture or lithiasis were found.Conclusion The primary reason is lack of understanding of the anatomy variety and pathological change,as well as responsibility and experience or skill of the operaters.The bile duct injurycaused by LC should be found and tackled in time in order to achieve satisfactory prognosis.
Iatrogenic injury
Open cholecystectomy
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Clipping (morphology)
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Good results from endoscopic sphincterotomy (EST) for removing choledochal stones following cholecystectomy, have led to increasing use of the method when the gallbladder is in situ. The need for cholecystectomy after successful EST has been questioned. As cholecystectomy in elderly patients involves substantial risk, we routinely defer cholecystectomy in such patients while they remain asymptomatic. Experience of 40 cases is reported. Thirty-four were discharged without cholecystectomy and one underwent elective cholecystectomy at his own request. The remaining 33 patients were followed up for 6-53 (mean 21.5) months. Four died from causes unrelated to gallstone disease. Symptoms requiring cholecystectomy arose in two cases (6%). We found no problems due to refraining from routine elective cholecystectomy following EST for common bile duct stones. The rarity of later symptoms appears to justify a "wait and see" attitude to post-EST cholecystectomy.
Gallbladder disease
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