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General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
What is the risk of biliary injury during cholecystectomy?The risk with laparoscopic cholecystectomy is 0.3%–0.7%.The risk with open cholecystectomy is 0.13%.It occurs in elective straightforward cases as well as after pancreatitis/cholangitis and emergency cases.The main cause is misinterpretation of biliary anatomy − CBD confused with cystic duct.Associated injury to the right hepatic artery can occur if it is mistaken for the cystic artery.Partial injury to the CBD can occur from a diathermy burn or after rigorous traction on the cystic duct, avulsing it from the CBD.
Intraoperative Cholangiogram Shows <1 cm Stone at the Lower End
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Patients who have had a prior cholecystectomy that present with common bile duct stones require an endoscopic retrograde cholangiopancreatography to treat these stones. Patients with a previous cholecystectomy and Billroth I partial gastrectomy may still be able to have an endoscopic retrograde cholangiopancreatography. However, patients with a partial gastrectomy and Roux-en-Y anastomosis, a total gastrectomy, or gastric bypass bariatric surgery will not have endoscopic access to the ampulla. If these patients present with cholangitis (grade II or III) the biliary tree can be drained with a percutaneous biliary drain to resolve the sepsis. The definitive management of the common bile duct stone, whether percutaneous drainage is required or not, shall be either a laparoscopic or an open exploration of the common bile duct. There remains the possibility of performing a laparoscopic, transgastric endoscopic retrograde cholangiopancreatography via the gastric remnant in a patient who has had a previous Roux-en-Y gastric bypass for obesity. The advantage of this procedure is that it can be done synchronously with the laparoscopic cholecystectomy. However, this is a difficult complex procedure and should only be attempted by experienced laparoscopic surgeons with endoscopic expertise or in association with an experienced medical endoscopist.
Acute pancreatitis
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
Robert Adams, Christopher Limb
When an underlying cause has been found it should be managed appropriately. For example, patients with gallstone pancreatitis should have a laparoscopic cholecystectomy within 2 weeks of discharge. If no cause is found then the patient should be followed up in clinic for further investigations including bloods, further imaging and genetic testing. It is important to limit risk factors, as there is significant morbidity and mortality associated with each episode of pancreatitis.
Erector Spinae Plane Block Enhances Multimodal Analgesia for Laparoscopic Cholecystectomy
Published in Journal of Investigative Surgery, 2022
Hao Tan, Hui-Fang Huang, I-Cheng Lu
Laparoscopic cholecystectomy has become the gold standard for the treatment of gallbladder disease, with the advantages being minimal invasiveness, less postoperative pain, and faster recovery. The enhanced recovery after surgery (ERAS) protocols for laparoscopic gastrointestinal surgery have shown beneficial outcomes, not only in terms of reducing opioid consumption, but also in reducing the number of adverse events and achieving a shorter hospital stay [2,3]. To our best knowledge, there are no reports of ERAS guidelines for minor abdominal procedures, such as laparoscopic cholecystectomy. We were thus interested to see how the authors used multimodal analgesia, which is one of the core elements of ERAS protocols, in their comparative study of EPS and STAP blocks [1]. The authors report using a routine multimodal analgesia regimen including a preoperative ESP or STAP block, intraoperative paracetamol and tenoxicam, postoperative intravenous paracetamol, and patient-controlled fentanyl analgesia. Our major concern with this study is that we found it partially against ERAS guidelines to use patient-controlled fentanyl analgesia and meperidine as a rescue in laparoscopic surgery. The purpose of multimodal analgesia is to reduce opioid consumption and associated adverse events for enhanced recovery after abdominal surgery [4].
A Systematic Review of Laparoscopic Cholecystectomy in Situs Inversus
Published in Journal of Investigative Surgery, 2021
Mohamed Ali Chaouch, Hichem Jerraya, Mohamed Wejih Dougaz, Ramzi Nouira, Chadli Dziri
LC in SI is a widely performed procedure. This systematic review investigates the most suitable technique for LC in SI. To our knowledge, this is the first systematic review of patients with SI, involving 93 patients. It showed that many procedures could lead to successful and safe laparoscopic cholecystectomy. There was no mortality and no major complications were reported, especially bile duct injuries. An associated CBD stone was found in eight cases (8.6%). ERCP with endoscopic sphincterotomy was used to treat the associated CBD stone in 7 cases and a choledecoscopy with stones extraction in one case. This procedure was easier for left-handed surgeons. The fastest technique for right-handed surgeons seems to be the “American mirror technique”. The only reported case of conversion was performed using the “French mirror technique”. The conversion rate in this systematic review was 1.07%.
Case report: an unwanted leftover after laparoscopic cholecystectomy
Published in Acta Chirurgica Belgica, 2018
Eline Stroobants, Peter Cools, Francis Somville
Laparoscopic cholecystectomy is the golden standard in the treatment of symptomatic gallbladder disease nowadays. The approach deals with mainly two specific complications, the first one is damage of the bile ducts and second a rupture of the gallbladder with or without spillage of gallstones. The first complication is linked to the competence and experience of the surgeon and diminishes with an increased amount of laparoscopic cholecystectomies performed. The spillage of gallstones is a lesser known complication and stays invariable during all those years of laparoscopic expertise [1]. Complications due to spillage can present themselves immediately post-surgery and up to 10 years after surgery [1]. The presented case shows that, however rare, spilled gallstones can be the reason of an important complication. The aim of this case report is to take a closer look on how to manage spilled gallstones.