[Laparoscopic cholecystectomy--current status]. / Die laparoskopische Cholezystektomie--aktuelle Situation.

Laparoscopic cholecystectomy (LCHE) is a safe and effective way to treat gall stones. The procedure was carried out for the first time in France in 1987 and since then it has spread rapidly all over the world, in view of the excellent results achieved. The major benefits are the low morbidity, the very short hospitalization, the early return to daily life and work and its excellent cosmetic results. LCHE is indicated in symptomatic non-complicated gall-bladder disease. The operative technique is standardized, the complication rate is low. Compared with other treatments such as litholysis, extracorporeal shock wave therapy and standard cholecystectomy it is a superior, definitive alternative, which is prognosed to become the therapy of choice in gallbladder disease.

[The cystic duct stump after laparoscopic cholecystectomy]. / Der Zystikusstumpf nach laparoskopischer Cholezystektomie.

The aim of this study was to evaluate the length of cystic-duct stumps after laparoscopic cholecystectomy. 113 patients underwent intravenous cholangiography 2 to 3 months postoperatively, whereby a cystic-duct remnant of up to 1 cm was found in 34.5% (n = 39) and between 1 and 2 cm in 36.3% (n = 41). In 24.8% (n = 28) a stump measuring 2 to 3 cm was registered and in 4.4% (n = 5) the cystic-duct remnant was more than 3 cm. Possible consequences with regard to the development of the postcholecystectomy syndrome are discussed. In our experience laparoscopic cholangiography seems to be a useful procedure to detect cysticolithiasis and as preliminary measure to undertaking the correct therapeutic steps. Adherence of this strategy might avoid possible later complications by elimination of their principal cause.

[Laparoscopy-assisted reoperation after sigmoid resection and Hartman rectal occlusion]. / Die laparoskopisch assistierte Rückoperation nach Sigmaresektion und Rectumverschluss nach Hartmann.

The anastomosis between the descending colon an the rectal stump after sigma-resection and blind closure of the rectum according to Hartmann could be performed as well via an open laparotomy approach as via a laparoscopic procedure. By means of a first group of five laparoscopically reoperated patients the authors are demonstrating the good practicability of their laparoscopic method. Extended adhesions in the pelvic area could be detached in all cases. The advantages of this laparoscopic operation are obvious and in the authors opinion laparoscopic assisted reconnection between colon and rectal stump seems to be a serious alternative to open surgery by laparotomy.

Intraperitoneal cholelithiasis after laparoscopic cholecystectomy--behavior of 'lost' concrements and their role in abscess formation.

UNLABELLED: In two experimental studies we sought preliminary information about the behavior of concrements lost in the peritoneal cavity during laparoscopic cholecystectomy. MATERIALS AND METHODS: In study 1, human gallstones were analyzed using X-ray diffraction, classified in three groups and examined with an ultramicroscope; then they were implanted in the peritoneal cavity of rats. After 8 weeks or 6 months, the animals were sacrificed and the concrements analyzed again as before. The tissues surrounding the calculi were also examined histologically. In study 2, human gallstones were examined with regard to bacterial contamination on the surface or in the middle of the calculi. The cholesterol content was analyzed, and the stones were divided into three groups and implantated in the rats as in the first study. After 8 weeks, the animals were sacrificed and areas with identifiable tissue reactions were examined histologically and microbiologically. RESULTS: The concrements lost their crystalline formation without any relation to their former cholesterol content, as shown by X-ray diffraction as well as ultramicroscopy. Mineralogically, these changes are a certain sign of structural dissolution. Cholesterol stones only caused abscess formations in association with gram-negative bowel germs. Sterile pigment concrements often led to a mesenchymal reaction such as granulomas. Contaminated pigment stones also resulted in extensive abscess formations.