Management and outcome of gallbladder perforation during laparoscopic cholecystectomy

One of the frequent incidents during laparoscopic cholecystectomy is gallbladder perforation, with subsequent leakage of bile and/or gallstones inside the penitoneal cavity. In this 357 case series, gallbladder perforation occurred in 96 patients [26.9%]. We followed a pre-defined protocol for management of such patients. Stones were retrieved as much as possible, bile was aspirated, the abdominal cavity irrigated until clear, and a closed suction drain was left. There were no late intra-abdominal infectious complications, and no patient required re-operation for intra-abdominal sepsis, abscess formation, intestinal obstruction, or incisionab hernia. Wound sieroma occurred in 2.8% of cases, who were almost evenly distributed in both groups. Prolonged gastrointestinal symptoms were prevalent during the long-term follow up, and included upper abdominal pain [25.2%], flatulence [24.6%], indigestion [12.6%], loose stools [7.8%], and nausea [2.8%]. The incidence of these symptoms was similar in patients with and without gallbladder perforation. The study concluded that inadvertent perforation of the gallbladder during laparoscopic cholecystectomy does not carry the risk of long-term complications, if it is properly managed intra-operatively

Management of cholelithiasis during pregnancy

Twenty-seven pregnant women, with symptomatic gallstone disease, were admitted to this prospective study. All patients received initial medical therapy, and surgical intervention was performed in cases with frequent relapses or no response to medical treatment. Twelve patients underwent surgery during pregnancy, 2 in the first and 10 in the second trimester. Eight patients underwent laparoscopic cholecystectomy, while 4 had open cholecystectomy [one had exploration of the common bile duct]. While no maternal or fetal deaths occurred secondary to medical treatment, one spontaneous abortion occurred following open cholecystectomy in the first trimester. Patients, after receiving primary medical treatment, had 74.1% rate of relapse and additional days in hospital, compared to no relapse and less hospital stays after surgery. Patients acute cholecystitis had increased incidence of medical treatment failure and need of surgery. It is concluded that management of biliary tract disease during pregnancy should follow a protocol, with clear indications for the role of surgical intervention during the second trimester of pregnancy does not increase maternal or fetal morbidity. It may in fact reduce the number of relapses during pregnancy, hence reduces the consequent complications and additional hospital stay. Laparoscopic cholecystectomy is feasible in the great majority of patients, except those with large uteri in the late second trimester and the presence of common bile duct stones

On-table colonic lavage in emergency large bowel surgery: is it always feasible?

A series of 42 patients who required emergency surgery for distal colonic lesions were admitted to this study. Out of these patients, 24 were operated upon with primary bowel resection and immediate anastomosis after intraoperative colonic irrigation and 18 had primary resection with delayed anastomosis. The overall results proved on- table lavage to be an affective method that enables primary colonic anastomosis and less hospital stay, without a significant increase in complication rates. However, the study concluded that the best results were obtained in patients presented with colonic bleeding, next in those with intestinal obstruction, then in the group presented with peritonitis. Thus, the technique is not considered to be an absolute one and cases should be selected according to the presenting lesion in addition to other factors as age and general condition of the patient