Efficacy of Lidan Tang on high-fat-diet induced hepatolithiasis in mice and possible mechanism.

OBJECTIVE: To investigate efficacy of Lidan Tang (LDT) on gallstone induced by high fat diet in mice, and to study its underlying mechanism. METHODS: Mice were fed with high fat diet every day and treated with LDT (9.01 times of human clinic dosage). Mice were randomly divided into 6 groups as control group, gallstone model group (high-fat diet), positive control ursodeoxycholic acid (UDCA) group (80 mg·kg-1·d-1, i.g.), LDT low dose group (6 kg/d, i.g.), LDT middle dose group (12 kg/d, i.g.), and LDT high dose group (24 kg/d, i.g.). The whole experiment was lasted for 4 weeks. The levels of ALT, AST, LDH, CHO, HDL-C and LDL-C in serum were measured, the pathological sections were observed by hematoxylin-eosin staining, the activities of antioxidant enzymes were measured by kits, and the proteins related to oxidative stress and lipid transport were detected by Western blot analysis. RESULTS: LDT could significantly reduce the contents of ALT and AST in serum and improve the pathological tissue of liver. LDT could significantly reduce the content of MDA and LPO, and increase the level of GSH and GSH-PX in liver tissue. The data of Western blot showed that LDT had antioxidant effect promoting Keap1/Nrf2 pathway and regulated the process of lipid transport, which was statistically significant. In addition, LDT treatment inhibited the expression of ATP-binding cassette transports ABCG5/8 in liver, and reduced cholesterol transport from the hepatocytes to the gallbladder. CONCLUSION: LDT has protective effect on gallstones induced by high fat diet in mice, which might be based on the protective effect on liver, including enhancing the antioxidant capacity of liver and reducing the production of lipid peroxides.

Laparoendoscopic Single-Site Cholecystectomy: First Experiences with a New Standardized Technique Replicating the Four-Port Technique.

BACKGROUND: After reports on laparoendoscopic single-site (LESS) cholecystectomy, concerns have been raised over the level of difficulty and a potential increase in complications when moving away from conventional gold standard multiport laparoscopy due to incomplete exposure and larger umbilical incisions. With continued development of technique and technology, it has now become possible to fully replicate this gold standard procedure through an LESS approach. First experiences with the newly developed technique and instrument are reported. METHODS: Fifteen patients presenting with cholelithiasis without signs of inflammation were operated using all surgical steps considered appropriate for the conventional four-port laparoscopic approach, but applied through a single access device. Operation-centered outcomes are presented. RESULTS: There were no peri- or postoperative complications. Mean operating time was 32.3 minutes. No conversion to regular laparoscopy was required. The critical view of safety was achieved in all cases. Mean skin incision length was 2.2 cm. CONCLUSION: The application of a standardized technique combined with the use of a four-port LESS device allows us to perform LESS cholecystectomy, giving us a correct exposure of the structures and without increasing the mean operating time combining previously reported advantages of LESS. A universal trait of any new technique should be safety and reproducibility. This will enhance its applicability by large number of surgeons and to large number of patients requiring cholecystectomy.