Laparoscopic cholecystectomy can be performed safely with only three ports in the majority of cases.

Reducing the number of ports used to perform laparoscopic cholecystectomy (LC) is indicated as means of further minimising postoperative pain, allowing a rapid return to activity and work, and obtaining patient satisfaction and better cosmetic results. It is still debatable whether the three-port technique is comparably safe. Since 2001, 374 consecutive patients underwent laparoscopic cholecystectomy in elective and emergency surgery. Three ports were routinely positioned and the need for a fourth cannula was evaluated during the surgical procedure. Of the 374 consecutive cholecystectomies performed, 204 were completed with three ports and 161 needed a fourth port to be completed, while 9 required conversion to laparotomy. Patients who were operated on with just three ports were significantly younger and mostly female. Complications of procedures completed with three ports were negligible and those of procedures completed with four ports were in line with the recent literature. Our experience shows that the three-port technique is always a good initial option when performing laparoscopic cholecystectomy. It is safe and requires conversion to four-port placement in only a minority of cases overall.

Hydatid cyst of the liver: spontaneous rupture with peritoneal and thoracic involvement. Report of a case.

Hydatidosis due to Echinococcus granulosus is an endemic parasitic disease in Mediterranean countries. The most frequent anatomical locations are the liver and lung and the most significant complication of liver hydatidosis is rupture into the biliary tract. Spontaneous rupture into the free peritoneal cavity associated with thoracic involvement is an unusual complication accompanied by a high mortality rate. An isolated abdominal approach is necessary when peritoneal cavity drainage is required and may be sufficient in cases of contamination of the pleural cavity by scolices without suppurative involvement. An unusual case of spontaneous rupture of a hydatid cyst of the liver into the free peritoneal cavity associated with diaphragmatic and pleural involvement is reported. This complication requires immediate surgical treatment consisting in a combined thoracic and abdominal approach. The isolated abdominal approach not requiring thoracotomy may be satisfactory if there is no intrathoracic damage due to the chronic presence of scolices. Intrabdominal and intrathoracic cyst rupture still remains a serious complication because of the complexity of the lesions which are often difficult to treat in a one-stage operation. The mortality remains high in various series.

Wide rectal duplication cyst in an adult resected by anterior approach: efficacy and recurrence.

Alimentary tract duplications are uncommon congenital abnormalities usually diagnosed and treated in childhood. Rectal involvement is extremely rare. We report the case of a 22-year-old female who presented with chronic abdominal and perianal pain; feeling of rectal fullness. Workup revealed a rectal duplication cyst. The patient underwent a complete transabdominal excision of the cyst: an hybrid laparoscopic and laparotomic technique was adopted. The hybrid isolated anterior abdominal approach is safe and feasible even for the treatment of wide rectal duplication cysts. Real recurrence in rectal duplication cysts is uncommon when the first operation was performed with radical intent.

Laparoscopic treatment of Morgagni-Larrey hernia: technical details and report of a series.

Three patients with Morgagni-Larrey hernia were admitted to the surgical department between August 2000 and September 2003 with slight chest pain and dyspnea. Laparoscopic repair of the diaphragmatic hernia was performed using a tension-free closure of the defects with either Vicryl-Prolene or dual facing mesh fixed by Prolene extracorporeal knots and Endostitch devices. The patients were discharged on postoperative day 5 without complications. Mean follow-up has been 23 months (range, 15-36 months) and no recurrence or morbidity related to the procedure has been seen. Laparoscopic repair of Morgagni-Larrey hernia represents an attractive alternative to open surgery. The benefits are gentle and easy manipulation of the content of the sac, reduced surgical trauma, and rapid and uneventful recovery.