Surgical endoscopy
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Laparoscopic cholecystectomy is the treatment of choice for gallbladder stones. In the current study, this approach was associated with a higher incidence of biliary injuries. The authors evaluate their experience treating complex biliary injuries and analyze the literature. ⋯ Complex BDIs after laparoscopic cholecystectomy are potentially life-threatening complications. In this study, late complications of complex BDIs appeared when there was a delay in referral or the patient received multiple procedures. On occasion, hepatic resections and liver transplantation proved to be the only definitive treatments with good long-term outcomes and quality of life.
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The proper diagnosis and appropriate treatment are paramount in ensuring a satisfactory outcome after a bile duct injury associated with laparoscopic cholecystectomy. Immediate recognition of a bile duct injury during laparoscopic cholecystectomy can allow proper treatment at that time, averting difficult complications that could occur in the postoperative period should the injury be missed. Unfortunately, most bile duct injuries are not recognized at the time of laparoscopic cholecystectomy. An appropriate level of suspicion followed by prompt and complete evaluation should result in accurate delineation of the biliary anatomy, which is essential for directing appropriate surgical reconstruction.
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The laparoscopic approach for the treatment of sigmoid volvulus has been a rare surgical indication. This phase 2 study investigated the feasibility and surgical outcomes of elective laparoscopic surgery for sigmoid volvulus. ⋯ Considering that patients with sigmoid volvulus often are elderly and chronically ill, laparoscopic elective surgery after a successful colonoscopic decompression may be a good choice for a selected group of patients in terms of minimized surgical complications and quick convalescence.
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Randomized Controlled Trial
Placement of 0.5% bupivacaine-soaked Surgicel in the gallbladder bed is effective for pain after laparoscopic cholecystectomy.
This study aimed to determine the character of pain after laparoscopic cholecystectomy and its relief with 0.5% bupivacaine-soaked Surgicel placed in the gallbladder bed. ⋯ Visceral pain is prominent after laparoscopic cholecystectomy and can be effectively controlled by 0.5% bupivacaine-soaked Surgicel in the gallbladder bed alone. Trocar-site infiltration alone is ineffective.