Laparoscopic Resection of Cholecystocolic Fistula and Subtotal Cholecystectomy by Tri-Staple in a Type V Mirizzi Syndrome

The Mirizzi syndrome (MS) is an impacted stone in the cystic duct or Hartmann’s pouch that mechanically obstructs the common bile duct (CBD). We would like to report laparoscopic subtotal cholecystectomy (SC) and resection of cholecystocolic fistula by the help of Tri-Staple™ in a case with type V MS and cholecystocolic fistula, for first time in the literature. A 24-year-old man was admitted to emergency department with the complaint of abdominal pain, intermittent fever, jaundice, and diarrhea. Two months ago with the same complaint, ERCP was performed. Laparoscopic resection of cholecystocolic fistula and subtotal cholecystectomy were performed by the help of Tri-Staple. At the eight-month follow-up, he was symptom-free with normal liver function tests. In a patient with type V MS and cholecystocolic fistula, laparoscopic resection of cholecystocolic fistula and SC can be performed by using Tri-Staple safely

Laparoscopic Resection of Cholecystocolic Fistula and Subtotal Cholecystectomy by Tri-Staple in a Type V Mirizzi Syndrome

The Mirizzi syndrome (MS) is an impacted stone in the cystic duct or Hartmann’s pouch that mechanically obstructs the common bile duct (CBD). We would like to report laparoscopic subtotal cholecystectomy (SC) and resection of cholecystocolic fistula by the help of Tri-Staple™ in a case with type V MS and cholecystocolic fistula, for first time in the literature. A 24-year-old man was admitted to emergency department with the complaint of abdominal pain, intermittent fever, jaundice, and diarrhea. Two months ago with the same complaint, ERCP was performed. Laparoscopic resection of cholecystocolic fistula and subtotal cholecystectomy were performed by the help of Tri-Staple. At the eight-month follow-up, he was symptom-free with normal liver function tests. In a patient with type V MS and cholecystocolic fistula, laparoscopic resection of cholecystocolic fistula and SC can be performed by using Tri-Staple safely

The effect of payment and working system of specialist surgeons on the rate of negative appendectomy in different types of hospitals in Turkey

Aim. The negative outcome following appendectomy in those with presumptive diagnosis of acute appendicitis varies from 10-20%. We aimed to evaluate the rate of negative appendectomies and to investigate whether the fee-for-service policy and working system of hospitals for doctors increases the rate of negative appendectomies or not. Methods. The number of appendectomies with the presumptive diagnosis of acute appendicitis in Turkey is 85350 in 2010; 3437 patients selected by simple random sampling from randomly selected 42 hospitals. The effect of payment system and working system of state, private and university hospitals for doctors on the rate of negative appendectomies were evaluated. Fee for service payment system is valid in the state and private hospitals. Specialist surgeons are on duty for 24 hours in state hospitals. Results. The negative appendectomy rate was 13.5% in state hospitals, 18.5% in university hospitals and 20.8% in private hospitals. The rate of negative appendectomy in state hospitals in which surgeons were on duty for 24 hours was significantly lower than the university and private hospitals in which surgeons were on call (p<0.001) Fee for service had no direct effect on the rate of negative appendectomy, since this rate was higher in private hospitals, and lowest in the state hospitals. Conclusion. The negative appendectomy rate was significantly lower in state hospitals where the specialist surgeons were on duty for 24 hours. The data obtained is contradictory to the common belief that payment policy increases the negative appendectomy rates