Intraoperative ERCP for Management of Gallbladder and Common Bile Duct Stones

It is not an uncommon scenario to have CBD stones in association with gallbladder stones. There is a general agreement in the surgical society that CBD stones should be removed. The classic option is to do open cholecystectomy and CBD exploration. With the emergence of minimally invasive surgery, namely laparoscopic cholecystectomy and ERCP, the therapist has better option to treat such patients such as preoperative ERCP, postoperative ERCP, and laparoscopic CBD exploration. The latest advance in that field is the use of ERCP at the time of laparoscopic cholecystectomy, i.e. intraoperative ERCP. This chapter with discuss the issue of minimally invasive management of cholecystocholedocholithiasis stressing on intraoperative ERCP

Tulžies latakų akmenligė: ligos įtarimas, diagnozė, gydymas

Bile duct stones are a quite common (10–18%) complication of gallstone disease or an autonomous condition. New noninvasive diagnostic methods established in the last decades allow to confirm suspected choledocholithiasis with minimal risk of iatrogenic complications.In this literature review we discuss various scores for choledocholithiasis risk degree, different diagnostic investigations and management approaches including timing for invasive procedures.Tulžies latakų akmenys – gana dažna (10–18 %) tulžies pūslės akmenligės komplikacija ar savarankiška patologija. Pastaraisiais dešimtmečiais atsiradę nauji neinvaziniai diagnostikos metodai leidžia patikslinti įtariamą tulžies latakų akmenligės diagnozę minimalizavus jatrogeninių komplikacijų riziką.Šioje literatūros apžvalgoje aptariamos rizikos vertinimo sistemos, leidžiančios apsispręsti dėl papildomų tyrimų tikslingumo, pristatomi įvairūs diagnostiniai metodai, skirtingos gydymo ir tyrimo taktikos, aptariamas gydymo laiko pasirinkimas

Tokyo Guidelines 2018 surgical management of acute cholecystitis:safe steps in laparoscopic cholecystectomy for acute cholecystitis (with videos)

In some cases, laparoscopic cholecystectomy (LC) may be difficult to perform in patients with acute cholecystitis (AC) with severe inflammation and fibrosis. The Tokyo Guidelines 2018 (TG18) expand the indications for LC under difficult conditions for each level of severity of AC. As a result of expanding the indications for LC to treat AC, it is absolutely necessary to avoid any increase in bile duct injury (BDI), particularly vasculo-biliary injury (VBI), which is known to occur at a certain rate in LC. Since the Tokyo Guidelines 2013 (TG13), an attempt has been made to assess intraoperative findings as objective indicators of surgical difficulty; based on expert consensus on these difficulty indicators, bail-out procedures (including conversion to open cholecystectomy) have been indicated for cases in which LC for AC is difficult to perform. A bail-out procedure should be chosen if, when the Calot's triangle is appropriately retracted and used as a landmark, a critical view of safety (CVS) cannot be achieved because of the presence of nondissectable scarring or severe fibrosis. We propose standardized safe steps for LC to treat AC. To achieve a CVS, it is vital to dissect at a location above (on the ventral side of) the imaginary line connecting the base of the left medial section (Segment 4) and the roof of Rouviere's sulcus and to fulfill the three criteria of CVS before dividing any structures. Achieving a CVS prevents the misidentification of the cystic duct and the common bile duct, which are most commonly confused. Free full articles and mobile app of TG18 are available at: . Related clinical questions and references are also include

Laparoscopic Sleeve Gastrectomy Outcomes of 750 Patients: A 2.5-Year Experience at a Bariatric Center of Excellence

Laparoscopic sleeve gastrectomy (LSG) is gaining popularity worldwide. This retrospective cohort study evaluated the outcomes of a large cohort of patients with obesity who underwent LSG in a Bariatric Center of Excellence. All consecutive patients who underwent LSG between July 2013 and April 2016 were identified retrospectively. Preoperative and postoperative variables and comorbidities were recorded. The study consisted of 750 patients. Their mean age was 37.4 years; 72% were women, and the mean body mass index was 42.8 kg/m2. The most common preoperative comorbidities were diabetes (23.3%), hyperlipidemia (21.9%), hypertension (21.1%), and obstructive sleep apnea (21.1%). The rates of comorbidity resolution during follow-up were 80.6%, 74.4%, 82.9%, and 94.3%, respectively. The percentage average excess weight loss 1, 3, and 6 months and 1 and 2 years after surgery was 29.4% +/- 11.3%, 54.4% +/- 17.7%, 76.9% +/- 20.9%, 85.5% +/- 23.6%, and 89.7% +/- 27.6%, respectively. There was no mortality. LSG effectively and safely induced weight loss and comorbidity resolution