Cases Of Laparoscopic Cholecystectomy Research Articles

A prospective study comparing routine subhepatic drain vs no drain in patients undergoing simple elective laparoscopic cholecystectomy

Background: Cholelithiasis is one of the major causes of morbidity with prevalence rate of 10-20%. Cholecystectomy is the mainstay of treatment of gall stone disease. Open cholecystectomy was the traditional method of treatment. It has now largely been replaced by laparoscopic cholecystectomy. To put a subhepatic drain in laparoscopic cholecystectomy patients routinely is a big question. Our aim is to find out whether routine use of drains in all patients undergoing elective laparoscopic cholecystectomy to be recommended.Methods: A prospective study of 100 cases was carried out in department of surgery in Heritage Institute of Medical Sciences, Varanasi between January 2020 to august 2021 with the aim of making comparisons between drained & non drained laparoscopic cholecystectomy patients. The patients were randomly assigned into two groups. Group A consists of patients with subhepatic drain and in group B no drains were kept.Results: Patients with subhepatic drains have similar pain as compared to non-drain group in immediate post-operative period but had more pain, discomfort, longer hospital stay and required slightly long time for complete wound healing especially of drain port wound and full recovery.Conclusion: Routine subhepatic drain after every case of laparoscopic cholecystectomy is not necessary especially in clear, uncomplicated cases.

The choice of operation timing of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) for acute cholecystitis: a retrospective clinical analysis.

This study aimed to evaluate the timing of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD). Patients with acute moderate to severe cholecystitis treated by LC after PTGBD in the Department of Hepatobiliary and Pancreatic Surgery, Nankai Hospital (N-362) between January 2017 and August 2019were retrospectively enrolled into this study. According to the interval times from PTGBD to LC, the patients were divided into six groups, including group A (105 cases, within 1 week), group B (62 cases, 1-2 weeks), group C (34 cases, 3-4 weeks), group D (54 cases, 5-8 weeks), group E (24 cases, 9-12 weeks), and group F (83 cases, over 12 weeks). The gender, age, hospital stay, duration of operation, rate of conversion to laparotomy, incidence of complications, and hospitalization expenses of the six groups were evaluated and compared. Of the 362 cases of LC, 346 patients were operated successfully (95.6%), 10 were converted to laparotomy (2.8%), 16 had various complications (4.4%), and 2 died (0.6%). There were no significant differences between groups in the gender ratio, complication rate, and rate of conversion to laparotomy. The hospital stay and hospitalization expenses in group A were the least and significantly lower than those in other groups (P<0.01), and the duration of operation in group D was the longest and significantly higher than that in groups A, B, E, and F (P<0.05). For non-elderly patients diagnosed with acute moderate to severe cholecystitis with an anesthesia risk score [American Society of Anesthesiologists (ASA)] ≤2, LC is recommended to be performed within 1 week after PTGBD surgery. If delayed LC is performed within 2 to 8 weeks after PTGBD, the operation time will be longer due to inflammatory edema and fibrous adhesion of the gallbladder triangle. If PTGBD is performed for more than 2 months and the clinical circumstances are good, delayed LC can be considered to reduce the inconvenience of patients with a long-term catheter as much as possible.

An observational study to assess male gender as an isolated risk factor in the laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy is the procedure of choice for majority of patients with gall bladder disease. The aim of the study was to investigate the role of male gender as an isolated risk factor responsible for the increased peri-operative morbidity of laparoscopic cholecystectomy by excluding associated risk factors.Methods: This was a prospective observational descriptive study 60 cases of elective laparoscopic cholecystectomy admitted to the S. M. S. Hospital from July 2019 to May 2020 were included.Results: The most common age group in male was 41-50 years and in female was 51-60 years. Impacted stones and gall bladder wall thickness &gt;4 mm was causes of difficult cholecystectomy and evenly distributed in both sexes. Operative time (p value=0.268), visual analogue score on day 1 (p value=0.307) and hospital stay (p value=0.376) was more in male group but not statistically significant.Conclusions: Impacted stone and gall bladder wall thickness &gt;4 mm were only factors associated with difficult laparoscopic cholecystectomy and excludes male gender as an isolated risk factor for difficult cholecystectomy however large-scale studies may provide different results.

Anatomical mapping of the biliary tree during laparoscopic cholecystectomy by using indocyanine green dye.

Background:Fluorescent cholangiography using intravenous indocyanine green (ICG) is a noninvasive technique that enables real-time intraoperative imaging of biliary anatomy. The objective of this study was to visualise the biliary anatomy in routine and complicated cases of laparoscopic cholecystectomy (LC).Methods:This was a prospective observational study of patients undergoing LC for various indications. After obtaining consent, 5 mg/1 ml of ICG dye was administered intravenously in each patient, 2 h before the incision time. LC was performed by standard critical view of the safety technique. The biliary tree was visualised using near-infrared (NIR) view before clipping any structure. Intra-operative findings, visibility of ducts in the NIR view, conversion, adverse reactions to ICG and post-operative outcomes in all patients were recorded.Results:Out of 43 patients undergoing LC, 24 had cholelithiasis, 10 had acute cholecystitis, 3 had chronic cholecystitis, 1 had mucocele of the gall bladder, 1 had gall bladder polyp and 4 cases had common bile duct (CBD) stone clearance with endoscopic retrograde cholangiopancreatography. Cystic duct (CD) and CBD were visualised in 100% of cases among all groups except for those with acute cholecystitis where CD and CBD were visualised in 90% and 80% of cases, respectively, and in chronic cholecystitis CD and CBD were visualised in 66.6% and 80% of patients, respectively. There was one elective conversion in the chronic cholecystitis group due to dense adhesions and non-progression. Only the CBD was visualised in this case. There were no cases of CBD injury or any allergic reactions to the dye.Conclusions:Fluorescent cholangiography during LC is a safe and non-invasive method, allowing superior anatomical visualisation of the biliary tree in comparison to simple laparoscopy. This method can correct misinterpretation errors and detect aberrant duct anatomy, thus increasing the confidence of the operating surgeon enabling safe dissection. This simple technique has the potential to become standard practice to avoid bile duct injury during LC.

The efficacy and safety of laparoscopic cholecystectomy using indocyanine green fluoroscopy

Laparoscopic cholecystectomy (LCC) is now accepted as the gold standard for the management of gallbladder diseases. Currently, one of the basic techniques of general surgical residency in Korea is cholecystectomy. However, it is not easy to overcome the learning curve during fellowship period because about 150 cases are required to overcome. Intraoperative imaging using indocyanine green (ICG) might reduce learning curve and the risk of bile duct injury by improving visualization of the biliary tree. We compared the outcomes of LCC in patients with and without ICG. We performed a retrospective review of total 300 conventional LCC cases with and without ICG performed by three surgeons who started the fellowship of hepatobiliary surgery in a single center. The outcomes of LCC with and without ICG were compared using the operation time, the rate of conversion, complications and the length of stay. The median operation time was 43.0 vs. 39.0 min (p = 0.45) in the group with and without ICG, respectively. Without ICG, after the first 50 cases, operation time is gradually diminished and the mean operation time reached a plateau (average = 35 min). In cases of using ICG, after 30 cases experience, we reached plateau. The rate of conversion was 4.6% in the group without ICG, while 2.5% in the group with ICG. Bile duct injury occurred 1% vs. 2.2% in the group with and without ICG, respectively (p < 0.05). LCC with ICG enables a better visualization and identification of biliary tree and should be considered as a means of increasing the safety and reducing learning curve of LCC.

A Study to Compare Single Dose Versus Multidose Antimicrobial Treatment in Elective Laparoscopic Cholecystectomy

Background: Gallstones are the most common cause of emergency hospital admission for people with abdominal pain worldwide. In most of cases they don't cause any symptoms and no need to be treated. Material and methods: A prospective study conducted on 100 patients involving all diagnosed patients of cholelithiasis admitted and supposed to undergo Laparoscopic Cholecystectomy. The first fifty patients undergoing elective Laparoscopic Cholecystectomy will be given injection Ceftriaxone 1.5 gm i.v. after the test dose outside the operation theater in the wards and the antibiotics were continued for 2 days. The next fifty patients were given a single dose of injection Ceftriaxone 1.5 gm i.v. after the test dose just before the induction of anaesthesia. Results: Majority of the cases belongs to 35 patients were in 18-30 years age group, 86 (86%) were females. Our study shows that incidence of Cholelithiasis is more among females which is consistent with general population. Out of the 100 cases of elective Laparoscopic Cholecystectomy, drain were placed in 45 (45%) patients, and no drain required in 55 (55%) of patients. Out of 50 patients of single dose antimicrobial group 32 (64%) developed post-operative fever, 3 patients (6%) had post-operative raised WBC count and 3 patients (6%) had post-operative surgical site infection. Out of 50 patients of multidose antimicrobial group 31 (62%) had post-operative fever, 2 patients (4%) had post-operative raised WBC count and 2 patients (4%) had post-surgical site infection. Conclusion: There is no statistical difference between single dose and multi dose antimicrobial treatment in terms of surgical site infections and post-operative hospital stay.

Port site metastases a year after initial laparoscopic cholecystectomy. Should the use of retrieval bags during laparoscopic cholecystectomy be the new gold standard?

Port site metastases a year after initial laparoscopic cholecystectomy. Should the use of retrieval bags during laparoscopic cholecystectomy be the new gold standard?

Anaotmical variability in the position of cystic artery during laparoscopic visualization

BackgroundThe laparoscopic view of extrahepatic biliary tract and cystic artery is different anatomically from open approach. Consequently iatrogenic injuries due to inadverent damage to cystic artery are not uncommon. These complications can be prevented by careful dissection in Calots triangle and better knowledge of laparoscopic anatomy of cystic artery and its variations. The aim of this study is to establish the prevalence of variation in position of cystic artery in relation to cystic duct. This will help identify the safe area for dissecting peritoneum in Calots triangle and thus help young surgeons overcome the long learning curve associated with laparoscopy.Materials and methodsDuring a 10 year period from January 2009 to January 2019, 1850 laparoscopic cholecystectomies that were performed at a tertiary care hospital were studied. Patients with history of previous abdominal surgery were excluded from the study. Cystic artery was divided into four groups based on its relative position to cystic duct. It includes superomedial, superolateral, anterior and absent cystic artery relative to the cystic duct.ResultsOut of 1850 cases of laparoscopic cholecystectomy 1676 (90.59%) patients had cystic artery superomedial to cystic duct and 96 (5.19%) had a cystic artery at superolateral position to cystic duct. In 48 (2.59%) patients it was found anterior to cystic duct and in 30 (1.62%) patients it was absent.ConclusionsIt is concluded that the most common position of cystic artery is superomedial while the least common position was found to be anterior to cystic duct. Hence it is postulated that blind dissection from anterior side is the safest approach to avoid injury to cystic artery.

811 Should We Be Performing Day Case Laparoscopic Cholecystectomy (DCLC) After 3pm? Correlation Between Time of Operation and Post-Operative Hospital Stay

Abstract Introduction Laparoscopic cholecystectomy (LC) is a common daycase procedure. The British Association of Day Surgery (BADS) Procedure Directory sets out national performance targets for the number of LC’s treated as day cases. This study aimed to assess if operation time predicted unplanned inpatient admission. Method An annonymised retrospective review of all patients undergoing LC. The data was undertaken over two cycles. The first cycle was a 6-month period followed by a second cycle that was undertaken over three months. Data was obtained from multiple sources: discharge letters and the theatre data manager. Results Total number of cases was 160. In the first cycle, the zero night stay for DCLC was 56%, which lies within the top 50% of current national performance but is below the BADS target of 75%. In the second cycle, the zero-night stay was 70%, which falls just below the BADS target. While unplanned admissions resembled 30%. We had 136 cases underwent LC before 3 pm. While 24 cases had their operation after 3 pm. 19 patients out of those 24 stayed at the hospital. Conclusions The timing of operation of DCLC predicts inpatient admission; our data suggests that DCLC should not take place after 3pm in the afternoon.

Laparoscopic Cholecystectomy in a patient with Situs Inversus Totalis

There are diagnostic and therapeutic challenges in cases of symptomatic gall bladder disease in patients with situs inversus totalis (SIT), where there is complete reversal of visceral topography in thorax, abdomen or both. The difficulty to treat these patients with conventional laparoscopic cholecystectomy may be more pronounced for right handed surgeon and requires modifications in working ports and their positions. We present a case of laparoscopic cholecystectomy in a patient with SIT, and describe the technical details that enable the safe conclusion of the operation.&#x0D; Bangladesh Crit Care J March 2021; 9(1): 43-45

Laparoscopic Cholecystectomy Experience in District General Hospital from January 2018 – October 2019

Introduction: Laparoscopic cholecystectomy (LC) is the gold standard treatment for gallstones. However, to avoid serious biliovascular injury, conversion is advocated for distorted anatomy at the Calot’s triangle. This study aimed to review our experience handling elective LC cases, (simple and difficult) as a district general hospital.

Indocyanin greens cholangiography for intra-operative bile duct visualization during pediatric laparoscopic hepato-biliary surgery

Intraoperative cholangiography involving the excretion of fluorescent indocyanine green (NIR/ICG) into the bile is used to determine biliary anatomy in adult laparoscopic cholecystectomy (LC) and other hepatobiliary surgery. This study aimed to evaluate the features of intraoperative ICG cholangiography in 3 cases The 1st case of pediatric LC with previous cholelithiasis & Cholecystitis, and The 2nd and 3rd cases of choledochal cyst with previous pancreatitis then compare the delineation of the hepatic duct (HD), cystic duct (CD), common bile duct (CBD) between ICG cholangiography, magnetic resonance cholangiopancreatography (MRCP) and intraoperative finding. The ICG 0.2 mg/kg was injected intravenously before operation 2 hours to demonstration. We performed 3 cases of pediatric laparoscopic hepato-biliary surgery under NIR/ICG visualization. No conversions to open occurred. No adverse and allergic reactions to NIR/ICG or other postoperative complications were reported. Indocyanin Green cholangiography for intraoperative bile duct visualization during laparoscopic surgery enables a better identification of the biliary tree and thus increases surgical safety.

Study of open cholecystectomy for gallbladder disorders

Background: Cholecystectomy is one of the most common surgeries done worldwide. Most common indication is biliary colic due to cholelithiasis. Presently most cholecystectomies are done by laparoscopic approach, however conversion to open cholecystectomy is needed in few circumstances and there are some absolute indications for open cholecystectomy where laparoscopic procedure can’t be done.Methods: This is a prospective observational study of 50 open cholecystectomies operated during March 2017 to Feb 2019 in our medical college. Various data including demographic data of patients, different indications, post-operative complications were documented and analyzed.Results: Mean age of the patients was 40.58 (16-65) years. Female patients were more in number 32 (64%) when compared with males. Maximum patients were in the age group 31-40 years accounting to 17 (34%) of study population. Pain abdomen 24 (48%) was the chief presenting complaint. Cholelithiasis 38 (76%) was the major indication for surgery. Complications like bile leak, bleeding, subphrenic abscess and infection occurred in 04 (08%) patients. Total four cases of laparoscopic cholecystectomy were converted to open cholecystectomy. Mean hospital stay was 7.48 (5-14) days.Conclusions: Even though laparoscopic cholecystectomy is the gold standard in the present era, it is important that the surgeon is also competent in doing open cholecystectomy. Certain conditions require planned open cholecystectomy as the standard procedure. In difficult laparoscopic cases, the surgeon must take timely decision to convert to the open technique. Surgeons experience and proper clinical judgment skills are important in difficult cases.

Day case laparoscopic cholecystectomy: Identifying patients for a 'COVID-Cold' isolated day-case unit during the pandemic.

The UK practice of laparoscopic cholecystectomy has reduced during the COVID-19 pandemic due to cancellation of non-urgent operations. Isolated day-case units have been recommended as 'COVID-cold' operating sites to resume surgical procedures. This study aims to identify patients suitable for day case laparoscopic cholecystectomy (DCLC) at isolated units by investigating patient factors and unexpected admission. Retrospective analysis of 327 patients undergoing DCLC between January and December 2018 at Ysbyty Gwynedd (District General Hospital; YG) and Llandudno General Hospital (isolated unit; LLGH), North Wales, UK. The results showed that 100% of DCLCs in LLGH were successful; 71.4% of elective DCLCs were successful at YG. Increasing age (p = 0.004), BMI (p = 0.01), ASA Score (p = 0.006), previous ERCP (p = 0.05), imaging suggesting cholecystitis (p = 0.003) and thick-walled gallbladder (p = 0.04) were significantly associated with failed DCLC on univariate analysis. Factors retaining significance (OR, 95% CI) after multiple regression include BMI (1.82, 1.05-3.16; p = 0.034), imaging suggesting cholecystitis (4.42, 1.72-11.38; p = 0.002) and previous ERCP (5.25, 1.53-18.00; p = 0.008). Postoperative complications are comparable in BMI <35kg/m2 and 35-39.9kg/m2. Current patient selection for isolated day unit is effective in ensuring safe discharge and could be further developed with greater consideration for patients with BMI 35-39.9kg/m2. As surgical services return, this helps identify patients suitable for laparoscopic cholecystectomy at isolated COVID-free day units.

The Study of Laparoscopic Cholecystectomy in Acute Cholecystitis, Complication and Management: Analysis of 150 Cases in the Ibn Sina Medical College, Bangladesh

Background: Laparoscopic Cholecystectomy has now become a better option instead of the Open Cholecystectomy for treatment of Cholelithiasis that it has been a gold standard for the Cholelithiasis condition throughout the Globe. Last century was the most fruitful era for the treatment of the biliary tract disease as it has already proved the progress from the open to laparoscopic surgery with a single port surgery.&#x0D; Methods: The purpose of our study is to grading of the Laparoscopic Cholecystectomy in Acute Cholecystits and has been studying the outcome of problematic and challenging Laparoscopic Cholecystectomy cases, its’ complication (s) and management to decide when to converting Laparoscopic Cholecystectomy to Open Cholecystectomy. The study analyzes the conversion rate of Laparoscopic Cholecystectomy in the Ibn Sina Medical College, Kallyanpur, Dhaka, Bangladesh. This is a retrospective study of 150 patients (Male - 75% and Female - 25%) which was conducted during the period from January 2015 to January 2017.&#x0D; Results: Out of the 150 cases 140 (93%) had been successfully operated by Laparoscopic Cholecystectomy. And, only 10 (7%) cases (out of a total of 150) got converted from the Laparoscopic to Open Cholecystectomy and they belonged to Grade - E with severely contracted gallbladder, morbid adhesion, short cystic duct and bile duct injury.&#x0D; Conclusions: The Laparoscopic Cholecystectomy has familiar as a unique procedure of choice for the management of symptomatic gall bladder. Laparoscopic Cholecystectomy intra operatively for grade A to E where Grade A is very easy level to perform Gall Bladder Surgery to Grade E where conversion is 115% due to bad.&#x0D; Bangladesh Journal of Medical Science Vol.20(2) 2021 p.318-322

Healthcare utilization associated with adherence to antibiotics for abdominal surgeries in Japan: cross-sectional analysis of administrative database.

Since patients receiving surgery may experience surgical site infections, therapeutic guidelines for reducing hospitalization time and cost include appropriate antibiotic use. However, the association between adherence to therapeutic guidelines and healthcare utilization is currently unclear. This study aimed to confirm the positive association between the adherence to guidelines of antibiotic therapy and a reduction in the length of stay and cost of hospitalization, especially considering the high infection rates in abdominal surgery. This cross-sectional study used administrative data (diagnosis procedure combination data) collected using the case-mix system implemented in acute-care hospitals in Japan. We assessed the length of hospital stay and cost of hospitalization for patients who received prophylactic antibiotic for abdominal surgeries consistent with therapeutic guidelines. The data of patients aged 15 years or older who received appendectomy, laparoscopic cholecystectomy or inguinal hernia repair were extracted. The appropriateness of antibiotic prophylaxis was evaluated in terms of the Japanese guidelines for antibiotic selection and treatment duration. To assess the mean difference in antibiotic costs and length of stay, we performed the propensity score matching by confounding factors. Furthermore, we assessed the progress in healthcare utilization of this therapy over a decade. Of the 302 233 patients who received single general surgery from April 2014 to March 2016, 198 885 were eligible for analysis after applying the exclusion criteria (143 975 in the adherence and 54 910 in the non-adherence group). Each group comprised 48 439 patients after propensity score matching. Inappropriate antibiotic selection and duration were observed in 9294 (9.8%) and 687 (0.7%) of inguinal hernia repairs, 6431 (25.3%) and 311 (1.2%) of appendectomies and 38 134 (48.5%) and 391 (0.5%) of laparoscopic cholecystectomy cases, respectively. After propensity score matching by operation type, average hospitalization length (6.5 [SD 3.8] and 7.3 [SD 4.8] days) and costs (536 000 [SD 167 000] JPY and 573 000 [SD 213 000] JPY) differed significantly between adherence and non-adherence groups. The results revealed that unnecessary healthcare utilization was associated with failure to adhere to therapeutic guidelines for prophylactic antibiotic therapy in elective general surgeries. We concluded that the progress of reduction in length of hospitalization over the decade was successful. Notably, adherence to treatment duration was better than that was 10 years ago. In this decade, administrators in hospitals have attempted to reduce the duration of hospitalization by developing various clinical pathways for surgical procedures and quality indicators. However, 15 877 patients (8.7%) were prescribed oral antibiotics the day after surgery. These observations should be evaluated further.

Efficiency of Increasing Prospective Resident Entrustment in the Operating Room

BackgroundProspective resident entrustment (i.e., trust an attending surgeon intends to give to a resident in the near future) in the operating room (OR) closely associates with granted future autonomy. However, the process of determining resident entrustment takes time and effort. Thus, this study aimed to assess the efficiency of granting incremental resident entrustment for upcoming surgical cases. MethodsWe analyzed prospective resident entrustment of 6 chief residents in 76 cases of laparoscopic cholecystectomy, laparoscopic colectomy, ventral hernia, and inguinal hernia scored by attending surgeon, resident, and a surgeon observer. Matched direct costs and operative time were extracted from hospital billing. We assessed the efficiency of granting incremental prospective resident entrustment with direct cost per minute incurred in the evaluated case. Effect size was computed to assess the differences between groups. ResultsSixty-three cases (82.9%) were matched; 47.6% (30/63) of matched cases received prospective resident entrustment score ≥ 4. The direct cost per minute increased in three procedures (laparoscopic cholecystectomy, laparoscopic colectomy, and ventral hernia) with increased intention of granting incremental resident entrustment. Inguinal hernia was the only procedure in which chiefs were entrusted with future independence while the direct cost per minute decreased. ConclusionsOur findings demonstrate more time and effort are required (except for inguinal hernia) for residents to be entrusted with increased independence in the future. Faculty and resident development programs are recommended to improve the efficiency of the process of granting incremental operative entrustment to optimize resident training quality and cost of care delivery.

Surgical Simulation and Navigation for HPB Surgery

Introduction: In Japan, preoperative 3D simulation and navigation are becoming popular in hepato-biliary-pancreatic (HPB) surgery. Herein, we report various surgical simulations and navigations in HPB surgery in our department. Methods:i)We have developed a novel liver surgical navigation system that measures the shape of liver, its position, the cut surface/cut line in real time and gives feedback to the simulation software, using 3D camera.ii)ICG fluorescence navigation has been performed in seven cases of laparoscopic cholecystectomy. ICG fluorescence was observed with VISERA ELITE II (Olympus Co., Ltd., Tokyo).iii)We perform simulation and navigation using 3DCT image when performing pancreatectomy. Results:i)A total of six cases have been performed: lateral, posterior segmentectomy and left, right lobectomy. The surgical field of a hepatectomy that progresses during the real operation was measured with two 3D cameras. The group of measurement points was converted to polygon, and the cut line was extracted. The position of the cut surface/cut line was projected on the 3DCG model.ii)Although the ICG fluorescence intensity in the bile duct was slightly weak and difficult to confirm in 3 cases with high inflammation, ICG fluorescence navigation was effective in 4 cases in which bile duct was confirmed.iii)In pancreatectomy, important blood vessels such as hepatic artery, GDA, SMA, SMV, and pancreatic arcade can be routinely confirmed by 3DCT before and during surgery, so that we were able to perform the operation safely. Conclusions: Surgical simulation and navigation for HPB surgery have become indispensable.

Suture Closure Using a Barbed Suture in Five Cases of Laparoscopic Subtotal Cholecystectomy

Suture Closure Using a Barbed Suture in Five Cases of Laparoscopic Subtotal Cholecystectomy

A case of early laparoscopic cholecystectomy for gallbladder metastasis from breast cancer with acute cholecytetis

A case of early laparoscopic cholecystectomy for gallbladder metastasis from breast cancer with acute cholecytetis