Laparoscopic Procedures For Treatment Research Articles

Preoperative Diagnosis and Efficacy of Laparoscopic Procedures in the Treatment of Mirizzi Syndrome

The role of laparoscopic procedures in the treatment of Mirizzi syndrome (MS) is not well-defined and remains controversial. We evaluated the preoperative diagnosis and efficacy of laparoscopic procedures in treatment of MS. Preoperative diagnosis and cholecystectomy were attempted on 2,012 consecutive patients at a single center and 24 (1.2%) were finally diagnosed with MS. Patients without preoperative endoscopic retrograde cholangiography underwent preoperative spiral CT after IV infusion cholangiography (IVC-SCT). Fourteen patients had McSherry type I MS (MS I) and 10 had type II MS (MS II). Open operation was performed on patients with MS II or a preoperative suspicion of gallbladder cancer. Laparoscopic cholecystectomy (LC) was performed successfully on 10 of 14 patients with MS I and the remaining 4 patients with MS I were converted to open procedure. At preoperative endoscopic retrograde cholangiography (n = 3) or IVC-SCT (n = 11) on patients with MS I, 3 of 4 (75%) patients who were converted to open operation had a nonvisualized cystic duct, and 9 of 10 (90%) patients with LC had a visualized cystic duct. MS I with a visualized cystic duct can be considered to be an indication for laparoscopic operation. IVC-SCT can be a useful tool for correct preoperative diagnosis and assessment of the feasibility of LC in patients with MS I.

Laparoscopic vagotomy for chronic duodenal ulcer disease.

Two laparoscopic procedures for treatment of chronic duodenal ulcer are described: bilateral truncal vagotomy with balloon pyloric dilatation and posterior truncal vagotomy with anterior lesser curve seromyotomy. The first procedure is simple to perform and easily reproducible, but the latter is preferred because it respects the physiology of the stomach. Thirty-six patients were operated on over a period of 18 months with good results comparable to those with open surgery. The indications for surgery were intractable chronic duodenal ulcers resistant to optimal medical therapy. There was no perioperative morbidity or mortality, and recurrent ulcers have not been demonstrated during early postoperative follow-up. The proper role of laparoscopic surgery in the arsenal of treatment of duodenal ulcers is unclear. The method of laparoscopic vagotomy requires rigorous experimental evaluation in specialized centers before widespread clinical application. Future multicentric prospective studies with long-term follow-up are necessary to assess the results of this innovative therapy of acid-peptic disease.