Tripartite comparison of single-incision and conventional laparoscopy in cholecystectomy: A multicenter trial

AIM: To compare the characteristics of two singleincision methods, and conventional laparoscopy in cholecystectomy, and demonstrate the safety and feasibility.METHODS: Three hundred patients with gallstones or gallbladder polyps were admitted to two clinical centers from January 2013 to January 2014 and were randomized into three groups of 100: single-incision three-device group, X-Cone group, and conventional group. The operative time, intraoperative blood loss, complications, postoperative pain, cosmetic score, length of hospitalization, and hospital costs were compared, with a follow-up duration of 1 mo.RESULTS: A total of 142 males(47%) and 158 females(53%) were enrolled in this study. The population characteristics of these three groups is no significant differences exist in terms of age, sex, body mass index and American Society of Anesthesiology(P > 0.05). In results, there were no significant differences in blood loss, length of hospitalization, postoperative complications.The operative time in X-Cone group was significantly longer than other groups.There were significant differences in postoperative pain scores and cosmetic scores at diffent times after surgery(P < 0.05).CONCLUSION: This study shows that this two singleincision methods are safe and feasible. Both methods are superior to the conventional procedure in cosmetic and pain scores.

Evaluating risk factors for surgical site infections and the effectiveness of prophylactic antibiotics in patients undergoing laparoscopic cholecystectomy

BACKGROUND Surgical site infections(SSIs)are a significant complication in laparoscopic cholecystectomy(LC),affecting patient outcomes and healthcare costs.AIM To identify risk factors associated with SSIs and evaluate the effectiveness of prophylactic antibiotics in reducing these infections.METHODS A comprehensive retrospective evaluation was conducted on 400 patients who underwent LC from January 2022 to January 2024.Patients were divided into infected(n=36)and non-infected(n=364)groups based on the occurrence of SSIs.Data collected included age,diabetes mellitus status,use of prophylactic antibiotics,and specific surgical complications.Statistical analyses using SPSS(Version 27.0)involved univariate and multivariate logistic regression to determine factors influencing the risk of SSIs.RESULTS The use of prophylactic antibiotics significantly reduced the incidence of SSIs(χ²=68.34,P<0.01).Older age(≥60 years)and comorbidities such as diabetes mellitus were identified as significant risk factors.Surgical complications like insufficient cystic duct stump,gallbladder perforation,and empyema also increased SSI risk.Notably,factors such as intraoperative blood loss and operation time did not significantly impact SSI occurrence.CONCLUSION Prophylactic antibiotics are effective in reducing the risk of SSIs in patients undergoing LC.Age,diabetes mellitus,and certain surgical complications significantly contribute to the risk.Effective management of these risk factors is essential to improve surgical outcomes and reduce the incidence of SSIs.

Near-infrared cholangiography with intragallbladder indocyanine green injection in minimally invasive cholecystectomy

Laparoscopic cholecystectomy(LC)remains one of the most commonly performed procedures in adult and paediatric populations.Despite the advances made in intraoperative biliary anatomy recognition,iatrogenic bile duct injuries during LC represent a fatal complication and consist an economic burden for healthcare systems.A series of methods have been proposed to prevent bile duct injury,among them the use of indocyanine green(ICG)fluorescence.The most commonly reported method of ICG injection is the intravenous administration,while literature is lacking studies investigating the direct intragallbladder ICG injection.This narrative mini-review aims to assess the potential applications,usefulness,and limitations of intragallbladder ICG fluorescence in LC.Authors screened the available international literature to identify the reports of intragallbladder ICG fluorescence imaging in minimally invasive cholecystectomy,as well as special issues regarding its use.Literature search retrieved four prospective cohort studies,three case-control studies,and one case report.In the three case-control studies selected,intragallbladder near-infrared cholangiography(NIRC)was compared with standard LC under white light,with intravenous administration of ICG for NIRC and with standard intraoperative cholangiography(IOC).In total,133 patients reported in the literature have been administered intragallbladder ICG administration for biliary mapping during LC.Literature includes several reports of intragallbladder ICG administration,but a standardized technique has not been established yet.Published data suggest that NIRC with intragallbladder ICG injection is a promising method to achieve biliary mapping,overwhelming limitations of IOC including intervention and radiation exposure,as well as the high hepatic parenchyma signal and time interval needed in intravenous ICG fluorescence.Evidence-based guidelines on the role of intragallbladder ICG fluorescence in LC require the assessment of further studies and multicenter data collection into large registries.

Analysis of the Effect of Laparoscopic Versus Open Cholecystectomy in Patients with Cholelithiasis and the Effect on CRP and IL-1βLevels

Objective:To evaluate the therapeutic effect of laparoscopic cholecystectomy(LC)and open cholecystectomy(OC)on cholelithiasis.Methods:92 cases of cholelithiasis patients admitted to the hospital in the past 2 years were selected and grouped by random number table;the observation group was treated with LC;the reference group was treated with OC,and the inflammatory factor and other indexes were compared.Results:The total effective rate of the observation group was higher than that of the reference group,and the perioperative indexes were better than that of the reference group(P<0.05).Preoperatively,the C-reactive protein(CRP)and interleukin-1β(IL-1β)levels and immune function indexes of the two groups were compared,and no difference was seen(P>0.05).At 5 days postoperatively,the CRP and IL-1βlevels of the observation group were lower than those of the reference group,and the immune function indicators were higher than those of the reference group(P<0.05).The complication rate of the observation group was lower than that of the reference group(P<0.05).Conclusion:LC can increase the effective rate of cholelithiasis patients,improve their perioperative indexes,reduce the inflammatory response,protect patients’immune function,and ensure higher surgical safety.

Clinical Outcomes of Complete Mesocolic Excision for Right-Sided Colon Cancer Using 3D Laparoscopy versus 2D Laparoscopy

Objective:To study the clinical outcomes of complete mesocolic excision(CME)for right-sided colon cancer using 3D(three-dimensional)laparoscopy compared to 2D(two-dimensional)laparoscopy.Methods:From January 2022 to December 2023,58 patients with right-sided colon cancer treated at the Affiliated Hospital of Hebei Engineering University were randomly divided into a 3D laparoscopy group(observation group)and a 2D laparoscopy group(control group),with 29 patients in each group.Intraoperative blood loss,postoperative time to first flatulence,length of hospital stay,and incidence of complications in both groups were recorded.Results:There was a statistically significant difference in intraoperative blood loss between the two groups(P<0.05).There was no statistically significant difference in the time to first flatulence between the groups(P>0.05).However,there was a statistically significant difference in the length of hospital stay(P<0.05)and the incidence of complications(P<0.05)between the two groups.Conclusion:3D laparoscopy for CME can reduce intraoperative blood loss,shorten hospital stay,and decrease postoperative complications,showing significant clinical advantages over traditional 2D laparoscopy.

Evaluating effectiveness and safety of combined percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in acute cholecystitis patients:Meta-analysis

BACKGROUND Acute cholecystitis(AC)is a common disease in general surgery.Laparoscopic cholecystectomy(LC)is widely recognized as the"gold standard"surgical procedure for treating AC.For low-risk patients without complications,LC is the recommended treatment plan,but there is still controversy regarding the treatment strategy for moderate AC patients,which relies more on the surgeon's experience and the medical platform of the visiting unit.Percutaneous transhepatic gallbladder puncture drainage(PTGBD)can effectively alleviate gallbladder inflammation,reduce gallbladder wall edema and adhesion around the gallbladder,and create a"time window"for elective surgery.AIM To compare the clinical efficacy and safety of LC or PTGBD combined with LC for treating AC patients,providing a theoretical basis for choosing reasonable surgical methods for AC patients.METHODS In this study,we conducted a clinical investigation regarding the combined use of PTGBD tubes for the treatment of gastric cancer patients with AC.We performed searches in the following databases:PubMed,Web of Science,EMBASE,Cochrane Library,China National Knowledge Infrastructure,and Wanfang Database.The search encompassed literature published from the inception of these databases to the present.Subsequently,relevant data were extracted,and a meta-analysis was conducted using RevMan 5.3 software.RESULTS A comprehensive analysis was conducted,encompassing 24 studies involving a total of 2564 patients.These patients were categorized into two groups:1371 in the LC group and 1193 in the PTGBD+LC group.The outcomes of the meta-analysis revealed noteworthy disparities between the PTGBD+LC group and the LC group in multiple dimensions:(1)Operative time:Mean difference(MD)=17.51,95%CI:9.53-25.49,P<0.01;(2)Conversion to open surgery rate:Odds ratio(OR)=2.95,95%CI:1.90-4.58,P<0.01;(3)Intraoperative bleeding loss:MD=32.27,95%CI:23.03-41.50,P<0.01;(4)Postoperative hospital stay:MD=1.44,95%CI:0.14-2.73,P=0.03;(5)Overall postoperative compli-cation rate:OR=1.88,95%CI:1.45-2.43,P<0.01;(6)Bile duct injury:OR=2.17,95%CI:1.30-3.64,P=0.003;(7)Intra-abdominal hemorrhage:OR=2.45,95%CI:1.06-5.64,P=0.004;and(8)Wound infection:OR=0.These find-ings consistently favored the PTGBD+LC group over the LC group.There were no significant differences in the total duration of hospitalization[MD=-1.85,95%CI:-4.86-1.16,P=0.23]or bile leakage[OR=1.33,95%CI:0.81-2.18,P=0.26]between the two groups.CONCLUSION The combination of PTGBD tubes with LC for AC treatment demonstrated superior clinical efficacy and enhanced safety,suggesting its broader application value in clinical practice.

Hem-o-lok clip migration to duodenal bulb post-cholecystectomy:A case report

BACKGROUND Hem-o-lok clips are typically used to control the cystic duct and vessels during laparoscopic cholecystectomy(LC)and common bile duct exploration for stones in the bile duct and gallbladder.Here,we report a unique example of Hem-o-lok clip movement towards the duodenal bulb after LC,appearing as a submucosal tumor(SMT).Additionally,we provide initial evidence of gradual and evolving endoscopic manifestations of Hem-o-lok clip migration to the duodenal bulb wall and review the available literature.CASE SUMMARY A 72-year-old man underwent LC for gallstones,and Hem-o-lok clips were used to ligate both the cystic duct and cystic artery.Esophagogastroduodenoscopy(EGD)2 years later revealed an SMT-like lesion in the duodenal bulb.Due to the symptomatology,the clinical examination did not reveal any major abnormalities,and the patient was followed up as an outpatient.A repeat EGD performed 5 months later revealed an SMT-like lesion in the duodenal bulb with raised edges and a central depression.A third EGD was conducted,during which a Hem-o-lok clip was discovered connected to the front side of the duodenum.The clip was extracted easily using biopsy forceps,and no complications occurred.Two months after the fourth EGD,the scar was surrounded by normal mucosa.CONCLUSION Clinicians should be aware of potential post-LC complications.Hem-o-lok clips should be removed if symptomatic.

Are outcomes for emergency index-admission laparoscopic cholecystectomy performed by hepatopancreatobiliary surgeons better compared to non-hepatopancreatobiliary surgeons?A 10-year audit using 1:1 propensity score matching

Background:Emergency index-admission cholecystectomy(EIC)is recommended for acute cholecystitis in most cases.General surgeons have less exposure in managing“difficult”cholecystectomies.This study aimed to compare the outcomes of EIC between hepatopancreatobiliary(HPB)versus non-HPB surgeons.Methods:This is a 10-year retrospective audit on patients who underwent EIC from December 2011 to March 2022.Patients who underwent open cholecystectomy,had previous cholecystitis,previous endoscopic retrograde cholangiopancreatography or cholecystostomy were excluded.A 1:1 propensity score matching(PSM)was performed to adjust for confounding variables(e.g.age≥75 years,history of abdominal surgery,presence of dense adhesions).Results:There were 1409 patients(684 HPB cases,725 non-HPB cases)in the unmatched cohort.Majority(52.3%)of them were males with a mean age of 59.2±14.9 years.Among 472(33.5%)patients with EIC performed≥72 hours after presentation,40.1%had dense adhesion.The incidence of any morbidity,open conversion,subtotal cholecystectomy and bile duct injury were 12.4%,5.0%,14.6%and 0.1%,respectively.There was one mortality within 30 days from EIC.PSM resulted in 1166 patients(583 per group).Operative time was shorter when EIC was performed by HPB surgeons(115.5 vs.133.4 min,P<0.001).The mean length of hospital stay was comparable.EIC performed by HPB surgeons was independently associated with lower open conversion[odds ratio(OR)=0.24,95%confidence interval(CI):0.12–0.49,P<0.001],lower fundus-first cholecystectomy(OR=0.58,95%CI:0.35–0.95,P=0.032),but higher subtotal cholecystectomy(OR=4.19,95%CI:2.24–7.84,P<0.001).Any morbidity,bile duct injury and mortality were comparable between the two groups.Conclusions:EIC performed by HPB surgeons were associated with shorter operative time and reduced risk of open conversion.However,the incidence of subtotal cholecystectomy was higher.

Missed Pancreaticobiliary Malignancy: The Flaw of the Expedited Cholecystectomy

Background: Early cholecystectomy has been recommended for patients with acute cholecystitis and gallstone pancreatitis. However, patients with pancreaticobiliary malignancy may present acutely with similar symptoms. We hypothesize that the diagnoses of these malignancies may potentially be delayed as an unintended consequence of expedited cholecystectomies. This study reviews a cohort of patients who underwent pancreaticoduodenectomy (PD) to identify those who underwent a separate cholecystectomy before their PD. Methods: We retrospectively reviewed 162 PDs performed between 2012 and 2022. Data collected included: demographics, disease etiology and the presence of cholelithiasis. We identified patients who had a previous cholecystectomy and the time elapsed before PD as well as procedures done during the interval. We reported detailed case summaries on those patients who had a cholecystectomy within 1 year of PD. Results: In the entire cohort, mean age was 65 years, 54% were males, and 83% had a malignant reason for PD. Thirty-one patients had cholelithiasis with 23 (14%) patients having had previous cholecystectomy. Six patients had cholecystectomy within 1 year of PD. They had the following malignancies: ampullary—3, pancreas—1, cholangiocarcinoma—1 and neuroendocrine—1. Four of these patients had expedited cholecystectomy on their index hospital admission and were later found to have a periampullary malignancy with further work up. Conclusions: Pancreaticobiliary malignancies can be difficult to diagnose, and surgeons should not overlook these potential diagnoses when considering expedited cholecystectomy. Future studies in large cohorts are needed to identify high risk candidates who should undergo more detailed testing to exclude malignancy before proceeding with cholecystectomy.

A Case Report and Literature Review: A Case of Delayed Bile Leakage Following Laparoscopic Cholecystectomy

Background: Delayed bile leakage after laparoscopic cholecystectomy, defined as occurring more than 72 hours after surgery, is a rare and serious complication of laparoscopic cholecystectomy, with an incidence rate of 0.060%. Case Declaration: This case report details a patient diagnosed with delayed bile leakage 43 days after laparoscopic cholecystectomy. The patient was discharged from our hospital after undergoing CT-guided puncture treatment, with no obvious complications identified. The patient was monitored for one year following the procedure, during which time no significant discomfort was reported. Objective: This case report is to analyse and review the clinical manifestations, diagnosis, treatment and prevention of delayed bile leakage after cholecystectomy, with reference to the relevant literature. Results: Delayed bile leakage after laparoscopic cholecystectomy can be prevented, although not eliminated. It is recommended that the operator treat the operation with caution, avoid taking risks, and adhere to careful procedures and strict separation according to the requirements. This approach is key to preventing late bile leakage in the postoperative period.

Radical cholecystectomy without liver resection for peritoneal side early incidental gallbladder cancer

Gallbladder cancer(GBC)is a rare disease with a poor prognosis.Simple cholecystectomy may be an adequate treatment only for very early disease(Tis,T1a),whereas reoperation is recommended for more advanced disease(T1b and T2).Radical cholecystectomy should have two fundamental objectives:To radically resect the liver parenchyma and to achieve adequate clearance of the lymph nodes.However,recent studies have shown that compared with lymph node dissection alone,liver resection does not improve survival outcomes.The oncological roles of lymphadenectomy and liver resection is distinct.Therefore,for patients with incidental GBC without liver invasion,hepatic resection is not always mandatory.

A new abdominal drainage tube fixation method for 3-port laparoscopic cholecystectomy improves patients’postoperative quality of life

Objective Laparoscopic surgery has become a routine general surgery with many advantages,such as alleviating abdominal pain.However,postoperative pain caused by abdominal drainage tubes has attracted little attention from medical staff.The aim of this study was to explore the influence of a new abdominal drainage tube fixation method for 3-port laparoscopic cholecystectomy(LC)on patients’postoperative quality of life.Methods Patients who underwent 3-port LC with abdominal drainage tubes in the Department of Hepatobiliary Surgery of Linyi People’s Hospital from March 1,2023 to October 31,2023 due to gallstones with chronic cholecystitis were selected for this study.The patients were randomly divided into an experimental group and a control group.In the experimental group,the new abdominal drainage tube fixation method was used,while in the control group,the traditional method was used.Afterward,the quality of life of patient in terms of pain,activity,recovery time,and mental health status was evaluated.The exudate around the patient’s drainage tube was collected for bacterial culture and analysis.Results A total of 139 patients were randomly divided into an experimental group(70 patients)and a control group(69 patients).The patients’baseline characteristics were not significantly different.The patients in the experimental group had better outcomes in quality of life,with higher pain scores(24.03±2.37 vs.15.48±2.29,p<0.001)and activity scores(20.57±1.78 vs.14.13±1.43,p<0.001),and a shorter postoperative recovery time(2.36±0.68 d vs.2.96±1.34 d,p<0.001).The same results were shown in linear regression analysis scores of the 2 groups.The positive rate of bacterial culture in the exudate around the patient’s drainage tube in the experimental group was significantly lower than that in the control group(12.9%vs.43.5%,p<0.001);and furthermore,the positive rate of conditional pathogenic bacteria was even lower(7.1%vs.33.3%,p<0.001)in the experimental group than in the control group.Conclusion This new abdominal drainage tube fixation method can effectively promote patient rehabilitation and improve the quality of life for patient following 3-port LC with abdominal drainage tubes.

Laparoscopy combined with hysteroscopy in the treatment of Robert’s uterus accompanied by adenomyosis:A case report

BACKGROUND Gynaecologists should be aware of a rare obstructive Mullerian duct abnormality like Robert’s uterus and perform further surgery when necessary.CASE SUMMARY We report a 41-year-old mother of two children with Robert’s uterus who was examined and treated by laparoscopy and hysteroscopy.Unlike the existing cases reported in the literature,this patient had a late onset of Robert’s uterus symptoms.Due to right tubal ectopic pregnancy 3 years previously,the patient was treated with right salpingectomy and left tubal ligation but suffered aggravated left lower abdominal pain.She was examined and treated by laparoscopy and hysteroscopy,and is completely asymptomatic at 5-year followup.CONCLUSION The typical obstructive Mullerian abnormality requires further surgery.Combined laparoscopy and hysteroscopy is an effective,minimally invasive technique with better recovery outcomes than traditional transabdominal procedures.

Efficacy of multi-color near-infrared fluorescence with indocyanine green:A new imaging strategy and its early experience in laparoscopic cholecystectomy

BACKGROUND Near-infrared fluorescence imaging via using intravenous indocyanine green(ICG)has a wide range of applications in multiple surgical scenarios.In lapa-roscopic cholecystectomy(LC),it facilitates intraoperative identification of the biliary system and reduces the risk of bile duct injury.However,the usual single color fluorescence imaging(SCFI)has limitations in manifesting the fluorescence signal of the target structure when its intensity is relatively low.Moreover,sur-geons often experience visual fatigue.We hypothesized that a novel imaging stra-tegy,named multi-color fluorescence imaging(MCFI),could potentially address these issues by decreasing hepatic and background fluorescence pollution and improving biliary visualization.AIM To investigate the novel imaging strategy MCFI in LC.METHODS This was a single-center retrospective study conducted at Peking Union Medical College Hospital,Beijing,China.Patients who underwent LC from June 2022 to March 2023 by the same surgical team were enrolled.Demographic features,clinical and surgical information were collected.The clarity,visual comfort,and effectiveness of different imaging strategies were subjectively evaluated by surgeons.RESULTS A total of 155 patients were included,60 patients were in the non-ICG group in which only bright light illuminance without ICG was applied,60 patients were in the SCFI group,and 35 patients were in the MCFI group.No statist-ically significant differences were found in demographics or clinical history.Post-surgical complications were minimal in all 3 groups with no significant differences observed.MCFI improved the clarity of imaging and visual comfort.Clarity of imaging and visual comfort were improved with MCFI.CONCLUSION MCFI improves biliary visualization and reduces liver fluorescence contamination,which supports its routine use in LC.MCFI may also be a better choice than SCFI in other clinical settings.

Effect of smoking on the risk of gastrointestinal cancer after cholecystectomy: A national population-based cohort study

BACKGROUND The role of smoking in the incidence of colorectal cancer(CRC)or gastric cancer(GC)in populations undergoing cholecystectomy has not been investigated.AIM To evaluate the effect of smoking on CRC or GC development in cholecystectomy patients.METHODS A total of 174874 patients who underwent cholecystectomy between January 1,2010 and December 31,2017 were identified using the Korean National Health Insurance Service claims database.These patients were matched 1:1 with mem-bers of a healthy population according to age and sex.CRC or GC risk after cholecystectomy and the association between smoking and CRC or GC risk in cholecystectomy patients were evaluated using adjusted hazard ratios(HRs)and 95%CIs.RESULTS The risks of CRC(adjusted HR:1.15;95%CI:1.06-1.25;P=0.0013)and GC(adjusted HR:1.11;95%CI:1.01-1.22;P=0.0027)were significantly higher in cholecystectomy patients.In the population who underwent cholecystectomy,both CRC and GC risk were higher in those who had smoked compared to those who had never smoked.For both cancers,the risk tended to increase in the order of non-smokers,ex-smokers,and current smokers.In addition,a positive correlation was observed between the amount of smoking and the risks of both CRC and GC.CONCLUSION Careful follow-up and screening should be performed,focusing on the increased risk of gastrointestinal cancer in the cholecystectomy group,particularly considering the individual smoking habits.

Research on the prognostic value of adjusting intraperitoneal threedimensional quality evaluation mode in laparoscopic cholecystectomy patients

BACKGROUND Benign gallbladder diseases have become a high-prevalence condition not only in China but also worldwide.The main types of benign gallbladder diseases include gallbladder polyps,acute and chronic cholecystitis,and gallstones,with gallstones being the most common,accounting for over 70%of cases.Although the mortality rate of benign gallbladder diseases is low,they carry obvious potential risks.Studies have shown that an increased incidence of benign gallbladder diseases can increase the risk of cardiovascular diseases and gallbladder cancer,resulting in a substantial disease burden on patients and their families.AIM To assess the medical utility of the Configuration-Procedure-Consequence(CPC)three-dimensional quality evaluation model in modulating the prognosis of laparoscopic cholecystectomy patients.METHODS A total of 98 patients who underwent laparoscopic cholecystectomy in our hospital from February 2020 to January 2022 were selected as the subjects.According to the random number table method,they were divided into a study group and a control group,with 49 patients in each group.The control group received routine perioperative care,while the study group had the addition of the CPC three-dimensional quality evaluation.The postoperative recovery-related indicators(time to first flatus,time to oral intake,time to ambulation,hospital stay),stress indicators(cortisol and adrenaline levels),distinctions in anxiety and RESULTS The time to first flatus,time to oral intake,time to ambulation,and hospital stay of the study group patients were obviously lower than those of the control group patients,with statistical significance(P<0.05).On the 1st day after admission,there were no obvious distinctions in cortisol and adrenaline levels in blood samples,as well as in the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)scores between the study group and the control group(P>0.05).However,on the 3rd day after surgery,the cortisol and adrenaline levels,as well as SAS and SDS scores of the study group patients,were obviously lower than those of the control group patients(P<0.05).The study group had 2 cases of incisional infection and 1 case of pulmonary infection,with a total incidence of complications of 6.12%(3/49),which was obviously lower than the 20.41%(10/49)in the control group(P<0.05).CONCLUSION Implementing the CPC three-dimensional quality evaluation model for patients undergoing laparoscopic cholecystectomy can help accelerate their perioperative recovery process,alleviate perioperative stress symptoms,mitigate anxiety,depression,and other adverse emotions,and to some extent,reduce the incidence of perioperative complications.

Laparoscopic cholecystectomy with communicating accessory hepatic duct injury and management: A case report

BACKGROUND Laparoscopic cholecystectomy is considered the gold standard for the treatment of patients with gallstones.However,bile duct injury is one of the most serious complications of this surgery,with an incidence rate of 0.3%-0.7%.Variations in anatomical structures are one of the main reasons for such injuries.CASE SUMMARY We report a 26-year-old male patient who presented with repeated upper abdominal pain for 1 year.Ultrasound examination and blood tests indicated gallstones accompanied by chronic cholecystitis.The patient underwent laparo-scopic cholecystectomy.During the surgery,a communicating bile duct connec-ting the gallbladder neck and the right hepatic duct was discovered and injured.Meticulous dissection identified it as a communicating accessory hepatic duct,which was then definitively ligated.Postoperatively,the patient recovered well,magnetic resonance imaging and magnetic resonance cholangiopancreatography showed no intrahepatic or extrahepatic bile duct strictures.The pathology report showed chronic cholecystitis with gallstones.CONCLUSION Carefully manage communicating accessory bile ducts in cholecystectomy using cholangiography or meticulous separation,followed by ligation is effective.

Unexpected right-sided sigmoid colon in laparoscopy: A case report and review of literature

BACKGROUND The presence of a right-sided sigmoid colon is a rare anatomical variation usually discovered incidentally during surgical interventions.This case report details an unexpected right-sided sigmoid colon identified during a laparoscopic appendectomy and examines the pertinent literature to explore its clinical importance.CASE SUMMARY A 71-year-old woman presented with acute appendicitis.A preoperative computed tomography(CT)scan showed peri-appendiceal inflammation but no significant anatomical abnormalities.During laparoscopic surgery,an unexpected finding was encountered:The sigmoid colon was situated on the right side and exhibited an abnormal relationship with the cecum and ascending colon.Postoperative pathological examination confirmed appendicitis with no additional pathological findings.The right-sided sigmoid colon anomaly was verified through intraoperative assessment and later re-evaluation with CT and colonographic imaging.The patient underwent a laparoscopic appendectomy and experienced a smooth postoperative recovery.CONCLUSION This case highlights the necessity of being attentive to anatomical variations during laparoscopic surgery,particularly when managing appendicitis.A review of the literature indicated that the occurrence of a right-sided sigmoid colon is infrequent and may be associated with anomalies in midgut rotation during embryonic development.Awareness of this variation can help prevent surgical complications and inform future clinical practice.

Clinical efficacy of laparoscopic cholecystectomy combined with endoscopic papillary balloon dilation in treatment of gallbladder stones with common bile duct stones: A retrospective study

BACKGROUND The incidence of cholelithiasis has been on the rise in recent years,but the choice of procedure is controversial.AIM To investigate the efficacy of laparoscopic cholecystectomy(LC)combined with endoscopic papillary balloon dilation(EPBD)in patients with gallbladder stones(GS)with common bile duct stones(CBDS).METHODS The clinical data of 102 patients with GS combined with CBDS were selected for retrospective analysis and divided into either an LC+EPBD group(n=50)or an LC+endoscopic sphincterotomy(EST)group(n=52)according to surgical methods.Surgery-related indexes,postoperative recovery,postoperative complications,and expression levels of inflammatory response indexes were compared between the two groups.RESULTS Total surgical time,stone free rate,rate of conversion to laparotomy,and successful stone extraction rate did not differ significantly between the LC+EPBD group and LC+EST group.Intraoperative hemorrhage,time to ambulation,and length of hospitalization in the LC+EPBD group were lower than those of the LC+EST group(P<0.05).The rate of total complications of the two groups was 9.80%and 17.65%,respectively,and the difference was not statistically significant.No serious complications occurred in either group.At 48 h postoperatively,the expression levels of interleukin-6,tumor necrosis factor-α,high-sensitivity Creactive protein,and procalcitonin were lower in the LC+EPBD group than in the LC+EST group(P<0.05).At 3 d postoperatively,the expression levels of aspartate transaminase,alanine transaminase,and total bilirubin were lower in the LC+EPBD group than in the LC+EST group(P<0.05).CONCLUSION LC combined with EPBD and LC combined with EST are both effective procedures for the treatment of GS with CBDS,in which LC combined with EPBD is beneficial to shorten the patient’s hospitalization time,reduce the magnitude of elevated inflammatory response indexes,and promote postoperative recovery.

Laparoscopic cholecystectomy plus common bile duct exploration for extrahepatic bile duct stones and postoperative recurrenceassociated risk factors

BACKGROUND There remain controversies regarding the surgical treatment of extrahepatic bile duct stones(EHBDSs)in clinical practice.AIM To explore the curative effect of laparoscopic cholecystectomy(LC)plus common bile duct exploration(CBDE)for the surgical treatment of EHBDSs and to analyze the risk factors that affect postoperative stone recurrence.METHODS Eighty-two patients with EHBDSs admitted between March 2017 and March 2023 were selected.Among them,patients treated with open choledocholithotomy plus LC or open cholecystectomy(OC)were set as the control group(n=40),and those treated with LC plus CBDE served as the observation group(n=42).The surgical outcomes of the two groups were compared,the surgical complications and Gas-trointestinal Quality of Life Index(GIQLI)scores were counted,and the one-year prognostic recurrence was recorded.Independent factors for postoperative re-currence were determined using univariate and multivariate analyses.RESULTS The two groups were comparable in the stone residual rate(P>0.05).The ope-ration time(P<0.05),intraoperative bleeding(P<0.05),and total complication rate(P=0.005)were lower in the observation group than in the control group.The observation group exhibited a marked increase in the GIQLI score,which was higher than the control group(P<0.05).A lower one-year recurrence rate was determined in the observation group vs the control group(P=0.027).Sphincter of Oddi dysfunction[odds ratio(OR)=5.712,P=0.007]and the treatment scheme of open choledocholithotomy plus LC or OC(OR=6.771,P=0.008)were the independent risk factors for one-year recurrence in patients after surgery.CONCLUSION LC plus CBDE for patients with EHBDSs can reduce stone residuals,intraoperative bleeding,complications,and postoperative recurrence.