Variations of Cystic Duct and Its Clinical Significance

Background: Cystic duct drains the bile from the gallbladder into the common bile duct. Gallstone disease is one of the most common problems affecting the digestive tract and may lead to many complications. To avoid the complications in these patients the gallbladder is removed surgically (Cholecystectomy). Ligation of cystic duct and cystic artery is a prerequisite procedure when cholecystectomy is done. Understanding about the normal anatomy & the possible variations in biliary ductal system is important for the surgeons for doing cholecystectomy surgery successfully. Errors during gallbladder surgery commonly result from failure to appreciate the common variations in the anatomy of the biliary system. Aim of the study: To find out the incidence of variations in the length, course, and termination of cystic duct in cadavers. Materials and Methods: Present study was done in 50 adult cadavers in the Department of Anatomy, Government Tiruvannamalai medical college, Tamilnadu. Meticulous dissection was done in the hepatobiliary system of these cadavers. Observations: During the study variations in the length of cystic duct, course and different modes of insertion of cystic duct were observed. Conclusion: Knowledge of variations in the length of cystic duct and knowing about different modes of course & insertion of cystic duct is necessary for surgeons while conducting cholecystectomy. The risk of iatrogenic injury is especially high in cases where the biliary anatomy is misidentified prior to surgery. KEY WORDS: Cystic duct, Gallbladder, Cholecystectomy.

P-BN17 Laparoscopic subtotal cholecystectomy is a safe and effective treatment for gallstone disease

Background Laparoscopic cholecystectomy is the gold standard treatment of gallstones in fit patients with symptomatic gallbladder disease. If the critical view of safety cannot be achieved intra-operatively, there are few options, one of which is laparoscopic subtotal cholecystectomy. This study aims to ascertain the outcomes of subtotal cholecystectomy. Methods Retrospective review of all patients who underwent laparoscopic subtotal cholecystectomy by a single surgeon over a 5 year period. Results 37 consecutive patients who underwent subtotal cholecystectomy were included in this study; seventeen of which were males (49%); the median age was 69, and 18 were emergencies (49%).The most common reasons for conversion to laparoscopic subtotal cholecystectomy were adhesions (57%) and fibrotic Calot’s triangle (22%). One patient required ERCP and biliary stenting for ongoing bile leak and another returned to theatre for post operative bleeding during index admission. 6 patients (16%) required further hospital admissions for gallstone disease (1 for biliary colic, two for cholecystitis and three for CBD stones). 3 patients required ERCP. None required further gallbladder surgery. Conclusions Laparoscopic subtotal cholecystectomy is a safe and effective alternative to total cholecystectomy when the critical view of safety cannot be achieved. In our experience, only a small proportion of patients have recurrent biliary problems.

The use of endoscopic cryoapplicator in liver and gallbladder surgery

Purpose of the study. To investigate the efficacy of focal destruction tissues of local liver diseases, chole- and hemostasis of created endoscopic cryoapplicator in operations on the liver and gallbladder.Material and methods. Review the results of surgical treatment of 121 patients with various diseases of the liver (tumors, alveococcosis, parasitic and non-parasitic cysts) and gallbladder (chronic and acute cholecystitis) using a new endoscopic porous TiNi cryoapplicator. 49 patients were operated by an open method, 72 - laparoscopically. Hemo-and cholestatic control of the instrument was performed intraoperative and in postoperative period - by clinical condition of patient and by ultrasonography. Efficiency of destruction of focal liver diseases was investigated by histological examinations of surgical materials, is confirmed by the absence of relapses in the period from 4 to 6 years.The results. Cryoapplicator is simple in use, in sterilization, no energy consumption, can be used both in open surgery, particularly in arduous regions of the liver and laparoscopic procedures and, most importantly, patients with artificial cardiac pacemakers.Cryodestruction of the liver stump after its resection and the bed of the gallbladder after cholecystectomy reduces blood loss by 30-40%, and also helps to reduce the number of relapses of the disease. There were not observed bleeding and bile leakage in postoperative period. Histological examination proved picture of avascular necrosis, a violation of tissue structure of subjected to destruction liver focal diseases, death of epithelial lining of non-parasitic cysts and membranes of echinococcal cysts. There were not diseases recurrences in the period from 4 to 6 years.Conclusion. Endoscopic porous TiNi cryoapplicator is simple and convenient in use, it has a good hemo- and cholestatic effects, pronounced effect to local destruction of liver focal diseases, can be recommended for open and laparoscopic operations on liver.

Study on Effect of Laryngeal Mask Anesthesia and Endotracheal Intubation Anesthesia on Elderly Patients Undergoing Laparoscopic Gallbladder Surgery

Objective: To analyze the effect of laryngeal mask anesthesia and endotracheal intubation anesthesia in elderly laparoscopic gallbladder surgery. Methods: 100 subjects of the experiment came from elderly patients with gallbladder stones admitted from September 2016 to September 2019 in our hospital. There were group A and group B of 50 cases each, and were used tube anesthesia and laryngeal mask anesthesia, then comparing the anesthesia effect. Results: Statistical significance(P<0.05): Air pressure and end-respiratory carbon dioxide partial pressure index changes when immediately after insertion, immediately after removal, 3 minutes after removal; heart rate, mean arterial pressure, airway pressure, and end-expiratory carbon dioxide index changes when 3 minutes after insertion and immediately before removal; blood glucose and cortisol changes when after insertion, immediately before removal and min after removal. No statistical significance(P>0.05): Changes in heart rate, mean arterial pressure, airway pressure, and end-expiratory carbon dioxide indexes before insertion; changes in blood glucose and cortisol indexes before insertion. Conclusion: It is more ideal for elderly patients with abdominal cavity and gallbladder surgery to have laryngeal mask anesthesia, which can effectively keep blood circulation stable and have promotion value.