2005 SAGES Abstracts

POSTER ABSTRACTS
laparoscopic equipment with very reduced diameter, which
has led to “state of the art” of 2mm instruments, also known
as mini or needle instruments.
OBJECTIVE: To present modifications to mini-laparascopic
technique which may make it possible to conduct minilaparascopic
procedures safely and effectively, thereby reducing
considerably the cost of this type of surgery.
PATIENTS: Patients suffering from chronic lithiasic cholecystitis
at various stages of the disease were submitted to procedures
fully performed by mini-laparascopy, including acute
cholecystitis and per-operative cholangiography.
METHOD: After performing the pneumoperitoneum in the
umbilical site, four trocars are inserted; two of 2mm (support
trocars), one of 3mm (work trocar) and one of 10mm, through
which a 10 mm 30 degrees laparoscope is inserted. Neither
the 3mm laparoscope nor clips are used, the cystic artery is
safely sealed by eletrocautery, near the gallbladder and the
cystic duct is sealed with surgical knots. Removal of the gallbladder
is carried out, in a bag made with a glove wrist,
through the 10mm umbilical site.
CONCLUSION: Mini-laparascopic cholecystectomy is a safe
and effective procedure which results in a better esthetic effect
for the patients, when compared to conventional laparascopy.
The technique described above allows a considerable reduction
in the costs associated with the original mini-laparascopic
procedure, since neither clips, endobags, nor mini-loops are
used. Neither is any use made of 3mm laparoscope which is
the most expensive component among mini-laparascopic
instruments.
P188–Hepatobiliary/Pancreatic
Surgery
LAPAROSCOPIC CBD EXPLORATION WITHOUT T-TUBE, In
Seok Choi PhD, Ji Hoon Park MD,Won Jun Choi PhD,Dae
Gyoung Go MD,Dae Sung Yoon MD, Dept. of Surgery,
Konyang University Hospital, Konyang University College of
medicine, Daejeon, Korea
(Objective) Laparoscopic common bile duct
exploration(LCBDE) is feasible and becoming popular. LCBDE
has traditionally been accompanied by T-tube drainage which
has a 4.7-17.5% morbidity rate and increases hospital stay.
Avoidance of T-tube drainage therefore should advantageously
contribute to the ideal approach for LCBDE. The authors report
a prospective evaluation of LCBDE without T-tube drainage.
(Methods and Procedures) Between March 2001 and August
2004, 30 patients with common bile duct(CBD) stones underwent
this approach. We adopted internal endobiliary stent in
11 patients and performed primary closure for choledochotomy.
Other 19 patients who had external drainage such as,
endoscopic nasobiliary drain(ENBD), percutaneous transhepatic
biliary drain(PTBD), were treated by LCBDE with primary
closure.
(Results) Open conversion, because of impacted large CBD
stones, was 1 case (3.5%). The mean operative time of LCBDE
was 134 minutes, postoperative hospital stay was 8.5 days.
Complication rate was 13.8%( 4/30 cases, 2 cases : migration
of endobiliary stent in CBD, 1case : subhepatic biloma, 1case:
retained stone) and no mortality. The rate of successful stone
removal was 96.6%. Biliary stents were eliminated spontaneously
via the gastrointestinal tract among 4 patients, and for
6 patients, the stents had to be removed endoscopically. The
other 1 patient underwent laparotomy for stent removal.
(Conclusions) LCBDE without T-tube was safe and feasible
technique. Further study and assessment of internal biliary
stent should be warranted.
P189–Hepatobiliary/Pancreatic
Surgery
LAPAROSCOPIC LIVER RESECTION IN PORCINE: DEVELOP-
MENT OF AN EXPERIMENTAL MODEL, Alex Escalona MD,
Felipe Bellolio MD,Nicolás Jarufe MD,Luis Ibáñez MD,Gustavo
Pérez MD,Matías Guajardo MS, Pontificia Universidad Católica
de Chile
Introduction: The development of the laparoscopic surgery has
permitted to incorporate this technology to the surgical treatment
of different pathologies. The left lateral segmentectomy
(LLS) (segments II and III of Couinaud) is the more frequently
carried out laparoscopic liver resection. The objective of this
study is to evaluate the feasibility to carry out laparoscopic
LLS in porcine model and to compare the results with the
open technique. Material and Methods: Ten animals of similar
age, weight and size were undergone to LLS. In 4 cases the
procedure was performed by open technique (group 1) and in
6 cases by laparoscopy (group 2). The operative time, bleeding
and weight of the resected liver segment was registered in a
prospective database. Autopsy was carried out at seventh
postoperative day. Results: The operative time was 77 ± 19
minutes in the group 1 and 52 ± 38 minutes in the group 2 (p =
0,21). Intraoperative bleeding was of 185 ± 67 and 70 ± 52 ml.
in the group 1 and 2 respectively (p = 0,01). The weight of the
extracted segment was of 128 ± 27 and of 128 ± 16 grams in
groups 1 and 2 respectively (p = NS). One animal operated by
open technique presented a wound infection. There were no
other complications or deaths. Conclusions: Laparoscopic LLS
in porcine model is a feasible procedure. In this series a less
intraoperative bleeding was observed in the animals operated
by laparoscopic technique. The operative time and weight of
the specimen is comparable in both techniques. The implementation
of this procedure in an animal model could be useful
in the development of research, acquisition of laparoscopic
skills in liver surgery and implementation of the technique in
humans.
P190–Hepatobiliary/Pancreatic
Surgery
IMPROVEMENT IN GASTROINTESTINAL SYMPTOMS AND
QUALITY OF LIFE FOLLOWING CHOLECYSTECTOMY, Kelly R
Finan MD, Leeth R Ruth MPH,Brian M Whitley MPH,Joshua C
Klapow PhD,Mary T Hawn MD, University of Alabama at
Birmingham
Background: Laparoscopic cholecystectomy (LC) is the accepted
treatment for symptomatic gallstone disease, but has been
criticized as an over-utilized procedure. The aim of this study is
to assess the effectiveness of LC on reduction of specific gastrointestinal
(GI) symptoms and the impact on quality of life
(QOL). Methods: A prospective cohort of consecutive subjects
evaluated for gallstone disease between 8/2001 and 7/2004
were given the SF-36 QOL survey and a gallbladder symptom
survey. The latter was developed to assess symptom frequency,
severity and distressfulness for 16 related GI symptoms.
Postoperative surveys were sent to all subjects who underwent
LC. A chart abstraction was performed to collect demographic
information and operative details. The surveys were
scored and evaluated using paired t-tests. Results: 100 patients
were mailed postoperative surveys with a 61% response rate
at a mean follow up of 17.5 months (2-31). Preoperative indications
were biliary colic (64%), cholecystitis (15%), biliary pancreatitis/cholodocholithiasis
(11%) and biliary dyskinesia (8%).
Preoperative QOL scores measured by the SF-36 were significantly
below normative values in 6 of 8 categories (p