**4. Conclusions**

Traditional open cholecystectomy is associated with a longer recovery than small-incision and laparoscopic cholecystectomy. To make a scientific evidence-based choice between small-incision cholecystectomy and laparoscopic cholecystectomy, surgeons and health care providers must scrutinize the evidence from randomised controlled trials and from defined populations, and they must consider the applicability of the techniques to their own setting. Conclusions reached may have a profound effect on costs and surgical training.

Gallbladder Surgery, Choice of Technique: An Overview 45

[20] Roslyn JJ, Binns GS, Hughes EF, Saunders-Kirkwood K, Zinner MJ, Cates JA. Open

[21] NIH Consensus conference. Gallstones and laparoscopic cholecystectomy. JAMA. 1993

[22] Plaisier PW, van der Hul RL, Nijs HG, den Toom R, Terpstra OT, Bruining HA. The

[23] Plaisier PW, van der Hul RL, den Toom R, Nijs HG, Terpstra OT, Bruining HA.

[24] Carrilho-Ribeiro L, Serra D, Pinto-Correia A, Velosa J, De Moura MC. Quality of life

[26] Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. Bmj. 2004 Jun 19;328(7454):1490. [27] Guyatt GH, Rennie D, Meade M, Cook D. Users' Guides to the Medical Literature:

[28] Drummond MF, Sculpher MJ, Torrance GW, O'Brien BJ, Torrance GW. Methods for the

[29] Maier RV. What the surgeon of tomorrow needs to know about evidence-based surgery.

[30] Jorgensen T. Prevalence of gallstones in a Danish population. Am J Epidemiol. 1987

[31] Attili AF, Carulli N, Roda E, Barbara B, Capocaccia L, Menotti A, et al. Epidemiology of

[34] Berger MY, van der Velden JJ, Lijmer JG, de Kort H, Prins A, Bohnen AM. Abdominal

[35] Berhane T, Vetrhus M, Hausken T, Olafsson S, Sondenaa K. Pain attacks in non-

[36] Beckingham IJ, Krige JE. ABC of diseases of liver, pancreas, and biliary system: Liver

Scandinavian journal of gastroenterology. 2006 Jan;41(1):93-101.

and pancreatic trauma. BMJ. 2001 Mar 31;322(7289):783-5.

Cholelithiasis (M.I.COL.). Am J Epidemiol. 1995 Jan 15;141(2):158-65. [32] Jorgensen T. Treatment of gallstone patients. Copenhagen: National Institute of Public Health, Denmark, and Danish Institute for Health Technology Assessment; 2000. [33] Portincasa P, Moschetta A, Palasciano G. Cholesterol gallstone disease. The Lancet.

Aug;218(2):129-37.

Feb 24;269:1018-24.

1994 May;89(5):739-44.

[25] www.cebm.net/index.aspx?o=1025. [11 Febraury 2011].

Arch Surg. 2006 Mar;141(3):317-23.

of gastroenterology. 2000 Jan;35(1):70-6.

Jun;41(3):260-2.

2008; 2008.

Nov;126(5):912-21.

2006;368.:230-9.

2005.

cholecystectomy. A contemporary analysis of 42,474 patients. Ann Surg. 1993

course of biliary and gastrointestinal symptoms after treatment of uncomplicated symptomatic gallstones: results of a randomized study comparing extracorporeal shock wave lithotripsy with conventional cholecystectomy. Am J Gastroenterol.

Gallstone lithotripsy: the Rotterdam experience. Hepatogastroenterology. 1994

after cholecystectomy and after successful lithotripsy for gallbladder stones: a matched-pairs comparison. Eur J Gastroenterol Hepatol. 2002 Jul;14(7):741-4.

essentials of Evidence-Based Clinical Practice. 2nd ed: MGraw-Hill. Professional,

economic evaluation of health care programmes. Oxford: Oxford University Press;

gallstone disease in Italy: prevalence data of the Multicenter Italian Study on

symptoms: do they predict gallstones? A systematic review. Scandinavian journal

complicated and complicated gallstone disease have a characteristic pattern and are accompanied by dyspepsia in most patients: the results of a prospective study.

#### **5. References**


[1] Langenbuch C. Ein Fall von Extirpation der Gallenblase wegen chronischer

[2] Dubois F, Berthelot B. [Cholecystectomy through minimal incision (author's transl)]. La

[3] Goco IR, Chambers LG. "Mini-cholecystectomy" and operative cholangiography. A

[4] Morton CE. Cost containment with the use of "mini-cholecystectomy" and intraoperative

[5] Salembier Y. [Cholecystectomy through a short transverse incision]. Presse Med. 1986

[6] Moss G. Discharge within 24 hours of elective cholecystectomy. The first 100 patients.

[7] Ledet WP, Jr. Ambulatory cholecystectomy without disability. Arch Surg. 1990

[8] Pelissier EP, Blum D, Meyer JM, Girard JF. Cholecystectomy by minilaparotomy

[9] Assalia A, Schein M, Kopelman D, Hashmonai M. Minicholecystectomy vs conventional

[10] Tyagi NS, Meredith MC, Lumb JC, Cacdac RG, Vanterpool CC, Rayls KR, et al. A new

[11] Belli G, Romano G, D'Agostino A, Iannelli A. Minilaparotomy with rectus muscle sparing: a personal technique for cholecystectomy. Giorn Chir. 1996;17(5):283-4.

[13] Sharma AK, Rangan HK, Choubey RP. Mini-lap cholecystectomy: a viable alternative to

[14] Seale AK, Ledet WP, Jr. Minicholecystectomy: a safe, cost-effective day surgery

[15] Oyogoa SO, Komenaka IK, Ilkhani R, Wise L. Mini-laparotomy cholecystectomy in the

[16] Syrakos T, Antonitsis P, Zacharakis E, Takis A, Manousari A, Bakogiannis K, et al.

[17] Harju J, Juvonen P, Eskelinen M, Miettinen P, Paakkonen M. Minilaparotomy

[18] Mühe E. Die erste Cholecystectomie durch das laparoskope. . Langenbecks Arch Chir.

[19] Dubois F, Berthelot G, Levard H. (Cholecystectomy by coelioscopy (see comments)].

special reference to obesity. Surg Endosc. 2006 Apr;20(4):583-6.

triangle": microceliotomy. Ann Surg. 1994 Nov;220(5):617-25.

[12] Daou R. [Cholecystectomy using a minilaparotomy]. Ann Chir. 1998;52(7):625-8.

without muscle section: a short-stay procedure. Hepatogastroenterology. 1992

cholecystectomy: a prospective randomized trial--implications in the laparoscopic

minimally invasive technique for cholecystectomy. Subxiphoid "minimal stress

laparoscopic cholecystectomy for the Third World? The Australian and New

era of laparoscopic cholecystectomy: a community-based hospital perspective. Am

Small-incision (mini-laparotomy) versus laparoscopic cholecystectomy: a retrospective study in a university hospital. Langenbecks Arch Surg. 2004

cholecystectomy versus laparoscopic cholecystectomy: a randomized study with

Cholelithiasis: Heilung. Berliner Klin Wochenschr. 1882;19:725-7.

means of cost containment. American Surgeon. 1983;49:143-5.

Nouvelle presse medicale. 1982 Apr 3;11(15):1139-41.

cholangiography. American Surgeon. 1985;51:168-9.

Arch Surg. 1986 Oct;121(10):1159-61.

era. World J Surg. 1993 Nov-Dec;17(6):755-9.

Zealand journal of surgery. 1998 Nov;68(11):774-7.

procedure. Arch Surg. 1999 Mar;134(3):308-10.

Surg. 2003 Jul;69(7):604-7.

Presse Med. 1989;18:980-2.

Jun;389(3):172-7.

1986;369.

**5. References** 

Feb 8;15(5):210-1.

Nov;125(11):1434-5.

Aug;39(4):294-5.


Gallbladder Surgery, Choice of Technique: An Overview 47

[54] Richardson WS, Fuhrman GS, Burch E, Bolton JS, Bowen JC. Outpatient laparoscopic

[55] Vagenas K, Spyrakopoulos P, Karanikolas M, Sakelaropoulos G, Maroulis I, Karavias D.

way to go? Surg Laparosc Endosc Percutan Tech. 2006 Oct;16(5):321-4. [56] Victorzon M, Tolonen P, Vuorialho T. Day-case laparoscopic cholecystectomy: treatment of choice for selected patients? Surg Endosc. 2007 Jan;21(1):70-3. [57] Gurusamy KS, Junnarkar S, Farouk M, Davidson BR. Day-case versus overnight stay in laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2008(1):CD006798. [58] Keus F, Gooszen HG, van Laarhoven CJ. Open, small-incision, or laparoscopic

193-5.

2010(1):CD008318.

2004 Aug;39(8):773-7.

mortality. BMC Gastroenterol. 2007;7:35.

2003 Feb;17(2):338-40; discussion 41.

Feb;251(2):205-12.

cholecystectomy. Am J Surg. 2004 Sep;188(3):205-11.

Journal of surgical research. 2007 Oct;142(2):246-9.

British Journal of Surgery. 2006;93:158-68.

2006;6:17.

cholecystectomy. Outcomes of 847 planned procedures. Surg Endoscop. 2001; 15:

Mini-laparotomy cholecystectomy versus laparoscopic cholecystectomy: which

cholecystectomy for patients with symptomatic cholecystolithiasis. An overview of Cochrane Hepato-Biliary Group reviews. Cochrane Database Syst Rev.

of meta-analyses of complications in laparoscopic vs. small-incision cholecystectomy:

year after cholecystectomy: outcome of a randomized trial comparing laparoscopic and minilaparotomy cholecystectomy. Scandinavian journal of gastroenterology.

cholecystectomy trial: characteristics, procedures, and outcomes. BMC Surg.

Sweden 2000-2003: a nationwide study on procedures, patient characteristics, and

surgery: effect on the residents' attitude toward bile duct surgery. Surg Endosc.

operative experience: analysis of two decades of national data. Ann Surg. 2010

residents to perform open gall bladder and common bile duct operations? The

[59] Keus F, Weterslev J, Gluud C, Gooszen HG, van Laarhoven CJ. Trial sequential analyses

[60] Ros A, Nilsson E. Abdominal pain and patient overall and cosmetic satisfaction one

[61] Ros A, Carlsson P, Rahmqvist M, Backman K, Nilsson E. Non-randomised patients in a

[62] Rosenmuller M, Haapamaki MM, Nordin P, Stenlund H, Nilsson E. Cholecystectomy in

[63] Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open

[64] Jenkins PJ, Paterson HM, Parks RW, Garden OJ. Open cholecystectomy in the laparoscopic era. The British journal of surgery. 2007 Nov;94(11):1382-5. [65] Chung RS, Wojtasik L, Pham Q, Chari V, Chen P. The decline of training in open biliary

[66] Livingston EH, Rege RV. Technical complications are rising as common duct exploration is becoming rare. J Am Coll Surg. 2005 Sep;201(3):426-33. [67] Chung RS, Ahmed N. The impact of minimally invasive surgery on residents' open

[68] Schulman CI, Levi J, Sleeman D, Dunkin B, Irvin G, Levi D, et al. Are we training our

[69] Connor S, Garden OJ. Bile duct injury in the era of laparoscopic cholecystectomy.

more randomized patients are needed. J Clin Epidemiol. 2009 Dec 9.


[37] Kang JY, Ellis C, Majeed A, Hoare J, Tinto A, Williamson RC, et al. Gallstones--an

[38] Aerts R, Penninckx F. The burden of gallstone disease in Europe. Aliment Pharmacol

[39] Sandler RS, Everhart JE, Donowitz M, Adams E, Cronin K, Goodman C, et al. The

[40] Shaffer EA. Gallstone disease: Epidemiology of gallbladder stone disease. Best Pract Res

[41] Gurusamy KS, Samraj K. Cholecystectomy versus no cholecystectomy in patients with

[42] Festi D, Reggiani ML, Attili AF, Loria P, Pazzi P, Scaioli E, et al. Natural history of

[43] Halldestam I, Kullman E, Borch K. Defined indications for elective cholecystectomy for gallstone disease. The British journal of surgery. 2008 May;95(5):620-6. [44] Lam CM, Murray FE, Cuschieri A. Increased cholecystectomy rate after the introduction

[45] Mjåland O, Adamsen S, Hjelmqvist B, Ovaska J, Buanes T. Cholecystectomy rates,

[46] Cohen MM, Young W, Th'riault ME, Hernandez R. Has laparoscopic cholecystectomy

[47] Steiner CA, Bass EB, Talamini MA, Pitt HA, Steinberg EP. Surgical rates and operative

[48] Legorreta AP, Silber JH, Costantino GN, Kobylinski RW, Zatz SL. Increased

[49] Al-Mulhim AA, Al-Ali AA, Albar AA, Bahnassy AA, Abdelhadi M, Wosornu L, et al.

[51] Amjad N, Fazal A. Mini cholecystectomy now a day stay surgery: anaesthetic management with multi modal analgesia. J Pak Med Ass. 2002;52:291-5. [52] Harju J, Kokki H, Paakkonen M, Karjalainen K, Eskelinen M. Feasibility of

[53] Arregui ME, Davis CJ, Arkush A, Nagan RF. In selected patients outpatient

cholecystectomy in Saudi Arabia. World J Surg. 1999 May;23(5):458-62. [50] Saltzstein EC, Mercer LC, Peacock JB, Daugherty SH. Outpatient open cholecystectomy.

prospective randomised study. Scand J Surg. 2010;99(3):132-6.

and 1999/2000. Aliment Pharmacol Ther. 2003 Feb 15;17(4):561-9.

silent gallstones. Cochrane Database Syst Rev. 2007(1):CD006230.

of laparoscopic cholecystectomy in Scotland. Gut. 1996;38:282-4.

Ther. 2003 Nov;18 Suppl 3:49-53.

Clin Gastroenterol. 2006;20(6):981-96.

May;122(5):1500-11.

Apr;25(4):719-24.

Endoscopy. 1998;12:1386-9.

JAMA. 1993;270(12):1429-32.

Association Journal. 1996;154(4):491-500.

England Journal of Medicine. 1994;330:403-8.

Surgery, Gynecology & Obstetrics. 1992;174:173-5.

charges. Surg Laparoscop Endoscop. 1991;1:240-5.

increasing problem: a study of hospital admissions in England between 1989/1990

burden of selected digestive diseases in the United States. Gastroenterology. 2002

gallstone disease: Expectant management or active treatment? Results from a population-based cohort study. Journal of gastroenterology and hepatology. 2010

gallstone prevalence, and handling of bile duct injuries in Scandinavia. Surgical

changed patterns of practice and patient outcome in Ontario? Canadian Medical

mortality for open and laparoscopic cholecystectomy in Maryland. The New

cholecystectomy rate after the introduction of laparoscopic cholecystectomy.

Increased rate of cholecystectomy after introduction of laparoscopic

minilaparotomy versus laparoscopic cholecystectomy for day surgery: a

laparoscopic cholecystectomy is safe and significantly reduces hospitalization


Gallbladder Surgery, Choice of Technique: An Overview 49

[85] Nilsson E, Fored CM, Granath F, Blomqvist P. Cholecystectomy in Sweden 1987-99: a

[86] Roukema JA, Carol EJ, Liem F, Jakimowicz JJ. A retrospective study of surgical common bile-duct exploration: ten years experience. Neth J Surg. 1986 Feb;38(1):11-4. [87] Seale AK, Ledet WP, Jr. Primary common bile duct closure. Arch Surg. 1999

[88] Martin IJ, Bailey IS, Rhodes M, O'Rourke N, Nathanson L, Fielding G. Towards T-tube

[89] Tokumura H, Umezawa A, Cao H, Sakamoto N, Imaoka Y, Ouchi A, et al. Laparoscopic

[90] Decker G, Borie F, Millat B, Berthou JC, Deleuze A, Drouard F, et al. One hundred

[91] Martin DJ, Vernon DR, Toouli J. Surgical versus endoscopic treatment of bile duct

[92] Hüttl TP, Hrdina C, Geiger TK, Meyer G, Schildberg FW, Krämling HJ. Management of

[93] Paganini AM, Guerrieri M, Sarnari J, De Sanctis A, D'Ambrosio G, Lezoche G, et al.

[94] Bergman JJ, van der Mey S, Rauws EA, Tijssen JG, Gouma DJ, Tytgat GN, et al. Long-

[96] Tanaka M, Takahata S, Konomi H, Matsunaga H, Yokohata K, Takeda T, et al. Long-

[97] Rolny P, Andren-Sandberg A, Falk A. Recurrent pancreatitis as a late complication of

[98] Mandryka Y, Klimczak J, Duszewski M, Kondras M, Modzelewski B. [Bile duct

[99] Stromberg C, Luo J, Enochsson L, Arnelo U, Nilsson M. Endoscopic sphincterotomy

[100] McAlister VC, Davenport E, Renouf E. Cholecystectomy deferral in patients with endoscopic sphincterotomy. Cochrane Database Syst Rev. 2007(4):CD006233.

younger than 60 years of age. Gastrointest Endosc. 1996 Dec;44(6):643-9. [95] Sugiyama M, Atomi Y. Follow-up of more than 10 years after endoscopic

choledochotomy. J Hepatobiliary Pancreat Surg. 2002;9(2):206-12.

of gastroenterology. 2005 Dec;40(12):1478-85.

Surg Endosc. 2003 Jan;17(1):12-8.

surgery. 1998 Jul;85(7):917-21.

Endosc. 1998 Nov;48(5):465-9.

Endoscopy. 2003 Apr;35(4):356-9.

Lekarski. 2006 Dec;21(126):525-7.

Hepatol. 2008 Sep;6(9):1049-53.

consecutive procedures. Ann Surg. 1998 Jul;228(1):29-34.

stones. Cochrane Database Syst Rev. 2006(2):CD003327.

Jan;134(1):22-4.

2002;127:282-8.

Jan;21(1):34-40.

nationwide study of mortality and preoperative admissions. Scandinavian journal

free laparoscopic bile duct exploration: a methodologic evolution during 300

management of common bile duct stones: transcystic approach and

laparoscopic choledochotomies with primary closure of the common bile duct.

common bile duct stones - Results of a nationwide survey with analysis of 8 433 common bile duct explorations in Germany. Zentralblatt für Chirurgie.

Thirteen years' experience with laparoscopic transcystic common bile duct exploration for stones. Effectiveness and long-term results. Surg Endosc. 2007

term follow-up after endoscopic sphincterotomy for bile duct stones in patients

sphincterotomy for choledocholithiasis in young patients. The British journal of

term consequence of endoscopic sphincterotomy for bile duct stones. Gastrointest

endoscopic sphincterotomy for common bile duct stones: diagnosis and therapy.

infections as a late complication after endoscopic sphincterotomy]. Pol Merkur

and risk of malignancy in the bile ducts, liver, and pancreas. Clin Gastroenterol


[70] Waage A, Nilsson M. Iatrogenic bile duct injury: a population-based study of 152 776

[71] de Reuver PR, Grossmann I, Busch OR, Obertop H, van Gulik TM, Gouma DJ. Referral

[72] Assalia A, Kopelman D, Hashmonai M. Emergency minilaparotomy cholecystectomy

[73] Johansson M, Thune A, Nelvin L, Stiernstam M, Westman B, Lundell L. Randomized

[74] Watanapa P. Mini-cholecystectomy: a personal series in acute and chronic cholecystitis.

[75] Koo KP, Thirlby RC. Laparoscopic cholecystectomy in acute cholecystitis. What is the optimal timing for operation? Arch Surg. 1996 May;131(5):540-4; discussion 4-5. [76] Peng WK, Sheikh Z, Nixon SJ, Paterson-Brown S. Role of laparoscopic cholecystectomy

[77] Wiseman JT, Sharuk MN, Singla A, Cahan M, Litwin DE, Tseng JF, et al. Surgical

[78] Young AL, Cockbain AJ, White AW, Hood A, Menon KV, Toogood GJ. Index admission

[79] Sanjay P, Moore J, Saffouri E, Ogston SA, Kulli C, Polignano FM, et al. Index

[80] Papi C, Catarci M, D'Ambrosio L, Gili L, Koch M, Grassi GB, et al. Timing of

[81] Gurusamy K, Samraj K, Gluud C, Wilson E, Davidson BR. Meta-analysis of randomized

[82] Riall TS, Zhang D, Townsend CM, Jr., Kuo YF, Goodwin JS. Failure to perform

[83] David GG, Al-Sarira AA, Willmott S, Deakin M, Corless DJ, Slavin JP. Management of

[84] Ainsworth AP, Adamsen S, Rosenberg J. Surgery for acute cholecystitis in Denmark.

Scandinavian journal of gastroenterology. 2007 May;42(5):648-51.

from a specialist centre. HPB (Oxford). 2010 May;12(4):270-6.

surgery for bile duct injury. Ann Surg. 2007 May; 245 (5):763-70.

cholecystitis. The British journal of surgery. 2005 Jan;92(1):44-9.

laparoscopic era. World J Surg. 1997 Jun;21(5):534-9.

Dec;141(12):1207-13.

HPB (Oxford). 2003;5(4):231-4.

surgery. 2005 May;92(5):586-91.

Surg. 2010 May;145(5):439-44.

Gastroenterol. 2004 Jan;99(1):147-55.

Jun;8(3):127-31.

2010 Feb;97(2):141-50.

Apr;95(4):472-6.

77-9.

cholecystectomies in the Swedish Inpatient Registry. Arch Surg. 2006

pattern and timing of repair are risk factors for complications after reconstructive

for acute cholecystitis: prospective randomized trial--implications for the

clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute

in the early management of acute gallbladder disease. The British journal of

management of acute cholecystitis at a tertiary care center in the modern era. Arch

laparoscopic cholecystectomy for patients with acute biliary symptoms: results

laparoscopic cholecystectomy for acute admissions with cholelithiasis provides excellent training opportunities in emergency general surgery. Surgeon. 2010

cholecystectomy for acute calculous cholecystitis: a meta-analysis. Am J

controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. The British journal of surgery.

cholecystectomy for acute cholecystitis in elderly patients is associated with increased morbidity, mortality, and cost. J Am Coll Surg. 2010 May;210(5):668-77,

acute gallbladder disease in England. The British journal of surgery. 2008


Gallbladder Surgery, Choice of Technique: An Overview 51

[118] Mofidi R, Madhavan KK, Garden OJ, Parks RW. An audit of the management of

[119] Aboulian A, Chan T, Yaghoubian A, Kaji AH, Putnam B, Neville A, et al. Early

[121] Rosing DK, de Virgilio C, Yaghoubian A, Putnam BA, El Masry M, Kaji A, et al. Early

[122] Nebiker CA, Frey DM, Hamel CT, Oertli D, Kettelhack C. Early versus delayed

[123] Barkun JS, Caro JJ, Barkun AN, Trindade E. Cost-effectiveness of laparoscopic and

[124] McGinn FP, Miles AJ, Uglow M, Ozmen M, Terzi C, Humby M. Randomized trial of

[125] McMahon AJ, Russell IT, Baxter JN, Ross S, Anderson JR, Morran CG, et al.

[126] Calvert NW, Troy GP, Johnson AG. Laparoscopic cholecystectomy: a good buy? A cost

[127] Srivastava A, Srinivas G, Misra MC, Pandav CS, Seenu V, Goyal A. Cost-effectiveness

[128] Secco GB, Cataletti M, Bonfante P, Baldi E, Davini MD, Biasotti B, et al. [Laparoscopic

[130] Keus F, de Jonge T, Gooszen HG, Buskens E, van Laarhoven CJ. Cost-minimization

[131] Rogers SJ, Cello JP, Horn JK, Siperstein AE, Schecter WP, Campbell AR, et al.

prospective randomized study]. Chir Ital. 2002 Sep-Oct;54(5):685-92. [129] Nilsson E, Ros A, Rahmqvist M, Backman K, Carlsson P. Cholecystectomy: costs and

journal of surgery. 2007 Jul;94(7):844-8.

J Am Coll Surg. 2007 Dec;205(6):762-6.

surgery. 1995 Oct;82(10):1374-7.

1994 Jan 15;343(8890):135-8.

Care. 2004 Dec;16(6):473-82.

hospital savings. Trials. 2009;10:80.

stone disease. Arch Surg. 2010 Jan; 145(1):28-33.

Surgery. 2000;166:782-6.

502.

256-9.

Mar;145(3):260-4.

Nov;9(11):1221-4.

patients with acute pancreatitis against national standards of practice. The British

cholecystectomy safely decreases hospital stay in patients with mild gallstone pancreatitis: a randomized prospective study. Ann Surg. 2010 Apr;251(4):615-9. [120] Alimoglu O, Ozkan OV, Sahin M, Akcakaya A, Eryilmaz R, Bas G. Timing of

cholecystectomy for acute biliary pancreatitis: outcomes of cholecystectomy on first admission and after recurrent biliary pancreatitis. World J Surg. 2003 Mar;27(3):

cholecystectomy for mild to moderate gallstone pancreatitis shortens hospital stay.

cholecystectomy in patients with biliary acute pancreatitis. Surgery. 2009

mini-cholecystectomy in a prospective randomized trial. Surg Endosc. 1995

laparoscopic cholecystectomy and mini-cholecystectomy. The British journal of

Laparoscopic versus minilaparotomy cholecystectomy: a randomised trial. Lancet.

comparison with small-incision (mini) cholecystectomy. European Journal of

analysis of laparoscopic versus minilaparotomy cholecystectomy for gallstone disease. A randomized trial. Int J Technol Assess Health Care. 2001 Fall;17(4):497-

versus mini-cholecystectomy: analysis of hospital costs and social costs in a

health-related quality of life: a comparison of two techniques. Int J Qual Health

analysis in a blind randomized trial on small-incision versus laparoscopic cholecystectomy from a societal perspective: sick leave outweighs efforts in

Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct


[101] Schiphorst AH, Besselink MG, Boerma D, Timmer R, Wiezer MJ, van Erpecum KJ, et al.

[102] Gurusamy KS, Samraj K. Primary closure versus T-tube drainage after open common bile duct exploration. Cochrane Database Syst Rev. 2007(1):CD005640. [103] Gurusamy KS, Samraj K. Primary closure versus T-tube drainage after laparoscopic

[104] Leida Z, Ping B, Shuguang W, Yu H. A randomized comparison of primary closure

[105] Uhl W, Warshaw A, Imrie C, Bassi C, McKay CJ, Lankisch PG, et al. IAP Guidelines for the Surgical Management of Acute Pancreatitis. Pancreatology. 2002;2(6):565-73.

[108] Taylor E, Wong C. The optimal timing of laparoscopic cholecystectomy in mild

[109] Kimura Y, Arata S, Takada T, Hirata K, Yoshida M, Mayumi T, et al. Gallstone-induced

[110] Petrov MS, van Santvoort HC, Besselink MG, van der Heijden GJ, van Erpecum KJ,

[112] Hernandez V, Pascual I, Almela P, Anon R, Herreros B, Sanchiz V, et al. Recurrence of

[113] Lankisch PG, Weber-Dany B, Lerch MM. Clinical perspectives in pancreatology:

[114] Pezzilli R, Uomo G, Gabbrielli A, Zerbi A, Frulloni L, De Rai P, et al. A prospective

[115] Al-Haddad M, Raimondo M. Management of acute pancreatitis in view of the

[116] Sandzen B, Haapamaki MM, Nilsson E, Stenlund HC, Oman M. Cholecystectomy and

[117] Nguyen GC, Boudreau H, Jagannath SB. Hospital volume as a predictor for

2003: a nationwide register study. BMC Gastroenterol. 2009;9:80.

sphincterotomy. Am J Gastroenterol. 2004 Dec;99(12):2417-23.

Meta-Analysis of Randomized Trials. Ann Surg. 2008 Feb;247(2):250-7. [111] Toh SK, Phillips S, Johnson CD. A prospective audit against national standards of the

Gooszen HG. Early Endoscopic Retrograde Cholangiopancreatography Versus Conservative Management in Acute Biliary Pancreatitis Without Cholangitis: A

presentation and management of acute pancreatitis in the South of England. Gut.

acute gallstone pancreatitis and relationship with cholecystectomy or endoscopic

compliance with acute pancreatitis guidelines in Germany. Pancreatology.

multicentre survey on the treatment of acute pancreatitis in Italy. Dig Liver Dis.

published guidelines: are we compliant enough? Dig Liver Dis. 2007 Sep; 39 (9):

sphincterotomy in patients with mild acute biliary pancreatitis in Sweden 1988 -

undergoing cholecystectomy after admission for acute biliary pancreatitis.

acute pancreatitis. J Hepatobiliary Pancreat Sci. 2010 Jan;17(1):60-9.

[106] UK guidelines for the management of acute pancreatitis. Gut. 2005;54(Suppl 3):1-9. [107] Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol.

gallstone pancreatitis. Am Surg. 2004 Nov;70(11):971-5.

stones. Surg Endosc. 2008 Sep;22(9):2046-50.

Surg Endosc. 2008 Jul;22(7):1595-600.

2006 Oct; 101(10):2379-400.

2000 Feb;46(2):239-43.

2005;5(6):591-3.

847-8.

2007 Sep;39(9):838-46.

Pancreas. 2010 Jan;39(1):e42-7.

2007(1):CD005641.

Timing of cholecystectomy after endoscopic sphincterotomy for common bile duct

common bile duct stone exploration. Cochrane Database Syst Rev.

and T-tube drainage of the common bile duct after laparoscopic choledochotomy.


**4** 

 *Japan* 

Masahiko Hirota et al.\*  *Department of Surgery,* 

*Kumamoto Regional Medical Center, Kumamoto-city,* 

**Laparoscopy-Assisted Distal Pancreatectomy** 

The advantage of laparoscopic surgery is obvious and has been extended to pancreatic and splenic operations. Since 1994, various laparoscopic pancreatectomy, including pancreatoduodenectomy (Gagner & Pomp, 1994), enucleation (Gagner et al., 1996; Dexter et al., 1999), and distal pancreatectomy (Gagner et al. 1996; Sussman et al., 1996), have been performed. As for laparoscopic splenectomy, nowadays it can be conducted safely even for splenomegaly due to portal hypertension (Hama et al., 2008). Open pancreatic surgery requires a relatively large incision for a small lesion, and therefore the potential benefits of the laparoscopic approach are substantial. The most common indications for laparoscopic pancreatic resection were presumed benign pancreatic diseases, such as insulinoma or localized neuroendocrine neoplasms and branch type intraductal papillary mucinous neoplasms. The most common indication for laparoscopic pancreatic resection appears to be enucleations and distal pancreatectomy. Laparoscopic pancreatectomy, however, is still technically rather difficult because of the retroperitoneal position of the pancreas and the complex anatomical relationship between the pancreas and surrounding vessels. Thus, hand-assisted laparoscopic pancreatectomy is gaining recognition as a new and feasible technique that introduces a surgeon's hand into the abdominal cavity during laparoscopic surgery (Klingler et al., 1998; Shinchi et al., 2001; Kaneko et al., 2004). As a modification of hand-assisted laparoscopic pancreatectomy, we devised a method of spleen and gastrosplenic ligament preserving distal pancreatectomy, in which pancreatic resection is performed under direct vision extracorporeally (Hirota et al., 2009). Furthermore, laparoscopic assistance is also helpful in no-touch distal pancreatectomy for pancreatic cancer. For invasive pancreatic ductal cancers, the transection of the pancreas, splenic artery and vein, left gastroepiploic vessels, and short gastric vessels is performed at first to prevent the dissemination of cancer cells. Division of the pancreas, splenic artery, and splenic vein is done under direct vision through minilaparotomy at epigastrium. Division of the left gastroepiploic and short gastric vessels is done under laparoscope with left hand assistance. And then, retroperitoneal dissection is performed laparoscopically. In this way, the same

no-touch distal pancreatectomy as open operation can be achieved.

*Department of Surgery, Kumamoto Regional Medical Center, Kumamoto-city, Japan* 

Daisuke Hashimoto, Kazuya Sakata, Hideyuki Kuroki, Youhei Tanaka, Takatoshi Ishiko,

Yu Motomura, Shinji Ishikawa, Yoshitaka Kiyota, Tetsumasa Arita, Atsushi Inayoshi and Yasushi Yagi

**1. Introduction** 

 \*

