Section 3 Biliary System

therapy with endoscopic band ligation: A randomized double-blind placebocontrolled trial. The American Journal of Gastroenterology. 2009;104(3):617-623

Digestive System - Recent Advances

[18] Escorsell A, Ruiz del Arbol L, Planas R, et al. Multicenter randomized controlled trial of terlipressin versus sclerotherapy in the treatment of acute variceal bleeding: The TEST study. Hepatology. 2000;32(3):471-476

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[21] Bhutta AQ, Garcia-Tsao G. The role of medical therapy for variceal bleeding. Gastrointestinal Endoscopy Clinics of North America. 2015;25(3):479-490

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[23] Chang TT, Lee FY, Tsai YT, et al. A randomized controlled study of lowdose and high-dose terlipressin in the control of acute oesophageal variceal

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2009;58(9):1275-1280

**89**

**Chapter 6**

**1. Introduction**

by gall stones.

history books.

and Background

*Sam Koruth and Sooraj Sankar*

most patients with symptomatic gallstones.

operative therapy of gallstone diseases.

Prologue: Biliary System - History

Cholecystectomy is one of the most common surgeries performed all around the world; over 600,000 people in the US undergo cholecystectomies each year. It is the treatment of choice for inflammation of the gallbladder (cholecystitis), pain and inflammation related to gall stones (calculus cholecystitis) and pancreatitis caused

Carl Johann August Langenbuch, a 27-year-old director of the Lazarus Hospital in Berlin, first practiced cholecystectomy on a cadaver, and then in the year 1882, he performed a cholecystectomy on a man who had suffered from gallstones for 16 years and cured his painful condition overnight. He was initially frustrated and disturbed that his patients continued to suffer after minor procedures to drain or clean the gallbladder, and then he became determined to give these patients a cure rather than temporary relief, and thus the first open cholecystectomy captured the

By 1897, over 100 cholecystectomies had been performed, and it turned out that the removal of the gallbladder not only would not take life but could in fact provide a pain-free future. Then in 1985, the modern era of cholecystectomies began when the surgeon Erich Mühe of Böblingen, Germany, did the first endoscopic cholecystectomy. Thereafter the pioneers in France and the US surgeons attached a CCD video camera to a laparoscope allowing the surgical team to view the operative field and perform with laparoscopic instruments. A French gynecologic surgeon performed a laparoscopic gallbladder removal in 1987. Soon after that in just 2 years, demand for the laparoscopic approach transformed surgical practice in the US and other countries and subsequently recognized laparoscopic cholecystectomies as the gold standard treatment for gallstone disease. The benefits of the laparoscopic approach were ultimately codified in the new National Institutes of Health (NIH) guidelines in 1992, and they stated that it provided a safe and effective treatment for

To date, it is documented that more than 80% of the cholecystectomies are done via laparoscopic approach. The advantages of laparoscopic over open surgeries are quite clear. These advantages include shorter length of hospital stay, very less operative pain, avoiding a big scar over the abdomen, earlier return of bowel function, improved cosmesis, earlier return to normal activities and overall decreased cost. The rates of cholecystectomies have increased subsequently with the introduction of laparoscopic procedures accompanied by evidence of lower clinical thresholds for
