Since the introduction of laparoscopic cholecystectomy, the management of common bile duct (CBD) stones has undergone significant change. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is now routinely done in cases where the diagnosis of choledocholithiasis is suspected preoperatively, with clearance of the bile ducts before laparoscopic cholecystectomy. Intraoperative discovery of CBD stones by cholangiography represents a challenge to the surgeon, who must make a decision about when to perform laparoscopic CBD exploration, convert to open surgery, or send the patient for ERCP during the postoperative period. Because ERCP has a definite failure rate, laparoscopic CBD exploration can be a treatment option. Among 2500 laparoscopic cholecystectomies done by our group from January 1991 to June 1997, 50 patients (2%) underwent laparoscopic CBD exploration, 13 by the transcystic technique and 37 by choledocotomy, with a conversion rate of 8% and a hospital stay of 4.3 days. One patient died from complicated pancreatitis following ERCP and unsuccessful extraction of a CBD stone. We obtained our goal of a CBD free of stones in 92% of the cases. We conclude that laparoscopic CBD exploration is an effective method for treating choledocolithiasis that allows management of this pathology in one stage, although it requires advanced laparoscopic skills and adequate equipment.

Anatomic and topographic studies were carried out in 30 recurrent laryngeal nerves (RLN), dissecting the vagus nerve retrogradely to identify corresponding fascicles to the RLN. By obtaining measurements of diameter and length, surgically practical data were obtained, allowing for a possible revision of reconstructive possibilities for nerve injuries to the RLN through dissection and nerve graft.

Laparoscopic adhesiolysis is a valuable tool for the surgeon performing complex minimally invasive procedures. It can be used for the management of intestinal obstruction and chronic abdominal pain syndromes. It is also an essential skill when performing laparoscopic surgery on patients who had prior abdominal operations. The use of laparoscopy for patients with an intestinal obstruction was once considered an absolute contraindication. With the advancement in optics and increasing experience, more and more surgeons are turning to laparoscopy as a useful diagnostic and therapeutic tool in more complex situations.

In this study, a 2 mm internal diameter (i.d.) polytetrafluoroethylene (PTFE) microprosthesis was used in the venous system of the rat, to determine whether or not it could serve as an acceptable microvenous substitute. Forty Long-Evans rats were divided into four groups: Group 1-10 rats with autotransplant of an inferior vena cava segment; Group 2-10 rats with a segment substitution of the inferior vena cava by a 2 mm i.d. PFTE microprosthesis; Group 3-10 rats with a laterolateral portacaval shunt; and Group 4-10 rats with a portacaval shunt and interposition of a 2 mm i.d. PTFE microprosthesis (new model). The rats were sacrificed at different time intervals up to 100 days, with cavography (femoral access) in Groups 1 and 2 and spleenoportography (direct puncture of the spleen) in Groups 3 and 4, before sacrifice. In Group 1, a 100 percent patency was observed at a mean of 49 days; in Group 2, a 70 percent patency with a 30 percent stenosis at a mean of 39.4 days (p less than 0.05); in Group 3, a 100 percent patency at a mean of 42.5 days; and in Group 4, a 30 percent patency at a mean of 38.4 days (p less than 0.01). Results showed that the 2 mm i.d. PTFE microprosthesis placed in the venous system of the rat is not an efficacious procedure, and that the search for better microvenous substitutes should focus on those of biologic origin.

Management of post-bariatric surgery emergencies is common practice in the USA and the world. Due to the popularity and widespread use of bariatric procedures to treat obesity and its comorbidities, emergency physicians and general surgeons will be challenged with the treatment of short- and long-term complications of bariatric procedures. In this article, we evaluate the most common long-term complications of the most commonly performed bariatric interventions.