Dermabrasion combined with 5-fluorouracil is the most efficacious of the three treatment modalities studied.

The incidence of bile duct injury in laparoscopic cholecystectomy is 0.3% to 1.0%. This is higher than the incidence reported for open cholecystectomy (i.e., 0.1-0.2%), and the surgeons all over the world are relentlessly trying to find the ways and means to lower this incidence. Various operating strategies, techniques, and instrumentations such as the 0 degrees telescope, intraoperative cholangiogram, hydrodissection, and peanut gauze dissection have been claimed by various authors to minimize the risk of bile duct injury during cholecystectomy. However, the surgical fraternity agrees that there has been no substitute for meticulous dissection and display of various vital structures near the common bile duct. The authors describe seven anatomic landmarks encountered during laparoscopic cholecystectomy that assist in safe dissection to prevent bile duct and vascular injury. On the basis of their experience, they believe that if surgeons adhere to these landmarks, excellent results can be achieved.

Introduction:The difficult gallbladder is the most common ‘difficult’ laparoscopic surgery being performed by general surgeons all over the world and the potential one that places the patient at significant risk. We present our experience of 6147 cases since January 1993 in a single center with respect to conversion to open cholecystectomy.Methods:Patients who underwent laparoscopic cholecystectomy (LC) from January 1993 to December 2004 were analyzed. The cases were analyzed in relation to conversion rate to open surgery, factors affecting the conversion, and completion rate of LC. Patients having absolute contraindications to LC like cardiovascular and pulmonary disease were not included in the study.Results:Out of 6147 cases, 1518 patients (21.5%) were identified as difficult cases. Laparoscopic cholecystectomy was successfully completed in 6125 patients with a completion rate of 99.6%. Laparoscopic procedure had to be converted to the open procedure in 22 patients with a conversion rate of 0.36% of the total LCs performed and 1.66% of the difficult cases. Conversion had to be done due to several reasons.Conclusion:It can be reliably concluded that LC is the preferred method even in the difficult cases. Our study emphasizes that although the rate of conversion to open surgery and complication rate are low in experienced hands the surgeon should keep a low threshold for conversion to open surgery and it should be taken as a step in the interest of the patient rather than be looked upon as an insult to the surgeon.

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