Background. In laparoscopic surgery errors are unavoidable and require proper
Purpose: Laparoscopic management analysis of a rare condition having potentially severe evolution, seen in pediatric surgical pathology. Aims: Outlining the optimal surgical approach method of hepatic hydatid double cyst and the laparoscopic method's limitations. Materials and Methods: The patient is a 6 years old girl that presented with two simultaneous giant hepatic hydatid cysts (segments VII-VIII), having close vicinity to the right branch of portal vein and to hepatic veins; she benefited from a single stage partial pericystectomy Lagrot performed by laparoscopy. Results: The procedure had no intraoperative accidents or incidents. Had good postoperative evolution without immediate or late complications. Trocars positioning had been adapted to the patient's size and cysts topography. Conclusions: The laparoscopic treatment is feasible and safe, but is not yet the gold standard for a hepatic hydatid disease due to certain inconveniences. Acne conglobata is a rare, severe form of acne vulgaris characterized by the presence of comedones, papules, pustules, nodules and sometimes hematic or meliceric crusts, located on the face, trunk, neck, arms and buttocks.
We remind you of some technical artifices required in order to resolve difficult cases, such as: antegrade laparoscopic cholecystectomy (LC), subtotal laparoscopic cholecystectomy (SLC) and the "stairs" clipping of the cystic duct. Also we acknowledge the closing of the cystic duct. We analyzed the medical records of 15251 laparoscopic cholecystectomies performed during 1994-2015, with emphasis on: surgical technique, conversion rate, hemorrhage, postoperative bile leaking, iatrogenic MBD injuries and mortality. We divided the cases in 5 study groups, group 1 (1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004) N= 5138, group 2 (2005-2015) N= 10113, group 3 (fundus first cholecystectomies, N=2348), group 4 (retrograde cholecystectomies, N=12889) and group 5 (subtotal laparoscopic cholecystectomy-SLC, N=14) which we compared regarding the main parameters. We prefer to perform a "step by step" clipping each time the length of the clip does not cover all the circumference of the cystic duct. This artifices, is a simple laparoscopic gesture easy to perform and has the advantage of avoiding a large excessive and risky laparoscopic dissection in the vicinity of the main biliary duct. More seldom we appeal to the suture of the cystic stump using the intracorporeal knots or a simple stump ligation with an extracorporeal preformed not. We did not encounter any late or early complications following the implementation of this technical laparoscopic artifice. Laborious laparoscopic cholecystectomies performed by a well-trained surgical team ensure the premises of a good performance even while adopting laparoscopic ingenious and difficile gestures that also respect the intraoperatory rules and principals. ObjectivesThe study is a retrospective evaluation of the last Materials and methodsWe 84Special attention should be paid to case of gallbladder hydrops that has a large bile stone stuck in the infundibulo-cystic region. The patient presents also important inflammatory modifications of the biliary pedicle ( Figure 7). In these situations we recommend the laparoscopic subtotal cholecystectomy and extraction of the stone using a Maryland forceps (Figure 8). Due to the fact that the electric hook dissection of the pedicle is considered dangerous we chose for a subtotal cholecystectomy performed in the infundibular area. Sealing the infundibular remaining is laparoscopic performed by intracorporeal knots (Figure 9). The subhepatic drainage tube is considered a safety measure in order to observe and treat eventual biliary leakages. We shall sustain the fundus first strategy, including here also the subtotal cholecystectomy and defensive approach of the cystic duct. Cholelithiasis is quite rare in children and adolescents, and the acute pathology is extremely rare.As we know, the most important moment of the surgery is the dissection of the Calot triangle, identification, dissection and treatment of the cystic artery and cystic duct, and that is not always easy to perform. However we can say that LC is...
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