BackgroundEven though laparoscopic cholecystectomy (LC) has become the customary method for treating gallstones, some incidents and complications appear rather more frequently than with the open technique. Several aspects of these complications and their treatment possibilities are analysed. Materials and methodsOver the last 9 years 9542 LCs have been performed at this centre, of which 13.9% were carried out for acute cholecystitis, 38.4% in obese patients and 7.6% in patients aged >65 years. ResultsThe main operative incidents encountered were haemorrhage

With a precise diagnosis and a good indication, the mini-invasive treatment of complications was completed with good results. 16 laparoscopic re-operations and 22 endoscopic sphyncterotomies were performed (for the treatment of bile leakage and remnant gallbladder stones).

Forty-six patients in whom sphincteroplasty was performed by an original technique are presented. In 43 cases the indication was oddian stenosis (associated or not with cholelithiasis or hepatic hydatid disease). Only in three patients a "security" operation was performed. Sphincteroplasty was achieved with the aid of an original probe, and average length of the incision of the ampullary area was 27 mm. The postoperative control, made by tube cholangiography and barium investigation, has evidenced the presence of a wide, open choledochoduodenal aperture. Amylase activity was also followed up in 25 patients. One case of acute pancreatitis, two upper digestive haemorrhages and one case of duodenal fistula were recorded as postoperative complications. Healing was obtained in all patients.

A progressive accumulation of fibrin in the small vessels of the isolated perfused rat liver was documented by both histological and autohistoradiographi c techniques, These changes occurred initially in the sinusoids and later extended to the interlobular branches of the portal vein. Fibrin deposition was accompanied by a reduction of perfusion flow, an increase of the lactate-pyruvate ratio in the perfusion medium, and a depletion of fiver tissue glycogen. All of these changes were prevented by adding streptokinase to the perfusing solution. Mechanisms leading to intravascular accumulation of fibrin and the possible involvement of this process in failure of prolonged fiver preservation, hemorrhagic accidents following liver transplantation, and liver allograft rejection are discussed. The use of fibrinolytic agents for perfusion preservation of the isolated fiver appears promising.

Seventy patients in whom sphincteroplasty was performed by an original technique are presented. In 65 cases the indication was stenosis of the sphincter of oddi, associated or not with cholelithiasis or hepatic hydatid disease. There were relative indications in another 5 patients. Sphincteroplasty was achieved with the aid of an original probe, and average length of the incision of the ampullary area was 28 mm.In the immediate postoperative period there was one case of acute postoperative pancreatitis, one duodenal fistula and an upper digestive haemorrhage; also a residual stone was detected. All these complications have responded favourably to conservative treatment. There was a single death in an old patient with bronchopneumonia.The late results were very good or good with the exception of two cases: one which presented with cholangitis episodes maintained by duodenal stasis, and one female patient, who after one year from sphincteroplasty had to be reoperated on for an hepatic abscess.KEY WORDS: Oddian sphincteroplasty, original technique, early and late results.

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