Background: Laparoscopic cholecystectomy is commonly performed, and several factors increase the

Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics.

No abstract

Emergency cholecystectomy is less costly and more effective than delayed cholecystectomy. This approach is likely to be beneficial to patients in terms of improved health outcomes and to the healthcare provider owing to the reduced costs.

Ann RC oll Surg Engl 2008; 90:6 85-688 685In the 'standard'approach to the carotid bifurcation used in carotid endarterectomy,t he dissection proceeds anteriorly and medial to the internal jugular vein. The facial vein requires division, allowing the jugular vein to be retracted laterally to expose the carotid bifurcation (Fig. 1).The retrojugular approach was originally described to allow dissectionthrough unscarred tissue for re-do surgery or to provide better exposure of the distal internal carotid artery in high lesions. Here, the dissection proceeds behind the internal jugular vein, which is retracted anteriorly and medially to expose the carotid bifurcation. This avoids the facial vein and the small anterior branches of the internal jugular vein at the upper end of the incision (Fig. 2).Recent reports have stimulated ar esurgence of interest in the retrojugular approach, showing it to be safe and possibly faster than the anteromedial approach. 2,3However, concerns have been raised with regard to cranial nerve injury witht he retrojugular approach, 4,5 in particular, whether the accessory nerve may be prone to injury.The aim of this study was to investigate whether the incidence of cranial nerve injuries associated with the retrojugular approach was differentf rom that of the anteromedial approach. Patients and Methods Study designData were obtained from ap rospectively maintained database containing details of 461 carotid endarterectomies performed by or under the supervision of asingle surgeon (CPG) over a1 6-year period and were analysed retrospectively to determine the incidence of cranial nerve injury. PatientsAtotal of 236 (164 males; 72 females; median age, 69 years; range, 43-85 years) primary carotid endarterectomies performed under local anaesthetic using the eversion technique were identified from the database of which 145 were performed via the anteromedial approach and 91 by the retrojugular approach. The choice of approach depended mainly on the date of surgery as the preference of