New adjustable knot for securing subcuticular running sutures

Abstract

CorrespondenceReturn to work after inguinal hernia repair La pa rosco pic c holecystectomy Sir We read with interest the Review on laparoscopic cholecystectomy by MessrsMacintyre and Wilson (Br JSurg 1993; 80: 552-9). The authors state that one of the generally agreed contraindications to laparoscopic cholecystectomy is the presence of a cholecystoenteric fistula.We have encountered five cholecystoduodenal fistulas in a series of 300 laparoscopic cholecystectomies, which we are reporting in Surgical Laparoscopy and Endoscopy. Of these, two were diagnosed before operation. One patient had a previous cholecystoduodenostomy and another had aerobilia on computed tomography. It was possible to deal with four fistulas laparoscopically. The fifth patient had to undergo conversion to laparotomy as the duodenum was inadvertently perforated during dissection. In the remainder it was possible to display the cholecystoduodenal fistula with a combination of careful blunt and sharp dissection. The fistula was divided and stapled at the same time by a single firing of an Endo-GIG30 stapler (US Surgical, Norwalk, Connecticut, USA) through an epigastric 12-mm cannula. Intraoperative cholangiography was performed in each patient to confirm biliary anatomy and detect bile duct stones.We maintain that, with increasing expertise, better imaging and improved instrumentation, it is feasible to repair most cholecystoduodenal fistulas laparoscopically.