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Dig Endosc 2019 Apr;31 Suppl 1:55-64

2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.

Early surgical treatment using the laparoscopic approach is generally accepted as the treatment of choice for acute cholecystitis (AC) according to Tokyo Guidelines 2018 (TG2018). If the patient is a poor candidate for surgery because of the presence of advanced malignancy or severe organ failure, this treatment may be too invasive. In such cases, gallbladder drainage is considered an alternative treatment method to surgery. Read More

Int J Surg Case Rep 2019 Apr 8;58:14-17. Epub 2019 Apr 8.

Department of Surgery, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China.

Introduction: Choledocholithiasis during pregnancy is relatively uncommon but it can be life-threatening. Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) poses the risk of ionizing radiation exposure to the developing fetus. Other strategies are thus needed to tackle this problem. Read More

Adv Clin Exp Med 2019 Apr 13. Epub 2019 Apr 13.

General Surgery Department, Atatürk Research and Education Hospital, Ankara, Turkey.

Background: Laparoscopic cholecystectomy (LC) is nowadays the gold standard in the surgical treatment of cholelithiasis and gallbladder diseases. But sometimes it may be inevitable to convert it to open surgery to safely end the procedure.

Objectives: In this study, we aimed to investigate the risk factors for conversion to open surgery from LC. Read More

BMJ Case Rep 2019 Apr 11;12(4). Epub 2019 Apr 11.

Hospital Pediatrico de Coimbra, Coimbra, Portugal.

Gallbladder diseases are uncommon in children. Acalculous acute cholecystitis, although rare, is the most frequent form of acute cholecystitis in childhood. In acalculous acute cholecystitis, clinical presentation and laboratory findings are unspecific, making the diagnosis challenging. Read More

Arch Pathol Lab Med 2019 Apr 10. Epub 2019 Apr 10.

From the Department of Pathology, University of Maryland Medical Center, Baltimore (Dr Rose); the Department of Pathology, The Ohio State University Wexner Medical Center, Columbus (Drs C. A. Arnold, Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold); and the Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio (Drs Badizadegan, Carter, Conces, Kahwash, Nicol, and M. A. Arnold). Dr Carter is now with Indiana University Health, Southern Indiana Pathologists, Bloomington.

Context.—: Cystoisospora belli is an intracellular parasite associated with gastrointestinal disease in immunocompromised hosts. Although infection has been classically associated with intestinal disease, studies have identified Cystoisospora in the gallbladder of immunocompetent patients based on hematoxylin-eosin morphology. Read More

BJS Open 2019 Apr 12;3(2):146-152. Epub 2019 Feb 12.

Department of Hepatobiliary and Transplant Surgery St Vincent's University Hospital Elm Park, Dublin 4 Ireland, D04 T6F4.

Background: Acute calculous cholecystitis (ACC) is a common disease across the world and is associated with significant socioeconomic costs. Although contemporary guidelines support the role of early laparoscopic cholecystectomy (ELC), there is significant variation among units adopting it as standard practice. There are many resource implications of providing a service whereby cholecystectomies for acute cholecystitis can be performed safely. Read More

Surg Case Rep 2019 Apr 5;5(1):54. Epub 2019 Apr 5.

Department of Surgery, Onomichi General Hospital, 1-10-23, Onomichi, Hiroshima, 722-8508, Japan.

Background: Left-sided gallbladder is a relatively rare anatomical variation that is frequently associated with a biliary system anomaly. Here, we describe a case of left-sided gallbladder with acute cholecystitis treated by laparoscopic cholecystectomy.

Case Presentation: An 86-year-old man with acute upper abdominal pain was admitted to our hospital. Read More

Surg Endosc 2019 Apr 4. Epub 2019 Apr 4.

Department Surgery and Cancer, Imperial College London, London, UK.

Background: Cholecystectomy on index admission for acute cholecystitis is associated with improved patient outcomes. The timing of intervention is mainly driven by service provision. This population-based cohort study aimed to evaluate timing of emergency cholecystectomy in England. Read More

BMJ Case Rep 2019 Apr 3;12(4). Epub 2019 Apr 3.

Department of Surgery, College of Medicine, University of Duhok, Duhok, Kurdistan Region, Iraq.

A 35-year-old woman presented to the surgical clinic complaining of right hypochondrial pain for 4 days. Abdominal examination revealed tenderness on deep palpation in the right hypochonrdium, with no palpable organs or masses. The patient had repeated attacks of the same pain that mandated repeated admissions to the emergency hospital and treated conservatively. Read More

Hum Pathol 2019 Apr 1. Epub 2019 Apr 1.

Department of Pathology and Immunology, School of Medicine, Washington University in St. Louis, 425 S Euclid Ave, Campus Box 8118, St. Louis, MO, USA 63110.. Electronic address:

Follicular cholecystitis (FC) is a relatively rare entity with uncertain causal associations. In this study, we aimed to explore different clinicopathologic associations of FC, and to better characterize the entity. A retrospective review of archival H&E slides and pertinent clinical information was undertaken for all cholecystectomy cases with a rendered diagnosis of "follicular cholecystitis", from 1991 to 2017. Read More

Medicine (Baltimore) 2019 Apr;98(14):e15042

Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai.

Rationale: The application of post-mortem computed tomography (PMCT) and PMCT angiography (PMCTA) is becoming increasingly common in forensic investigations. One of the most frequently applied techniques today is PMCTA. However, few studies have focused on the application of contrast-enhanced PMCT of hollow organs such as the gastrointestinal tract. Read More

Updates Surg 2019 Apr 3. Epub 2019 Apr 3.

Department of Surgery, Sapienza University of Rome-Polo Pontino, Via Firenze, 04019, Terracina, Italy.

In the literature, there is a large evidence against the use of drains in laparoscopic cholecystectomy (LC) in elective surgery. However, evidence is lacking in the setting of acute cholecystitis (AC). The present meta-analysis was performed to assess the role of drains to reduce complications and improve recovery in LC for AC. Read More

J Gastrointest Surg 2019 Apr 3. Epub 2019 Apr 3.

Division of Trauma and Emergency Surgery, General Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333, Republic of China.

Background: Percutaneous transhepatic gallbladder drainage (PTGBD) is an alternative treatment for acute cholecystitis (AC). We aimed to understand the natural course of AC in patients treated with PTGBD but without later definitive treatments, such as laparoscopic cholecystectomy.

Methods: This was a retrospective study of the period from June 2010 to December 2016, during which time 2371 patients were diagnosed with AC and 625 received PTGBD treatment. Read More

JFMS Open Rep 2019 Jan-Jun;5(1):2055116919838874. Epub 2019 Mar 27.

Pathology Sector, Clinic and Surgery Department, Veterinary School, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.

Case Summary: An adult cat presented with neurological signs and marked icterus. Clinical pathology tests detected increased serum alkaline phosphatase levels, as well as alanine aminotransferase, total bilirubin, unconjugated bilirubin and conjugated bilirubin above the normal reference intervals. Ultrasonography showed hepatomegaly and a dilated gall bladder. Read More

Khirurgiia (Mosk) 2019 (3):88-97

Vishnevsky National medical research center of surgery of Ministry of Health of Russia, Moscow, Russia.

In the following article, we present the key trends in emergency surgical care in the Russian Federation between 2000 and 2017. The study used data from federal statistical observations and a survey of state medical institutions in 80 regions encompassing 99.3% of the country's population. Read More

Laeknabladid 2019 Apr;105(4):171-176

Department of General Surgery, The Faculty of Medicine, University of Iceland.

Introduction: Acute cholecystitis is one of the most common reasons for acute admission in abdominal surgery. The recom-mended therapy is cholecystectomy but occasionally that is not possible and a conservative treatment with intravenous antibiotics is used. Should the patient not respond to conservative treatment a percutaneous catheter can be placed in the gallbladder (cholecystostomy). Read More

Zhonghua Wai Ke Za Zhi 2019 Apr;57(4):265-270

Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.

To investigate the rationale for appropriate diagnostic methods and treatment protocols for unexpected gallbladder carcinoma(UGC). The clinical and pathological data of 45 patients with UGC admitted at Department of General Surgery, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine,from January 2008 to December 2017 were retrospectively collected and analyzed.There were 11 males(28. Read More

Clin Gastroenterol Hepatol 2019 Mar 27. Epub 2019 Mar 27.

Digestive and Interventional Endoscopy Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.

Radiol Clin North Am 2019 May 10;57(3):535-548. Epub 2019 Feb 10.

Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Box 648, Rochester, NY 14642, USA.

Right upper quadrant (RUQ) abdominal pain is a common complaint. Acute cholecystitis (AC) is the primary diagnostic consideration in most adults presenting with acute onset RUQ abdominal pain; however, a variety of other conditions can mimic AC. Abdominal ultrasound (US) receives the highest score for imaging appropriateness for these patients. Read More

Can J Rural Med 2019 Apr-Jun;24(2):61-64

Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, Canada.

Introduction: Hepatobiliary iminodiacetic acid (HIDA)-radionuclear scans are used to diagnose biliary dyskinesia, the treatment for which is a laparoscopic cholecystectomy (LC). However, the predictive value of the HIDA scan for LC candidacy is debated.

Case: A physical, ultrasound, and blood test for a 53-year-old woman with biliary dyskinesia-like symptoms were normal, contradicting a textbook history. Read More

Pan Afr Med J 2018;31:52. Epub 2018 Sep 24.

Service de Chirurgie Viscérale et Digestive de l'Hôpital Militaire d'Instruction Mohamed V de Rabat, Maroc.

Surg Case Rep 2019 Mar 25;5(1):46. Epub 2019 Mar 25.

Department of Surgery, Yamaguchi Prefectural Grand Medical Center, Yamaguchi, Japan.

Background: Risk factors for bile duct injury in laparoscopic cholecystectomy include severe inflammation at Calot's triangle and aberrant bile duct variations. Knowledge of the various biliary anomalies and early identification may therefore assist in decreasing the rate of bile duct injury.

Case Presentation: A 65-year-old woman was admitted with right hypochondrial pain and high fever. Read More

World J Emerg Surg 2019 14;14:12. Epub 2019 Mar 14.

1Donegal Clinical Research Academy, Letterkenny University Hospital, Donegal, Ireland.

Introduction: Laparoscopic cholecystectomy, the gold-standard approach for cholecystectomy, has surprisingly variable outcomes and conversion rates. Only recently has operative grading been reported to define disease severity and few have been validated. This multicentre, multinational study assessed an operative scoring system to assess its ability to predict the need for conversion from laparoscopic to open cholecystectomy. Read More

J Midwifery Womens Health 2019 Mar 25. Epub 2019 Mar 25.

University of Louisiana at Lafayette, Lafayette, LA.

Cholelithiasis affects approximately 15% of the US population. Rising trends in obesity and metabolic syndrome have contributed to an increase in diagnosis of cholelithiasis. There are several risk factors for cholelithiasis, both modifiable and nonmodifiable. Read More

Minim Invasive Surg 2019 14;2019:5705039. Epub 2019 Feb 14.

General Surgery Department, Sri Ramachandra Medical University, Chennai, India.

Objectives: Pathogenesis of gallstone includes bile stasis due to defect in the gallbladder muscle contraction. Our aim of the study is to find out the role of 99mTc-HIDA scan in assessment of gallbladder dyskinesia in cholelithiasis patients before laparoscopic cholecystectomy and compare the gallbladder dyskinesia with various parameters like symptoms of patients, diabetic status of patients, gallstones size and number, and cholecystitis features in histopathology report after surgery.

Material And Method: This is a prospective observational study conducted at our hospital for three years. Read More

Clin Pract 2019 Jan 20;9(1):1091. Epub 2019 Feb 20.

Internal Medicine Service, Alvarez Buylla Hospital, Mieres, Spain.

In adults, intestinal malrotation is an oligosymptomatic entity that is occasionally discovered during the course of diagnostic studies for other causes. In the case described herein, intestinal malrotation was discovered during investigation for cholelithiasis and acute cholecystitis. Malrotation may occur due to alterations in the asymmetric cellular dynamics of the mesentery responsible for intestinal shortening and unilateral retraction, this may occur as a secondary event following alterations in the expression of homeodomain transcription factors. Read More

Vet Pathol 2019 Mar 21:300985819833452. Epub 2019 Mar 21.

5 Department of Veterinary Microbiology and Preventive Medicine, Iowa State University, Ames, IA, USA.

The aim of this study was to assess whether pregnant mice represent a useful model to study the reproductive pathology of Campylobacter jejuni IA3902 using the end point of positive microbial culture of the organism from the fetoplacental unit. Pregnant BALB/c and CD-1 mice (14 days' gestation) were inoculated orally and intraperitoneally (IP) with 1 × 10 colony-forming units/ml of C. jejuni IA3902. Read More

Ulus Travma Acil Cerrahi Derg 2019 Mar;25(2):154-158

Department of General Surgery, İnönü University Faculty of Medicine, Malatya-Turkey.

Background: This study aimed to present to evaluate the results of two different approaches in the management of acute cholecystitis during pregnancy: immediate surgery and delayed surgery following conservative management.

Methods: In this study, 20 pregnant women who were treated in our clinic for acute cholecystitis between 2010 and 2018 were included in the analysis. Demographic characteristics, parameters related with acute cholecystitis (gallbladder wall thickness, laboratory data), duration of hospitalization, readmission rates, and preterm labor rate were retrospectively evaluated. Read More

J Gastrointest Surg 2019 Mar 18. Epub 2019 Mar 18.

Department of General Surgery, St. Vincent's University Hospital, Dublin 4, Ireland.

Background: Percutaneous cholecystostomy (PCT) is a safe method of gallbladder drainage in the setting of severe or complicated acute cholecystitis (AC), particularly in patients who are high-risk surgical candidates. Small case series suggest that PCT aids resolution of acute cholecystitis in up to 90% of patients. However, reluctance is observed in utilising PCT more frequently, due to concerns that we are committing comorbid patients to an interval surgical procedure for which they may not be suitable. Read More

Histopathology 2019 Mar 18. Epub 2019 Mar 18.

Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan.

Aims: To investigate whether genetic or inflammatory pro-oncogenic factors are relevant to the increased risk of gallbladder cancers in patients with pancreaticobiliary maljunction (PBM).

Methods: Mutations in KRAS exon 2 were examined by a highly sensitive, droplet digital PCR platform using surgically resected specimens of PBM-associated (n=31) and non-associated gallbladder cancers (n=49). The tissue expression of IL-6 and IL-33, which are suspected to promote biliary carcinogenesis, was analyzed by quantitative real-time PCR and in situ hybridization. Read More

Chin Med J (Engl) 2019 Mar 4. Epub 2019 Mar 4.

Department of Burn and Plastic Surgery, Fourth Medical Center of PLA General Hospital, Beijing 100048, China.

Surg Innov 2019 Mar 15:1553350619835347. Epub 2019 Mar 15.

2 Royal Bolton Hospital, Bolton, UK.

Objectives: To compare the outcomes of extended postoperative antibiotics versus no postoperative antibiotics in patients with acute calculous cholecystitis undergoing emergency cholecystectomy.

Methods: We performed a systematic review and conducted a search of electronic information sources to identify all randomized controlled trials comparing outcomes of extended postoperative antibiotics versus no postoperative antibiotics in patients with acute calculous cholecystitis undergoing emergency cholecystectomy. Postoperative infectious complications and surgical site infections were primary outcome measures. Read More

Clin Endosc 2019 Mar 15. Epub 2019 Mar 15.

Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan.

Background/aims: : It is often difficult to manage acute cholecystitis after metal stent (MS) placement in unresectable malignant biliary strictures. The aim of this study was to evaluate the feasibility of endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) for acute cholecystitis.

Methods: : The clinical outcomes of 10 patients who underwent EUS-GBD for acute cholecystitis after MS placement between January 2011 and August 2018 were retrospectively evaluated. Read More

J Ayub Med Coll Abbottabad 2019 Jan-Mar;31(1):3-7

General Surgery, Dudley Group NHS Foundation Trust, West Midlands.

Background: Acute presentation of gall stone disease is a common emergency. Resource limitation often results in unnecessary long waiting times and repeat hospital admissions. The aim of this study was to investigate if funding a dedicated hot gall bladder list is justified. Read More

World J Emerg Surg 2019;14:10. Epub 2019 Mar 4.

6Department of Surgery, University Hospital of Verona, Verona, Italy.

Background: Gallstone disease is very common afflicting 20 million people in the USA. In Europe, the overall incidence of gallstone disease is 18.8% in women and 9. Read More

Ann Hepatobiliary Pancreat Surg 2019 Feb 28;23(1):34-40. Epub 2019 Feb 28.

Department of General Surgery, Maggiore Hospital, Parma, Italy and Department of Surgery, "Infermi" Hospital, Rimini, Italy.

Backgrounds/aims: The prevalence and risk factors of gangrenous cholecystitis in male are unknown.

Objective: To verify the prevalence and risk factors of gangrenous cholecystitis in males.

Methods: This cross-sectional study includes 95 patients (59. Read More

Rev Esp Anestesiol Reanim 2019 Mar 9. Epub 2019 Mar 9.

Servicio de Anestesiología y Reanimación y Terapéutica del Dolor, Hospital de Galdakao-Usansolo, Galdakao, Vizcaya, España.

Laparoscopic cholecystectomy is currently assumed to be the standard gold treatment of acute biliary tract pathology. Despite its many advantages compared to classical open surgery, it is not without complications. The case is presented of an 82 year-old male patient who, after the diagnosis of cholecystitis gangrenous, was urgently intervened using laparoscopic cholecystectomy. Read More

AJR Am J Roentgenol 2019 Mar 12:1-6. Epub 2019 Mar 12.

1 Department of Radiology, Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305.

Objective: In patients with acute cholecystitis (AC), accurate identification of a common bile duct (CBD) stone before cholecystectomy is of concern for surgeons, gastroenterologists, and radiologists. This study evaluates the utility of preoperative MRCP taking into consideration both sonographic findings and biochemical predictors for choledocholithiasis.

Materials And Methods: Fifty-seven patients (58% women; mean age, 54 years old) with signs of AC on right upper quadrant (RUQ) ultrasound (US) who underwent subsequent MRCP from 2007 to 2017 were identified using a text-based search and retrospectively analyzed, using ERCP as the reference standard. Read More

Khirurgiia (Mosk) 2019(2):32-39

The Department of hospital surgery with the course of pediatric surgery of the RUDN University, Moscow, Russia.

Aim: To develop rational tactics of surgical treatment of patients with acute calculous cholecystitis with their subsequent discharge within 1 day since admission.

Material And Methods: There were 283 patients with acute cholecystitis and 58 patients with chronic cholecystitis. All patients underwent laparoscopic cholecystectomy. Read More

Medicine (Baltimore) 2019 Mar;98(10):e14824

Department of Radiology, The First Affiliated Hospital of Dali University, Dali, Yunnan, People's Republic of China.

Rationale: Left gastric artery aneurysms are very rare which progresses into hemorrhagic shock and diagnosis is very challenging particularly in patients with acute pancreatitis and cholecystitis whose vitals become unstable suddenly.

Patient Concerns: A 72-year-old female has presented with severe progressing abdominal pain was treated with total parenteral nutrition for acute pancreatitis based on preliminary work up, but suddenly became unstable with dropping vitals over the ensuing 48 hours. Physical examination has a positive Murphy sign and appeared lethargic. Read More

Surg Res Pract 2019 3;2019:9709242. Epub 2019 Feb 3.

General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avenue Alcalde Rovira Roure 80, Lleida, Spain.

Background: The aim of this study was to evaluate the characteristics, management, and outcomes of acute cholecystitis in patients ≥80 years.

Methods: This was a retrospective analysis of data from a prospective single-center patient registry.

Results: The study population was composed of 348 patients, which were divided into two groups: those younger (Group A) and those older (Group B) than the median age (85. Read More

Int J Surg Case Rep 2019 28;56:78-81. Epub 2019 Feb 28.

Department of Surgery/Division of Trauma and Acute Care Surgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA.

Introduction: Anatomical variants of the extrahepatic biliary tree are numerous, adding significantly to the risk of bile duct injury during cholecystectomy, especially when laparoscopic approach is employed. Duplicated cystic ducts draining a single gallbladder are extremely rare.

Presentation Of Case: A 34-year-old female presented with signs and symptoms of acute cholecystitis which was confirmed on imaging. Read More

J Gastrointest Cancer 2019 Mar 8. Epub 2019 Mar 8.

Department of Surgery, Government Medical College, Haldwani, Nainital, Uttarakhand, 263139, India.

Gall stones are one of the major causes of morbidity and mortality all over the world and common health problems throughout in developing countries. Cholecystectomy is one of the most common surgical practices and postoperative analysis of cholecystectomy specimen has a great value since histopathological reports may document some entities with significant clinical significances. Gallbladder carcinomas in cholecystectomy specimens are received in our histopathology laboratory to analyse their clinicopathological features. Read More

Gastrointest Endosc Clin N Am 2019 Apr;29(2):293-310

Icahn School of Medicine at Mount Sinai, Dr. Henry D. Janowitz Division of Gastroenterology, One Gustave L. Levy Place, Box 1069, New York, NY 10029, USA. Electronic address:

"Gallbladder disease is one of the most common gastrointestinal diseases encountered in clinical practice. Surgical removal and percutaneous drainage are both widely available and effective in the management of acute cholecystitis. Several endoscopic approaches exist as an alternative to these interventions. Read More

Surg Clin North Am 2019 Apr;99(2):231-244

Rutgers, New Jersey Medical School, 185 South Orange Avenue, MSB G586, Newark, NJ 07102, USA.

Gallstone disease is a leading cause of morbidity in the United States and usually requires surgical or endoscopic interventions for diagnosis and/or treatment. Although gallstone disease is classically associated with the inflammatory sequela of cholecystitis, gallstones can also contribute to other clinical presentations such as gallstone ileus, Mirizzi syndrome, and Bouveret syndrome. This article explores the common-and uncommon-causes of surgical pathology owing to gallstones with an emphasis on clinical identification, diagnostics, and management options. Read More

World J Gastrointest Surg 2019 Feb;11(2):62-84

Transplant and HPB Surgery, the Iowa Clinic-Iowa Methodist Hospital, Des Moines, IA 50309, United States.

The incidence of biliary injury after laparoscopic cholecystectomy (LC) has shown a declining trend though it may still be twice that as with open cholecystectomy. Major biliary or vasculobiliary injury is associated with significant morbidity. As prevention is the best strategy, the concept of a culture of safe cholecystectomy has been recently introduced to educate surgeons and apprise them of basic tenets of safe performance of LC. Read More

Dtsch Med Wochenschr 2019 Mar 5;144(5):335-339. Epub 2019 Mar 5.

Medizinische Klinik 3, Centrum für Integrierte Onkologie (CIO) Köln-Bonn, Universitätsklinikum Bonn.

History:  A 23 years old, previously healthy woman was admitted to our clinic with neutropenic fever to rule out acute leukemia. Upon admission the patient reported that a few days ago the carcass of a pig had fallen on her from above, so that she experienced strong back pain.

Findings And Diagnosis:  The blood count showed thrombocytopenia and marked neutropenia of 0. Read More

J Hepatobiliary Pancreat Sci 2019 Apr;26(4):123-127

Section of Hepato-Pancreato-Biliary Surgery, Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, 660 South Euclid Avenue, Box 8109, St. Louis, MO, 63110, USA.

Bile duct injuries are the most common serious complication of cholecystectomy. Avoidance of bile duct injury is a key aim of biliary surgery. The purpose of this paper is to describe laparoscopic cholecystectomy from the viewpoint of three conceptual goals. Read More