Indications for Converting to Open Operation*
John G. Hunter, MD
Ten years ago (almost exactly), laparoscopic cholecystectomy altered general surgery
dramatically and forever. The operating room lights were turned out. Five years of
surgical residency spent learning the techniques of biliary tract surgery were replaced
with 2-day "retooling" courses. The term "learning curve" was
born. Community surgeons were the innovators and educators, usurping the traditional
role of university professors. Bile duct reconstruction was relearned at university
hospitals. The threshold of the physicians to recommend cholecystectomy and the patient
to accept the operation was lowered, and 20% more gallbladders were removed. Management
of bile duct stones-suspected or detected-was left to gastroenterologists.
Laparoscopic surgery has changed most of the rules, but not all of them. The management
of severe acute or chronic inflammatory conditions of the abdominal viscera represents
a challenge to laparoscopic access.
Excerpts from: Hunter JG. Acute cholecystitis revisited: Get it while itís hot.
Ann Surg. 1998; 227 (4): 468-469. |
Abstracts
"Dome
Down" Laparoscopic Cholecystectomy
Glenn L. Sandler, MD
Endoscopic
Drainage of Pancreatic Pseudocyst
Gary C. Vitale, MD
Thoracoscopic
Splanchnicectomy for Pancreatic Pain
Henry L. Laws, MD
CT
Guided Percutaneous Drainage of Infected Acute Necrotizing Pancreatitis
Patrick C. Freeny, MD
Management
of Metastatic Carcinoma
T. S. Ravikumar, MD
Management
of Liver Trauma
Juan C. Asensio, MD
Management
of Benign Liver Tumors
Leslie H. Blumgart, MD, FRCS
Role
and Techniques of "Dome-Down" Laparoscopic Cholecystectomy
Glenn L. Sandler, MD
Thoracoscopic
Splanchnicectomy for Pancreatic Pain
Henry L. Laws, MD
Current
ConceptsæAdequate Pain Management
Young K. Choi, MD
Prevention
and Management of Infection Complicating Acute Pancreatitis
Henry L. Laws, MD
Indication
for and Timing of ERCP in Biliary Pancreatitis
John Baillie, MB, ChB, FRCP
Timing
of Laparoscopic Cholecystectomy After Biliary Pancreatitis
Gary C. Vitale
Magnetic
Resonance Angiography
Martin R. Prince, MD, PhD
Pancreatic
Imaging
Patrick C. Freeny, MD
Endoscopic
Ultrasonography
Charles Noyer, MD
Limited
Gastric Resection
Jo Buyske, MD
Current
ConceptsæManagement of Pancreatic Carcinoma
Henry A. Pitt, MD
Watchful
Waiting in the Management of Inguinal Hernia
Robert J. Fitzgibbons, MD
Treatment
of Incisional (Ventral) Hernias: Open Repair
Maximo Deysine, MD, FACP
Treatment
of Incisional (Ventral) Hernias: Laparoscopic Repair
Adrian E. Park, MD
Indications
for Converting to Open Operation
John G. Hunter, MD
Medicolegal
Implications of Common Bile Duct Injury During Laparoscopic Cholecystectomy
Kenneth A. Kern, MD, FACS
Role
and Technique of Pylorus Preserving Pacreatectomy
Henry A. Pitt, MD |
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