Abstracts Role and Techniques of "Dome-Down" Laparoscopic Cholecystectomy* Glenn L. Sandler, MD Dome-Down Laparoscopic Cholecystectomy (DDLC) is an alternative approach to Laparoscopic Cholecystectomy that utilizes retrograde dissection of the gall bladder in an attempt to minimize common bile duct injuries. Since the advent of laparoscopic cholecystectomy (LC), the standard antegrade procedure has gained wide acceptance because of its benefits; however, the rate of complications has remained higher than open cholecystectomy. DDLC combines the advantages of laparoscopic with the safety of retrograde dissection. The most frequent causes of common bile duct injury (CBDI) during laparoscopic cholecystectomy include acute inflammation, landmark misidentification, and aberrant anatomy. Surgeons often commit to division of the cystic artery and duct early in antegrade dissection and may not recognize anatomic variations when dissecting in the triangle of Calot. DDLC provides the ability to evaluate the cystic duct circumferentially prior to its division. In DDLC, the cystic duct does not need to be divided to continue the procedure. Instead, it is the final step in the procedure, which occurs only after the anatomy is completely identified. The Harmonic Scalpel (Ethicon Endosurgery) also provides a margin safety when compared to monopolar electrocautery. The use of non-electrical energy eliminates the potential for arc injuries that may not be recognized at the time of surgery, minimizes the need for smoke evacuation, reduces the number of instrument exchanges, and provides superior hemostasis. DDLC relies on retrograde dissection of the gall bladder while maintaining standard port placement. Once the gall bladder has been dissected out of the gall bladder fossa, the cystic artery and duct are typically identified with ease. The cystic artery can be divided with the Harmonic Scalpel and an endoloop can be used to ligate the cystic duct. Intraoperative cholangiography is easily accomplished when indicated. The combination of retrograde dissection and a non-electrical energy source offers laparoscopic surgeons an alternative approach when performing a laparoscopic cholecystectomy. DDLC is an appropriate addition to our surgical armamentarium. 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