Laparoscopy in hepatic disease.
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Biomedical subjects
Publications and source records attributed to G Berci.
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The value of biliary endoscopy was determined in 100 consecutive patients undergoing choledochotomy. Using a compact, rigid, right-angled choledochoscope with a rod-lens optical system the biliary tract was inspected for residual stomes following conventional exploration. Completion operative cholangiography and postoperative T-tube cholangiography were performed in all patients. Of 52 patients undergoing primary choledocholithotomy, the duct was cleared of all calculi in 51. A small residual stone was found by postoperative cholangiography in one patient. Exploration revealed no calculi in the ducts of the remaining 30 patients. Biliary endoscopy was of benefit to the surgeon in the majority of patients. In 17 patients, calculi missed by standard exploration were detected; in five of these, the calculi could be retrieved only under endoscopic control. In 11 patients, interpretation of operative cholangiograms was aided, while in three the endoscopic findings clarified operative strategy. The use of biliary endoscopy did not increase the postoperative morbidity or mortality rates beyond those oridinarily encountered in choledocholithotomy. Current experience indicates that the new choledhchoscope overcomes limitations of previous endoscopes and should serve as the definitive diagnostic tool for operative biliary endoscopy. The addition of this technique to the armamentarium of the biliary surgeon will play a significant role in overcoming the age-old problem of the retained common duct stone.
The development of the new Hopkins rod indirect laryngoscope with the polished glass rod lens system and fiberoptic lighting promise to revolutionize the indirect examination of the larynx and nasopharynx. The improved optics and lighting facilitate the acquisition of still and moving picture photography for permanent records. Examples of the superior photographic resolution are presented.
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Colonoscopic polypectomy was done in one hundred patients. One hundred eighty-three polyps were removed from these patients during 111 colonoscopies and eight malignant polyps were found. The material suggests that pedunculated malignant polyps, when the stalk is clear of carcinoma, can be cured through colonoscopic polypectomy, thus obviating the need for laparotomy. At present, however, more cases and a longer follow-up are needed before this can be established. There were no deaths and no perforations. There were two cases of bleeding, only one requiring transfusion. The procedure costs less and entails less time in hospital than laparotomy, colotomy and polypectomy.
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