Objective To study the causes of conversions to open surgery during laparoscopic cholecystectomy (LC). Methods The study was based on a retrospective review of 156 cases of conversions to laparotomy out of 12672 cases of LC from December 1991 to October 2001 in this hospital. Results Ninety-two (58.97%) cases of conversions were due to complicated clinical condition and preoperative misdiagnosis, 47 (30.13%) cases of conversions due to technological complications, and 17 (10 90%) cases underwent delayed laparotomy. The total conversion rate was 1.23% and the rate of bile duct injuries was 0.2% (26/12672). Conclusions Inadequate preparation, deficiency of experience, complicated clinical situation, and anatomical variation of bile ducts are the leading causes to conversions.

Objective To discuss clinical effects of combined use of duodenoscopy and laparoscopy in the treatment of acute billiary pancreatitis (ABP), and to establish a systematic protocol of minimally invasive treatment for ABP. Methods According to the patients’ biliary tract conditions, severity of disease and treatment methods, a total of 696 patients with ABP were given laparoscopic cholecystectomy (LC) alone, or endoscopic retrograde cholangiopancreatography (ERCP) and LC, or ERCP and laparoscopic common bile duct exploration (LCBDE), or ERCP and endoscopic sphincterotomy (EST), or individualized treatment for severe acute pancreatitis (SAP). Clinical effects were observed. Results Among the 696 patients, 330 patients (47.4%) received EST and biliary stones were successfully removed under endoscope in 267 patients (38.4%). ERCP, LC and LCBDE were conducted in 411 (59.1%), 513 (73.7%) and 85 (12.2%) patients, respectively, and successfully accomplished in 409 (99.5%), 511 (99.6%) and 82 (96.5%) patients, respectively. Out of 36 patients with SAP, 34 patients survived (94.4%). The total cure rate was 99.7% (694/696). Conclusions Combined use of duodenoscopy and laparoscopy is significantly effective for acute billiary pancreatitis and benefits the improvement and standardization of the protocol of minimally invasive treatment for acute billiary pancreatitis.

Objective To study on the effectiveness and reliability of endoscopic varicose vein ligation (EVL) combined with hand-assisted laparoscopic splenectomy (HLS) in portal hypertensive patients. Methods Retrospectively 15 cases of EVL combined with HLS were reviewed from June 2001 to October 2004. These patients with severe esophageal varicose and hypersplenism were adapted to perform endoscopic varicose vein ligation, then 1 -2 weeks after the varicose became milder or disappeared, hand-assisted laparoscopic splenectomy was conducted. Results The number of preoperative ligation was 2. 2 times in average. Esophageal varicose was completely disappeared in 11 and mild in 4. There were no postoperative complications, conversion and death in Hand-assisted laparoscopic splenectomy. The average postoperative count of platelets were (38-67) ? 106/L preoperatively raised to (89-310) ? 106/L postoperatively. In the follow up period (average 17. 6 months) , no varicose vein bleeding happened. Conclusions EVL combined with HLS is not only minimal invasive, but also a secure and effective measure for portal hypertension.

Objective:To study the risk factors of acute gallstone pancreatitis (AGP) caused by impaction of duodenal papilla stones based on ERCP findings to provide evidence on prevention of AGP caused by stone impaction.Methods:The data of 304 patients with duodenal papilla stone impaction who were treated by ERCP at the Integrated Chinese and Western Medicine Hospital of Tianjin University from January 2009 to December 2020 were analyzed retrospectively. There were 177 males and 127 females, with a median age of 65.0 years. These patients were divided into the AGP group ( n=174) and the non-AGP group ( n=130) according to whether they developed acute pancreatitis before hospitalization. The analysis was performed on perioperative data. Multivariate logistic regression analysis was used to detect risk factors of AGP in patients with duodenal papillary stone impaction. Results:Multivariate logistic analysis showed that acute cholangitis ( OR=2.114, 95% CI: 1.279-3.494, P<0.05) and impacted stones ≤5 mm ( OR=1.738, 95% CI: 1.064-2.840, P<0.05) were independent risk factors of duodenal papillary stone impaction complicated with AGP. No perforation and death related to ERCP treatment occurred in both groups. The symptom alleviating time of patients in the AGP versus the non-AGP groups was (2.67±1.19) versus (1.88±0.88) d respectively ( t=-6.321, P<0.001). Conclusion:Among patients with duodenal papilla impacted stones, acute cholangitis and impacted stones ≤5 mm were risk factors of developing AGP, and ERCP should be carried out as early as possible.