Introduction. The principal therapy for gallstones was open cholecystectomy. Recently, however, with remarkable advances in laparoscopic surgery on the biliary tract in particular, laparoscopic cholecystectomy has become preferred treatment for symptomatic cholelithiasis. To assess our experience in surgical treatment for gallstones and determine the best method to reduce postoperative discomfort, cases of cholecystectomy performed in our institution were reviewed.
Patients.-During the past 14 years, 524 patients were treated for cholelithiasis (cholecystolithiasisin 412, choledocho-cholecystolithiasis in 75, choledocholithiasis in 36, intrahepatic stones in 1). The ratio of men to women was 1: 1.7 and the average age was 61 years. Results.-Only cholecystectomy was performed on 86% of the patients with cholecystolithiasis and 91% had accompaning open surgery with laparoscopic cholecystectomy in latest years. Open cholecystectomy by inserting a T tube was done on 61% of choledochocholecystolithiasis cases. In some cases papilloplasty and/or choledochoduodeno or choledochojejunostomy followed. Almost all patients with choledocholithiasis had open cholecystectomy with T-tube insertion and additional procedures to remove stones in thebiliary tract in earlier years. In these years, no more addidional procedures except for choledochotomy with T-tube insertion had been performed in any cholelithiasis cases.
Conclusions.-Laparoscopic cholencystetomy is a safe and effective procedure and should be preferred for symptomatic cholelithiasis except for cases with acute cholecystitis, common bile duct stones, gallbladder cancer and other severe complications.

Although aortic annular abscess and rupture of the sinus of Valsalva are known as complications of infective endocarditis, few cases in children have been reported. We report a surgical case of a 6-year-old girl with active infective endocarditis complicated with an annular abscess and pseudoaneurysm of the sinus of Valsalva. The patient presented progressive symptoms of heart failure and a subsequent echocardiogram demonstrated severe aortic regurgitation. A computed tomography indicated pseudoaneurysm of sinus of Valsalva and an emergency operation was performed. At operation, a bicuspid aortic valve with vegetation was noted. The annular abscess caused a large tissue defect of the left coronary sinus of Valsalva and formed a pseudoaneurysm. The infected lesion was resected completely. The defective aortic annulus and sinus of Valsalva were repaired with a bovine pericardial patch and aortic valve was replaced with a mechanical valve. The postoperative course was uneventful and the patient was discharged after adequate antibiotic treatment.

Posterior ventricular septal perforation (VSP) is a severe complication of acute myocardial infarction (AMI). In some cases, it is difficult to manage residual shunts after VSP repair. We report a patient who required reoperation early after surgery due to a residual shunt and underwent successful repair through a newly devised maneuver. A 55-year-old man developed VSP after catheter intervention for AMI. He underwent VSP closure with extended sandwich repair via a right ventricular (RV) incision. A residual shunt was observed on the 4th day after surgery. Follow-up echocardiography showed progress of the residual shunt, and he developed cardiac failure ; therefore, reoperation was performed 16 days after the initial surgery. The residual shunt was successfully repaired with only a reinforcing left ventricular (LV) side patch via an LV incision to extend between the LV side patch and septal myocardium without removing the RV side patch. The patient's clinical course after reoperation was uneventful, and no residual shunt was observed on postoperative echocardiography.