Objective To study the causes of conversions to open surgery during laparoscopic cholecystectomy (LC). Methods We retrospectively analyzed clinical data of conversions to open surgery during LC in this hospital between April 1998 to March 2002. Results Of 1368 cases of LC, conversions were required in 60 cases, the rate of conversion being 4.39%. Reasons leading to conversions included: 17 cases of adhesion in abdominal cavity and Calot's triangle, 14 cases of acute cholecystitis or recovery period of acute cholecystitis, 2 cases of carcinoma of gallbladder, 5 cases of internal fistula of blie duct to intestinal tract, 2 cases of common bile duct stones, 6 cases of atrophic cholecystitis, 2 cases of bleeding, 2 cases of bile duct injuries, 2 cases of Mirrizi's syndrome, 1 case of biliary fistula, 1 case of xanthogranulomatous cholecystitis, and 6 cases of other reasons. Conclusions Conversions to open surgery during LC are chiefly due to the unclear exposure of Calot's triangle, as well as the inadequacy of skills and experience of surgeons.

Objective To evaluate the safety and therapeutic effects of laparoscopic-assisted resection of the right colon for right colon cancer.Methods Laparoscopy-assisted resection of the right colon was performed on 21 patients with right colon cancer.The separation of the mesentery,ligation of the mesenteric vessels,and lymphectomy were completed by laparoscopy.And the resection of the right colon and end-to end anastomosis of the residual bowels were performed through a small incision in the abdomen.Results The operation was completed in all the cases without conversion to open surgery.The operation time was 136-248 min(mean,153.6 min).The length from the upper and lower ends of the resected colon to the tumor was(10.8?3.6)and(10.2?3.5)cm respectively.A mean of 9.7?4.9 lymph nodes were resected.One patient developed infection of the incision,and was cured by debridement 3 months later.A mean of 19 months(range,3-36)follow-up was achieved in 17 of the patients.During this period,liver metastasis occurred in 2 patients(8 and 20 months respectively after the operation).No implantation at the incision or puncture site was found in this series.Conclusions Laparoscopic-assisted resection of the right colon is safe and feasible for patients with colon cancer.The outcome of this procedure is as good as that of open surgery.

Objective To investigate the effect of imbedding chemotherapy of sustained release of 5-fluorouracil on the healing of colonic stoma in dog. Methods Twenty-eight adult hybrid dogs were randomly divided into chemotherapy group (n=22) and control group (n=6). The canine sigmoid colon were firstly detached and then anastomosed via median abdominal incision, 200 mg sustained release of 5-fluorouracil was imbedded in the mesentery 1.0-1.5 cm away from colonic stoma in chemotherapy group, whereas the control substance was injected into the dogs in control group. Tissue samples were collected from mesentery and stomas on 3, 5, 7, 10 and 15 days after operation, respectively, in order to observe the healing of stoma. The drug concentrations in the stoma and in the tissues that were 0, 1, 3, 5, 7, 10 and 15 cm away from the imbedding point were also measured by high performance liquid chromatography method at different phases. Results The tissues from colonic stoma only showed inflammatory reaction at early stage, with no necrosis and cellular degeneration. It was observed that the stoma healed basically on the tenth day after operation. The drug concentrations in the tissues gradually decreased at the range of 0-15 cm over time, but all of which were higher than the anti-tumor effective concentration (0.10 ?g/g). Conclusion The imbedding chemotherapy of sustained release of 5-fluorouracil in mesentery has little effect on the healing of stoma, and it could remain an effective anti-tumor concentration in a period of time.

Objective To investigate the surgical techniques of laparoscopic procedures in the management of stones straddling between the cystic duct and the common bile duct. Methods Clinical data of 19 cases of stones straddling between the cystic duct and the common bile duct treated by laparoscopic cholecystectomy (LC) from January 2001 to June 2003 were retrospectively reviewed. Results The operations were completed by opening the gallbladder ampulla and/or the cystic duct in all the patients. The stones were 0 4~0 6 cm in diameter (mean,0 5 cm).The drainage was removed 48 hours ofter the surgery.The patients were discharged from hospital 3~5 days postoperatively.Follow-up checkups in the 19 cases for 2~24 months (mean,10 months) found no residual stones. Conclusions Thorough exposure of the union of the cystic duct with the common bile duct and the opening of the cystic duct to expel the stones is the best way to manage stones straddling between the cystic duct and the common bile duct under laparoscope, and also the most effective method to prevent postoperative residual stones.