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A five-year follow-up was performed in 93 of 94 patients who successfully underwent laparoscopic cholecystectomy between 1985 and 1987. The results were compared to those in 130 of 136 patients of a non-randomized control group who had undergone open cholecystectomy during the same period. Patients characteristics and gallbladder findings were comparable in the two groups. Postoperative complications were infrequent and not significantly different in the two groups, whereas the mean hospital stay was shorter in the laparoscopic group. During follow-up, one patient in the laparoscopically treated group had a common bile duct stone which was treated surgically since he refused to undergo ERCP; this patient died of postoperative complications. Various abdominal complaints were reported in 27% and 25% of the patients undergoing laparoscopic and open cholecystectomy, respectively; in most cases no organic causes were found. Scar problems were less frequently reported in the laparoscopically treated group (2% versus 12%). It is concluded that the long-term results of laparoscopic cholecystectomy are as good as those of open cholecystectomy, however, the hospital stay is significantly shorter and the long-term cosmetic results are considerably better in laparoscopically treated patients.

This is a report of 117 pancreaticoduodenectomies performed for chronic pancreatitis, of which 49 were partial and 68 were total. The operative mortality rate of partial pancreaticoduodenectomy was 8.2% and of total pancreatectomy was 20.6%. During a follow-up period of 61/2 years, 76% and 63% of the surgical patients, respectively, continued to drink alcohol as heavily as before. Prior to total pancreatectomy, only 42% of the patients had diabetes. After total extirpation of the organ, all had diabetes and 75% were very difficult to stabilize with insulin, experiencing repeated episodes of hypoglycemic shock. The additional late mortality rate was 20.4% following partial pancreaticoduodenectomy and 19.1% after total resection. After total pancreatectomy, 50% of the late deaths were due to hypoglycemia. After total pancreatectomy, 11% fewer patients were still alive at the end of the follow-up period than after partial pancreaticoduodenectomy. Total pancreatectomy is justified only in patients who already have diabetes requiring insulin. A new technique is described in which, following resection of the head of the pancreas, the duct system is occluded by injection of a rapidly hardening amino acid solution, leading to atrophy of the excretory pancreas within a few weeks. This procedure has been carried out in 39 patients with a mortality rate of 2.5% and postoperative complications in 7.6%. We believe that the immediate risk of partial pancreaticoduodenectomy in chronic pancreatitis can be decreased markedly and the late results improved by this new technique.

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