We conclude that laparoscopy is an excellent diagnostic modality in acute small-bowel obstruction, the majority of which can be simultaneously managed laparoscopically. Laparotomy should be reserved for malignant adhesions, surgical misadventure, or when the pathology dictates.

Our continuing experience with UVg confirms that favorable results can be obtained with this biologic alternative to autologous vein for lower limb revascularization. Concern regarding biodegradation and aneurysm formation even after 5 years are unfounded at this time. Improved patency and limb salvage rates can be achieved in concert with lower nonthrombotic failure rates, increasing performance of associated endovascular procedures, use of tourniquets, and the addition of dAVF for crural bypass grafting. Prospective randomized studies are still necessary for the assessment of the comparative role of all graft materials, a project that continues to evade our specialty.

Cholecystocolonic fistula is an unusual complication of biliary tract disease. Many of the signs and symptoms of these fistulas are nonspecific, so the diagnosis is often not suspected preoperatively. It is important to make the diagnosis then to prevent fecal contamination when the fistula is divided. We recently encountered a patient who, while undergoing laparoscopic cholecystectomy, was found to have a fistula between the gallbladder and the proximal transverse colon. Important features in the management of this case are (1) maintaining a high index of suspicion for the presence of this complication, (2) use of cholecystography to establish the diagnosis, and (3) use of laparoscopic stapling techniques to divide the fistula while preventing fecal soilage.

Configuration of the adjunctive dAVF may impact on prosthetic graft patency in the crural position. In addition, the type of graft material used for bypass may be instrumental in preventing or precipitating the steal phenomenon. These issues require further study to better understand flow dynamics, patterns of intimal hyperplasia, and blood distribution as a function of conduit material and impedance of the arterial and venous runoff.

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