Aim-Background:The aim of the present review is to evidence the differences in the nature of PCS between open and laparoscopic cholecystectomy and also to examine how this condition has evolved over the years. In 5 to 40% of patients with cholelithiasis, regardless of the type of surgery, the symptoms persist postoperatively, leading to the development of the so-called postcholecystectomy syndrome (PCS). The time of the onset of symptoms ranges from 2 days to 25 years after cholecystectomy.Methods: A total number of 926 articles were found as a literature reference pool. We searched English language articles published in Medline, Scopus and google scholar. Only review articles were retrieved because no comparative studies or prospective clinical trials were found to provide statistically significant conclusions. The final group of articles was reviewed, and a total of 57 papers were used for the present review. Results:The literature is conflicting as concerns the pathophysiology and the aetiology of PCS. Regardless of the type of surgery, it seems that PCS is correlated to age and sex. The prevailing view is that retained or recurrent gallstones, gallbladder remnants and Sphincter of Oddi dysfunction are the primary causes. Moreover, systemic diseases of the gastrointestinal (GI) tract, cardiac disorders, autoimmune diseases, nervous system and psychological distress can mimic PCS symptoms. Nonetheless, there are many available techniques regarding diagnosis and treatment. Nowadays, the majority of researchers endorse ERCP as the gold standard for diagnosis and treatment. Conclusion:The preoperative meticulous investigation of patients with cholelithiasis is mandatory in order to identify coexisting disorders related to PCS, achieve a better therapeutic approach, and principally reduce PCS incidence.

Mastectomy and immediate reconstruction may be challenging in patients with large breasts, especially when significant ptosis is also present. Skin-reducing mastectomy (SRM) is usually indicated in these cases, although with increased morbidity. The aims of the study were to introduce 2 modifications of the classic technique and to incorporate them in the management algorithm to improve the outcomes. Twenty patients fulfilling the criteria for SRM underwent mastectomy and reconstruction either with the “classic SRM” (8 patients) or with 1 of the 2 modifications described here: modification A “vertical limb bridging” (for patients with very large breasts, 2 patients) and modification B “dual coverage” (for patients with moderate breasts, 10 patients). All reconstructions were performed using a slow progressive expansion of the implant. Herein, we describe the techniques along with the proposed indications for each one of them. There was no reconstruction failure, and all patients were satisfied with the final results. There were 2 cases with T junction, lateral skin flap partial ischemia managed with delayed revision of the wound on the fifth postoperative day to allow less skin excision. One patient (smoker) developed severe lower pole cellulitis, which was managed conservatively. Finally, 1 patient who underwent radiotherapy developed a late infected seroma, which was managed successfully with drainage and antibiotics. Overall, there was good lower pole projection even with the dual-coverage modification. Skin-reducing mastectomy can be tailored according to individual patient anatomy, and the high reported complication rate associated with this technique can be minimized using certain surgical modifications, tissue expanders with progressive inflation, and good patient selection.

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