The aim of the study was to analyse safety and benefits of laparoscopic common bile duct (CBD) exploration compared to open. Prospective randomized trial included a total of 256 patients with CBD stones operated from 2005 to 2009 years in a single center. There were two groups of patients: group I-laparoscopic CBD exploration (138 patients), group II-open CBD exploration (118 patients). Patient comorbidity was assessed by means of the American Society of Anesthesiology (ASA) score; i.e. ASA II-109 patients, ASA III-59 patients. Bile duct stones were visualized preoperatively by means of US examination in 129 patients, by means of ERCP in 26 patients, by magnetic resonance cholangiopancreatography in 72 patients. Preoperative evaluation was done through medical history, biochemical tests and ultrasonography. There was no statistical significant difference between 2 groups of patients. No mortality occurred. The mean duration of laparoscopic operations was 82 min (range, 40-160 min). The mean duration of open operations were 90 min (range, 60-150 min). Mean blood loss was much less in laparoscopic group than in open group (20 ± 2 vs. 285 ± 27 ml; p < 0.01). Postoperative complications were observed is nine patients of laparoscopic group and in 15 patients in open group (p < 0.01). There were 102 attempts to perform transcystic exploration of CBD. External drainage was used in 25 (32.8%) patients with transcystic approach. Conversion to laparotomy was performed in two patients. Open operations were performed in 118 patients with choledocholithiasis. External drainage was used in 85% of patients. Morbidity in open group was higher (12.7%) than in laparoscopic group (6.5%). Laparoscopic CBD exploration can be performed with high efficiency, minimal morbidity and mortality. Laparoscopic procedures have advances over open operations in terms of postoperative morbidity and length of hospital stay.

In conclusion, this study confirms that laparoscopic repair of large hiatal hernias is effective and durable over a long period of time. Reinforcement of crura repair with ProGrip™ mesh is safe and can prevent anatomical recurrences.

No abstract

Objective. Studying of possibility of application of a self-fixing mesh ProGrip™ while plasty performing for large hiatal hernias (HH).Маterials and methods. In the investigation 144 patients, ageing 30 – 78 yrs old, owing HH with square 10 - 20 сm2, took part. The patients were divided into two groups. Group I consisted of 71 patients, to whom crurorhaphy with additional strengthening of the sutures, using a self-fixing mesh ProGrip™ was peformed. Group II consisted of 73 patients, in whom sutures of crurorhaphy were not strengthened by the mesh implant. Dynamical follow-up in patients was conducted in 3, 6, 12, 24, 36, 48 and 60 mo after the surgical treatment.Results. Average duration of the operation in patients of Group i and Group II did not differ essentially – (94 ± 12) and (92 ± 15) min, accordingly (p > 0.1). In late terms of follow-up the HH recurrence have occurred in 3.2% in the Group I patients and in 21.5% - in the Group II patients. The quality of life index in patients of Group I, in accordance to questionnaire SF-36, was trustworthily better, than in patients of Group II (p < 0.05).Conclusion. The mesh ProGrip™ application while doing plasty of large HH permits to lower the recurrence rate significantly and to improve the operative interventions results essentially.

No abstract