J. Parikh

Total laparoscopic removal of accessory gallbladder: A case report and review of literature

Accessory gallbladder is a rare congenital anomaly occurring in 1 in 4000 births, that is not associated with any specific symptoms. Usually this cannot be diagnosed on ultrasonography and hence they are usually not diagnosed preoperatively. Removal of the accessory gallbladder is necessary to avoid recurrence of symptoms. H-type accessory gallbladder is a rare anomaly. Once identified intra-operatively during laparoscopic cholecystectomy, the surgery is usually converted to open. By using the main gallbladder for liver traction and doing a dome down technique for the accessory gallbladder, we were able to perform the double cholecystectomy with intra-operative cholangiogram laparoscopically. Laparoscopic cholecystectomy was performed in 27-year-old male for biliary colic. Prior imaging with computer tomography-scan and ultrasound did not show a duplicated gallbladder. Intraoperatively after ligation of cystic artery and duct an additional structure was seen on its medial aspect. Intraoperative cholangiogram confirmed the patency of intra-hepatic and extra-hepatic biliary ducts. Subsequent dissection around this structure revealed a second gallbladder with cystic duct (H-type). Pathological analysis confirmed the presence of two gallbladders with features of chronic cholecystitis. It is important to use cholangiogram to identify structural anomalies and avoid complications.

Variations in the perioperative management of pancreatoduodenectomy between academic and community institutions: An IHPBA/AHPBA web-based survey.

448 Background: Pancreatoduodenectomy is the surgical treatment for pancreatic head and periampullary malignancy and is performed by surgeons practicing in all kinds of hospital settings, academic, community and hybrid. The perioperative management is varied amongst surgeons owing to diverse training experience. We aim to evaluate these variations by comparing the hospital settings. Methods: A pilot 25-item survey questionnaire was electronically distributed using Survey Monkey to IHPBA and AHPBA members between May and August 2015 regarding practice patterns and perioperative care of pancreatoduodenectomy. Results: We received 285 responses with participants from academic (56.1%), community (12.6%) or hybrid institutions (31.2%). Most participants performed 10-25 cases annually in each group (46.9%, 50%, 51.7%, respectively). Surgeons from academic institutions routinely culture bile intraoperatively more often than in community institutions (46.3% vs. 22.2%, p<0.01). However, surgeons from community pro...