Many studies have shown similar results concluding that chol

Many studies have shown similar results, concluding that p38 pathway cholecystostomy might be a definite treatment for acute acalculous cholecystitis owing to its relatively lower recurrence rate, but cholecystostomy followed by elective cholecystectomy for 6–8 weeks delayed the recovery from the acute stage in patients with calculous cholecystitis. Many studies have described the management of acute cholecystitis in critically ill, elderly, or high surgical risk patients. Most of them received conservative treatment, which prolonged the patient\'s suffering, increased the healthcare cost, and exposed them to the risk of recurrence. Similar observations were made at our hospital. Although Yeh et al reported that LC was a safe elective procedure for ESRD patients, few studies have reported emergency LC in such patients. We retrospectively reviewed the medical records of the participants undergoing emergency LC via emergency department or ward consultation. Acceptable complication rates of 13.6%, conversion rates of 9%, and no perioperative mortality were found in our study.
Introduction Surgical resection is currently the curative treatment for hepatic tumors. It is common for hepatic surgeons to be confronted with the task of assuring adequate tumor clearance, minimizing intraoperative blood loss as well as preserving an ample functioning remnant liver. Most common complications of liver resection include bleeding, intra-abdominal infection, and postoperative hepatic failure. These events are often serious and even fatal in patients with liver cirrhosis. Over the years, the lowering of operative mortality from hepatic resections has been achieved, thanks to the advances in surgical techniques and accumulated experience in the field. However, good results are obtained only in a few major medical centers with modernized facilities and an advanced medical health system. Outcomes in less developed institutions are still unsatisfactory. Albeit Pringle\'s maneuver consisting of total vascular occlusion or isolation of the glissonian pedicle has been successfully employed in hepatic resections; nonetheless, these methods could potentially result in unexpected bleeding from a complex hilar dissection, and hepatic failure from ischemic injury. Because of the dismally short-term survival (<90 days), these methods are rarely used in institutions that deal with a small number of cases. In 1973, Lin reported the use of a simple clamp and crush technique to overcome these shortcomings. The objective of our study is to report our experience in liver surgery with Lin\'s technique and discuss its applicability.
Methods and patients
Results
Discussion In 1973, Lin described a simplified technique of hepatic resection using a clamp and crush method. This technique aimed at avoiding hilar dissection and clamping of the hilar vessels, thereby reducing pretransection blood loss and preventing ischemic–reperfusion injury to the remnant liver (Fig. 3). The clamps were commonly applied either at the anatomical boundary between the right and left lobe of the liver when performing right or left lobectomy or at the line medial to the tumor in a more peripheral segment. This resulted in an almost bloodless hepatic resection. According to Professor Lin\'s publication, thoracotomy was performed on the side of the tumor-bearing lobe for better mobilization of the liver. For applying Lin\'s clamp in our series, thoracotomy was not necessary. This method of hepatic resection can be divided into several steps, and the technique can be helpful to guide surgeons in training for parenchymal transection. The designed clamp can be applied easily by a JS himself, provided that sensory (afferent) pathways is under the supervision of an ES, and the transection can be performed in a bloodless field. Thus, unanticipated injury from rough transection due to blood loss can be avoided. Additionally, there would not be ischemic injury to the remnant liver, even if the transection time is prolonged. In our results, the transection time in cases by a JS was significantly longer in comparison to that of an ES but with almost equal blood loss. This apparently resulted from their lack of experience in liver surgery. Postoperative outcome was also similar in both groups.