• M. Halei
  • I. Dzubanovsky
  • I. Marchuk
Keywords: laparoscopy, simultaneously, gallstones, hiatal gernia


Summary. Aim of work: to determine and compare the level of visualization, comfort, safety and effectiveness of simultaneous technique of laparoscopic surgery of gallstone disease and concomitant hiatal hernia and standard «baseball diamond» technique of laparoscopic surgery of only hiatal hernia.

Materials and methods: the study was performed based on data developed in MISU VRCH. 359 patients were treated and divided on two groups, of which the group №1 — patients who underwent simultaneous laparoscopic cholecystectomy and cruroraphy with Toupet fundoplication (n=155), and group №2 — patients who underwent only laparoscopic crurography with with Toupet fundoplication. The level of visualization, comfort, frequency of «fencing», duration of operation, length of hospital stay, complication frequency were determined. The method with the null hypothesis, Pearson’s analysis, Mann-Whitney method were used.

The results of the study: the approach distance of the laparoscope was (8,11 ± 0,917) and (8,71 ± 0,256) cm for 30°-optics while (6,55 ± 0,491) and (6,66 ± 0,485) cm for 0°-optics in two groups, respectively. The frequency of fencing was just about 4 episodes in both groups and did not differ statistically significantly. The frequency of the need to change the viewing area` and the frequency of the need to change the position of the instruments did not differ statistically significantly in both groups. The operation time was longer in the group of simultaneous operations by 10 % or 4,24 minutes. The level of complications was comparable in both groups, no correlation was found. The length of hospital stay was (3,64 ± 0,71) days (2-8 days) versus (3,58 ± 0,67) days (2-8 days) for both groups, respectively (p = 0.967).


1. Huang J, Chang CH, Wang JL, Kuo HK, Lin JW, Shau WY, & Lee PH. Nationwide epidemiological study of severe gallstone disease in Taiwan. BMC gastroenterology, 2009;9:63.
2. Lee SW, Yang SS, Chang CS, & Yeh HJ. Impact of the Tokyo guidelines on the management of patients with acute calculous cholecystitis. Journal of gastroenterology and hepatology.2009;24(12):1857-61.
3. Mehta HB, Dimou F, Adhikari D, Tamirisa NP, Sieloff E, Williams TP, Kuo YF, & Riall TS. Comparison of Comorbidity Scores in Predicting Surgical Outcomes. Medical care. 2016;54(2):180-7.
4. Yamanaka T, Miyazaki T, Kumakura Y, Honjo H, Hara K, Yokobori T, Sakai M, Sohda M, & Kuwano H. Umbilical hernia with cholelithiasis and hiatal hernia: a clinical entity similar to Saint’s triad. Surgical case reports. 2015;1(1):65.
5. Leopold SS. Editorial: Overlapping Surgery - Honoring Our Patients’ Preferences. Clinical orthopaedics and related research. 2018;476(6):1133-34.
6. Hilliard AA, Weinberger SE, Tierney LM, Jr. Midthun DE, & Saint S. Clinical problem-solving. Occam’s razor versus Saint’s Triad. The New England journal of medicine. 2004;350(6): 599-603.
7. Barstad LH, Júlíusson PB, Johnson, LK, Hertel JK, Lekhal S, & Hjelmesæth J. Gender-related differences in cardiometabolic risk factors and lifestyle behaviors in treatment-seeking adolescents with severe obesity. BMC pediatrics. 2018;18(1):61.
8. Borgeraas H, Hjelmesæth J, Birkeland KI, Fatima F, Grimnes JO, Gulseth HL, Halvorsen E, et al. Single-centre, triple-blinded, randomised, 1-year, parallel-group, superiority study to compare the effects of Roux-en-Y gastric bypass and sleeve gastrectomy on remission of type 2 diabetes and β-cell function in subjects with morbid obesity: a protocol for the Obesity surgery in Tønsberg (Oseberg) study. BMJ open, 2019;9(6):024573.
9. Rønningen R, Wammer A, Grabner NH, & Valderhaug TG. Associations between Lifetime Adversity and Obesity Treatment in Patients with Morbid Obesity. Obesity facts. 2019;12(1):1-13.
10. Ryan JM, O’Connell E, Rogers AC, Sorensen J, & McNamara DA. Systematic review and meta-analysis of factors which reduce the length of stay associated with elective laparoscopic cholecystectomy. HPB : the official journal of the International Hepato Pancreato Biliary Association. 2020;S1365-182X(20)31125-4. Advance online publication.
11. Walle KV, Funk LM, Xu Y, Davies KD, Greenberg J, Shada A, & Lidor A. Persistent Dysphagia Rate After Antireflux Surgery is Similar for Nissen Fundoplication and Partial Fundoplication. The Journal of surgical research. 2020;235, 52-7.
12. Du X, Wu JM, Hu ZW, Wang F, Wang ZG, Zhang C, Yan C, & Chen MP. Laparoscopic Nissen (total) versus anterior 180° fundoplication for gastro-esophageal reflux disease: A meta-analysis and systematic review. Medicine.2017;96(37), e8085.
13. Jian Guan, MD, Michael Karsy, MD, PhD, Andrea A Brock, MD, MSCI, William T Couldwell, MD, PhD, Richard H Schmidt, MD, PhD, Overlapping Surgery: 2 Years Later, Neurosurgery, Volume 65, Issue CN_suppl_1, 2018, 55-7,
14. Törnqvist B, Waage A, Zheng Z, Ye W, & Nilsson M. Severity of Acute Cholecystitis and Risk of Iatrogenic Bile Duct Injury During Cholecystectomy, a Population-Based Case-Control Study. World journal of surgery. 2016;40(5),1060-7.
15. Huang J, Chang CH, Wang JL, Kuo HK, Lin JW, Shau WY, & Lee PH. Nationwide epidemiological study of severe gallstone disease in Taiwan. BMC gastroenterology. 2009;9:63.
16. Yamashita Y, Takada T, Kawarada Y, Nimura Y, Hirota M, Miura F, Mayumi T, Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines. Journal of hepato-biliary-pancreatic surgery.2007;14(1):91-7.
17. Levin PE, Moon D, & Payne DE. Overlapping and Concurrent Surgery: A Professional and Ethical Analysis. The Journal of bone and joint surgery. American volume.2017;99(23):2045-50.
18. Hamza Mohammed & Jaffar, Akram & Hassan, Hassan & Jasim, Zainab. Vascular and Gallbladder Variations in Laparoscopic Cholecystectomy. Medical Journal of Babylon.2008;5:119-34.
19. Warren H, Aye RW. Alternatives to Nissen Fundoplication: The Hill Repair and the Nissen-Hill Hybrid. In: Aye R., Hunter J. (eds) Fundoplication Surgery.2016; Springer, Cham.
20. Melloul E, Hübner M, Scott M, Snowden C, Prentis J, Dejong CH, Garden OJ, Farges O, Kokudo N, Vauthey JN, Clavien PA, & Demartines N. Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations. World journal of surgery.2016;40(10): 2425–40.
21. Francisco M. Sánchez-Margallo and Juan A. Sánchez-Margallo. Ergonomics in Laparoscopic Surgery. Intechopen. 2017. February 22nd 2017 DOI: 10.5772/66170
How to Cite
Halei, M., Dzubanovsky, I., & Marchuk, I. (2020). SIMULTANEOUS LAPAROSCOPIC CHOLECYSTECTOMY AND CRURORAPHY WITH TOUPET FUNDOPLICATION. Kharkiv Surgical School, (4), 25-31.