GİRİŞ ve AMAÇ: To determine the effects of pneumoperitoneum on renal functions during laparo­scopic cholecystectomy (LC). and compare with open cholecystectomy (OC).
YÖNTEM ve GEREÇLER: In this study, twenty-two cholelithiazis patients were divided into two groups. 10 patients underwent OC and LC (15 mm Hg of intraabdominal pressure) was applied in 12 patients. Patients in the latter group were operated under 15 mmHg intraperitoneal presure. 24 hours before the operation, the urine samples were collected and preoperative (preop) clearance of creatinine, IL-1, IL-6, TNF-alpha, beta-2-microglobuline, albumin, n-acetyl-beta-D-glu­coseaminidase (NAG) values were measured. Dynamic renal scintigraphies were taken with Tc- 99mEC. The same procedure was also performed postoperatively.
BULGULAR: 12 patients, 9 female and 3 male, with a mean age of 49.8 (26'.69) underwent LC. 10 patients, 9 female and a male with a mean age of 52.2 (32-72) underwent OC. The mean oper­ation time was 58.75 (35-85) minutes for LC and was 80 (60-100) minutes for OC. There were significant differences between postop and preop values of creatine clearance (p=0.002), IL-6 (p=0.017 ), urinary albumin (p=0.006 ) and T1;2 (p=0,0034 for right kidney, p=0.001 for left kid­ney) in patients who underwent LC, whereas there was significant difference between postop and preop values of Tmax (p=0.013 for right kidney, p=0,012 for left kidney) in the patients who underwent OC. In terms of preop and postop NAG values, no significant change was observed in the LC (p=O. 75) and the OC groups (p=O.O 16). Postoperative increase in NAG lev­els was found to be significantly higher in the LC group compared to the OC group (p=0.048). There were no significant differences in TNF alpha, B2 microglobulin, IL-1 in both groups.
TARTIŞMA ve SONUÇ: Minimal renal tubular defects due to pneumoperitoneum may occur when Le's per­formed under 15 mmHg of intraperitoneal pressure. lnconclusion it would be more secure to hold intraperitoneal pressure as low as possible in the patients with critical renal functions.

INTRODUCTION: To determine the effects of pneumoperitoneum on renal functions during laparo­scopic cholecystectomy (LC). and compare with open cholecystectomy (OC).
METHODS: In this study, twenty-two cholelithiazis patients were divided into two groups. 10 patients underwent OC and LC (15 mm Hg of intraabdominal pressure) was applied in 12 patients. Patients in the latter group were operated under 15 mmHg intraperitoneal presure. 24 hours before the operation, the urine samples were collected and preoperative (preop) clearance of creatinine, IL-1, IL-6, TNF-alpha, beta-2-microglobuline, albumin, n-acetyl-beta-D-glu­coseaminidase (NAG) values were measured. Dynamic renal scintigraphies were taken with Tc- 99mEC. The same procedure was also performed postoperatively.
RESULTS: 12 patients, 9 female and 3 male, with a mean age of 49.8 (26'.69) underwent LC. 10 patients, 9 female and a male with a mean age of 52.2 (32-72) underwent OC. The mean oper­ation time was 58.75 (35-85) minutes for LC and was 80 (60-100) minutes for OC. There were significant differences between postop and preop values of creatine clearance (p=0.002), IL-6 (p=0.017 ), urinary albumin (p=0.006 ) and T1;2 (p=0,0034 for right kidney, p=0.001 for left kid­ney) in patients who underwent LC, whereas there was significant difference between postop and preop values of Tmax (p=0.013 for right kidney, p=0,012 for left kidney) in the patients who underwent OC. In terms of preop and postop NAG values, no significant change was observed in the LC (p=O. 75) and the OC groups (p=O.O 16). Postoperative increase in NAG lev­els was found to be significantly higher in the LC group compared to the OC group (p=0.048). There were no significant differences in TNF alpha, B2 microglobulin, IL-1 in both groups.
DISCUSSION AND CONCLUSION: Minimal renal tubular defects due to pneumoperitoneum may occur when Le's per­formed under 15 mmHg of intraperitoneal pressure. lnconclusion it would be more secure to hold intraperitoneal pressure as low as possible in the patients with critical renal functions.

GİRİŞ ve AMAÇ: Laparoscopic cholecystectomy (LC) with the advantages of small incision, less pain and short hospitalization, is a also gold stantard surgical technique for symptomatic cholelithia­sis. But this technique has also complications ttue to surgical anatomy, clinical condition and technical failure. Bile leakage following LC poses a major problem. In this study, we evaluated the role and importance of endoscqpic retrogradecholangio-pancreaticography (ERCP) in the diagnosis and management of bile leakage after LC.
YÖNTEM ve GEREÇLER: Between May 2000 and June 2004, the patients with bile leakage after LC were evaluted prospectively in terms of etiology, preoperative diagnostic tests, surgical tech­nique, surgeon experience, anatomy and additional disease of the patient, postoperative diag­nostic tests, timing of the ERCP, ERCP findings, morbidity and mortality. All of the laparoscopies were done by 4 trocar method.
BULGULAR: A total of 260 LC were performed and 3 (1.15%) of them had bile leakage in the early postoperative period. The diagnosis of bile leakage was done by physical examination and abdominal ultrasonography. The drain which was placed intraoperatively, helped the diagnosis in two patients. The patients with bile leakage were operated by experienced surgeons.These patients had surgical anomical difficulties due to acute cholecystitis. The ERCP that was done within 24-48 hours of postoperative period, showed; cystic duct leakage due to clip insufficien­cy, gallbladder bed leak age from 6th segment of liver, common hepatic duct laseration at the level of junction of cystic duct and hepatic duct. All patients were treated by sphincterotomy and nasobiliary drainage was added in two patients. Mean duration of hospitalization was 4-7 days and no mortality was observed. Bile leakage was treated succefuly in all patients with no further complications by ERCP and there was no benign biliary stricture during 2.5 years medi­an follow-up period (6 months 4 years)
TARTIŞMA ve SONUÇ: ERCP is the most useful method in the diagnosis and management of bile leakage in patients with LC, especially in the early postoperative period.

INTRODUCTION: Laparoscopic cholecystectomy (LC) with the advantages of small incision, less pain and short hospitalization, is a also gold stantard surgical technique for symptomatic cholelithia­sis. But this technique has also complications ttue to surgical anatomy, clinical condition and technical failure. Bile leakage following LC poses a major problem. In this study, we evaluated the role and importance of endoscqpic retrogradecholangio-pancreaticography (ERCP) in the diagnosis and management of bile leakage after LC.
METHODS: Between May 2000 and June 2004, the patients with bile leakage after LC were evaluted prospectively in terms of etiology, preoperative diagnostic tests, surgical tech­nique, surgeon experience, anatomy and additional disease of the patient, postoperative diag­nostic tests, timing of the ERCP, ERCP findings, morbidity and mortality. All of the laparoscopies were done by 4 trocar method.
RESULTS: A total of 260 LC were performed and 3 (1.15%) of them had bile leakage in the early postoperative period. The diagnosis of bile leakage was done by physical examination and abdominal ultrasonography. The drain which was placed intraoperatively, helped the diagnosis in two patients. The patients with bile leakage were operated by experienced surgeons.These patients had surgical anomical difficulties due to acute cholecystitis. The ERCP that was done within 24-48 hours of postoperative period, showed; cystic duct leakage due to clip insufficien­cy, gallbladder bed leak age from 6th segment of liver, common hepatic duct laseration at the level of junction of cystic duct and hepatic duct. All patients were treated by sphincterotomy and nasobiliary drainage was added in two patients. Mean duration of hospitalization was 4-7 days and no mortality was observed. Bile leakage was treated succefuly in all patients with no further complications by ERCP and there was no benign biliary stricture during 2.5 years medi­an follow-up period (6 months 4 years)
DISCUSSION AND CONCLUSION: ERCP is the most useful method in the diagnosis and management of bile leakage in patients with LC, especially in the early postoperative period.

Cholecystocolonic fistulas are rare surgical pathologies. They are most commonly encountered in hepatic flexura and transverse colon. Treatment of cholecystocolonic fistulas with laparo­scopic surgery was contraindicated in early periods of laparoscopic experience. After improve­ment in both surgical techniques and practice these fistulas can be managed without the need of conversion to open surgery. We present a case report of cholecystocolonic fistula, detected during laparoscopy and treated with open method in trochar site.

Cholecystocolonic fistulas are rare surgical pathologies. They are most commonly encountered in hepatic flexura and transverse colon. Treatment of cholecystocolonic fistulas with laparo­scopic surgery was contraindicated in early periods of laparoscopic experience. After improve­ment in both surgical techniques and practice these fistulas can be managed without the need of conversion to open surgery. We present a case report of cholecystocolonic fistula, detected during laparoscopy and treated with open method in trochar site.