[Micro- and modern minilaparotomy in biliary tract surgery. (Remembering János Balassa)]

Abstract

The author remembering "János Balassa" points out how his legacy can be used as a moulding energy for surgery in our present time. After analysing the personality and values of Balassa the results of 1357 consecutive unselected cholecyatectomies and choledocholithotomies performed in micro- and modern minilaparotomy are analyzed. The issue of mini laparotomy has not been defined yet, so that abdominal incisions from 3 to 10 cm are also called mini laparotomy. The author suggested in 1992 that the term microlaparotomy be applied to incisions less than 4 cm, modern mini laparotomy from 4 to 6 cm, and conventional mini laparotomy from 6 to 10 cm. In contrast to other mini laparotomies he uses a vertical incision in the infrasternal triangle. From the functional anatomical point of view this approach is advantageous because it is situated above Calot's Triangle and Moosman's area and results in reduced postoperative pain. Special lighting retractors have been developed for excellent exposure and illumination of the surgical field to make the operation safe. Micro and mini laparotomies can be used for both early and late reoperations on the biliary system and also for the conversion of laparoscopic cholecystectomy. At our department conventional, laparoscopic and micro laparotomy cholecystectomy are used. Considering both surgical and economic factors, the author has found that micro laparotomy cholecystectomy offers better results than conventional and laparoscopic cholecystectomy.