Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Choledochostomy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 451 records · Page 25Linked to original sources
PubMed2004

[Results of surgical treatment of pancreatic cancer].

UNLABELLED: The aim of this study was to assess the results of the treatment of (255) patients with pancreatic cancer in the Department of Surgery, University of Szeged, during the time period 1997-2001. METHODS: The age, male/female ratio, postoperative morbidity and mortality were discussed. RESULTS: The resecability rate was 17.3% (44/255 patients). The mortality rate was 2.3% (1/44 patients) after radical operations and 12.1% (15/124 patients) after the palliative procedures. Localization and UICC staging after pancreatic tumors were analyzed. CONCLUSIONS: In spite of the improvement of the new diagnostic methods, the proportion of patients undergoing radical surgery has not been increased in this period. Palliative surgical procedures are indicated in the case of advanced tumor stage. Choledochojejunostomy with Roux-Y loop offers the best results for the treatment of biliary obstruction. The role of endoscopic stenting is very questionable and the increased rate of postoperative biliary infections indicates that this procedure should be avoided in the preoperative treatment of patients who are suitable for potentially curative operation.

Adult↗
PubMed1999

Laparoscopic choledochoduodenostomy.

Laparoscopic cholecystectomy has become the gold standard for treatment of patients with symptomatic cholelithiasis. Management of common bile duct stones in the era of laparoscopy is an area of controversy. Although perioperative endoscopic retrograde cholangiography remains as a widely used procedure, experience is accumulating on the exploration of the common bile duct with the laparoscope. A biliary drainage procedure is indicated in selected patients with choledocholithiasis. Initially described by Reidel in 1892, side-to-side choledochoduodenostomy has become a popular biliary-enteric anastomosis technique in the last century. We describe two patients with recurrent choledocholithiasis and biliary obstruction due to benign biliary strictures. Both patients underwent laparoscopic common bile duct exploration and stone extraction. A side-to-side choledochoduodenostomy is then performed laparoscopically as a drainage procedure. Laparoscopic choledochoduodenostomy resulted in resolution of jaundice and relief of biliary obstruction. Laparoscopic choledochoduodenostomy can be an acceptable alternative to the open choledochoduodenostomy. In addition to a tension-free anastomosis and an adequate-sized stoma, intracorporeal suturing and knot-tying skills are also essential to the success of this procedure.

Aged↗
PubMed1999

[Unexpected hyperkalemia during general anesthesia in three patients undergoing hepatic, cholangioler or pancreatic surgery].

Three patients developed unaccountable hyperkalemia during general anesthesia for pancreatectomy, hepatectomy, and cholangio-jejunostomy. The patients had normal preoperative renal function, serum potassium values, and intraoperative urine output. The surgical manipulations might have reduced portal venous and/or hepatic arterial blood flow resulting in the hepatic ischemia. Consequently, hepatic intra-cellular potassium might have leaked into the blood causing hyperkalemia. Anesthesiologists should be aware of the potential risk of hyperkalemia caused by surgical interventions on the liver and/or pancreas.

Aged↗
PubMedDate not supplied

Actual management of common bile duct stones: a continuous evolving approach.

The management of common bile duct stones (CBDS) has recently changed regarding either a more precise diagnosis of patients at high-risk to harbor CBDS and either the development of new therapeutic modalities. In patients with preoperative predictive suspicion of CBDS, new non-invasive radiologic and endoscopic investigations are now available, namely 3-D spiral CT-cholangiography and magnetic resonance cholangio-pancreatography on one hand, and endoscopic ultrasonography on the other hand. With the development of laparoscopic surgery, two strategies have emerged in order to maintain the minimally invasive nature of the procedure: perioperative endoscopic sphincterotomy or laparoscopic common bile duct exploration. However, considerable laparoscopic expertise, advanced and expansive technologies are required to achieve successful laparoscopic treatment of CBDS. An appropriate intraoperative strategy is mandatory during laparoscopic common bile duct exploration, with specific indications for the transcystic route and for laparoscopic choledochotomy, according to patient's biliary anatomy and stone's characteristics. A preliminary controlled trial has proved the safety, efficacy and excellent postoperative results of such approach. However, the best option of management for patients with CBDS remains open to discussion and the therapeutic choice should depend on the local hospital availability of technical expertise.

Cholangiography↗
PubMed1999

Laparoscopic choledochotomy in the management of choledocholithiasis. A report of 32 cases.

OBJECTIVE: we describe a choledochotomy technique for the laparoscopic removal of calculi in the management of choledocholithiasis, with an analysis of the results obtained in our first 32 patients. METHODS: a prospective study was made of all patients who underwent laparoscopic choledochotomy in our surgical service in the period between December 1993 and December 1996. A total of 112 patients diagnosed as having choledocholithiasis were operated on in our service in the course of the study. Of the 54 patients who initially underwent laparoscopic surgery, 32 underwent cholecystectomy, choledochotomy, extraction of stones and laparoscopic choledochorrhaphy. RESULTS: in 30 patients (93.75%) laparoscopic surgery could be completed without resorting to open surgery; in 5 of these patients primary choledochorrhaphy was performed, and in the remaining patients suturing was performed on a Kehr T-tube. Mean surgical time was 176 min. Two slight complications (one acute gastric dilatation and one small biliary fistula) and one severe complication (bowel fistula) were recorded. Mean hospital stay was 7 days. CONCLUSIONS: choledocholithiasis was successfully managed with laparoscopic choledochotomy and the extraction of stones, with no increase in morbidity or mortality in comparison to other therapeutic modalities.

Adolescent↗
PubMed1999

[Intermittent obstructive jaundice as a form of presentation of duodenal diverticulum].

We report the case of a previously well 89-years-old-healthy man who presented at least four episodes of intermittent obstructive jaundice during the eight months prior to admission in our Hospital. Studies revealed a duodenal diverticulum arising near of the ampulla of Vater. We believed the diverticulum was responsible for the intermittent obstructive jaundice and we performed a choledochoduodenostomy. He had no postoperative complications and was discharged from the hospital asymptomatic. This case documents an uncommon presentation of this disease generally asymptomatic with intermittent obstructive jaundice episodes.

Aged↗
PubMed1999

[Optimizing palliative therapy in pancreatic carcinoma].

Only an interdisciplinary approach between surgeon, medical oncologist and radiologist may allow the optimisation of palliative treatment for pancreatic carcinoma. If imaging diagnostics do not allow to decide about the resectability of a tumour, an explorative laparotomy should be performed, unless this is precluded by comorbidity. Due to similar morbidity and mortality, but better long-term results, a choloedocho-jejunostomy should be performed for intra-operatively unresectable tumors in favour of a cholecysto-jejunostomy. In selected patients a gastro-enterostomy may be indicated. However, this is not justified prophylactically. If imaging diagnostics show definite signs of unresectability in the absence of a gastric outlet obstruction, the treatment depends on the general condition of the patient: Insertion of a pigtail-catheter is sufficient for patients in poor general condition and a short life expectancy; metal wallstents should be preferred for patients in good general condition and a life expectancy in excess of six months, due to better results regarding quality of life. Chemoablation of the celiac plexus is an useful method to control the sever pain, which is common in these patients; radiotherapy or analgesic therapy may be used alternatively.

Anastomosis, Roux-en-Y↗
PubMedDate not supplied

[A rare nosological association: a villous gastric polyp and asymptomatic choledocholithiasis].

The authors present the case of a male patient, aged 68, admitted in our department for a upper gastrointestinal hemorrhage. The upper gastrointestinal series showed a large gastric villous adenoma located in the body of the stomach. Intraoperative, we found a gastric villous adenoma and multiple choledocholithiasis and gallbladder stones which evolved completely asymptomatic. We performed a mediogastric resection, Fredet pyloroplasty and laterolateral choledochoduodenostomy with a good postoperative result. This case is peculiar due to the concomitant occurrence of two rare diseases the gastric villous adenoma and the asymptomatic multiple choledocholithiasis.

Adenomatous Polyps↗
PubMedDate not supplied

Adenomyoma of the common bile duct.

An unusual case of adenomyoma of the common bile duct is reported. A 31 year-old woman with intermittent epigastralgia was found to have cholestasis and stenosis of the common bile duct. A malignant tumor could not be excluded. Resection of the common bile duct with the tumor was performed with choledochojejunostomy reconstruction. The tumor consisted of glandular hyperplasia and proliferation of smooth muscle fibers and fibrous connective tissue. The patient was well at the 30-month follow-up. Although the benign tumors of the extrahepatic bile ducts are rare, the clinical importance lies in the recognition that they can cause biliary tract obstruction. Intra-operative frozen section for histologic examination is required to make the diagnosis and plan the surgical procedure. Complete extirpation of the lesion is recommended. A radical operation is not necessary.

Adenomyoma↗
PubMedDate not supplied

[Choledochojejunostomy using a mechanical stapler].

Authors performed the mechanical termino-lateral bilio-digestive anastomosis, adopting a circular 21 mm stapler device. The patient was affected by non neoplastic papillary stenosis producing a common biliary tract dilatation so large to allow the stapler's head introduction. A 12 month follow-up was performed using ultrasonography and MRI cholangiopancreatography, that obtained a good demonstration of both biliary tract and bilio-digestive anastomosis.

Ampulla of Vater↗
PubMed1999

Clinical pathway implementation improves outcomes for complex biliary surgery.

BACKGROUND: Complex biliary surgery is associated with significant morbidity, prolonged hospital stay, and high cost. Clinical pathway implementation has the potential to standardize treatment and improve outcomes. Therefore the aim of this analysis was to determine whether clinical pathway implementation and/or feedback of outcome data would alter hospital stay, charges, and mortality rates for complex biliary surgery at an academic medical center METHODS: Pre- and postoperative length of stay, hospital charges, and mortality rates were monitored for 36 months before (period 1) and for 2 18-month periods (periods 2 and 3) after implementation of a clinical pathway for hepaticojejunostomy. Outcome data were provided to the surgeons 18 months after pathway implementation to determine whether further clinical practice improvement was possible. RESULTS: From 1991 to 1997, 339 patients underwent hepaticojejunostomy at The Johns Hopkins Hospital for malignant and benign biliary obstruction. Total length of stay was 13.3 +/- 0.9 days for period 1 compared with 12.5 +/- 0.8 days for period 2 (not significant) and 10.1 +/- 0.3 days for period 3 (P < .01 vs period 1; P < .03 vs period 2). Hospital charges averaged $24,446 during period 1 compared with $23,338 during period 2 and $20,240 during period 3 (P < .01 vs periods 1 and 2). Hospital mortality rate was 4.5% during period 1 compared with 0.7% during periods 2 and 3 (P < .05). CONCLUSIONS: These data suggest that implementation of a clinical pathway for hepaticojejunostomy reduces hospital mortality rates and that feedback of outcome data to surgeons results in further clinical practice improvement. Thus clinical pathway implementation and feedback are effective methods to control costs at an academic medical center.

Academic Medical Centers↗
PubMedDate not supplied

Intra-pancreatic rupture of the bile duct.

Injury of the bile duct after blunt trauma is rare but injury and rupture of the intrapancreatic portion of the bile duct is extremely rare. Injury is very difficult to recognize even if explorative laparotomy is done. Elevation of the liver tests, especially gamma GT and alkaline phosphatase, is very often the first sign of injury. When jaundice occurs the diagnostic procedures of ultrasound (US), computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) must be done. If there is no sign of great injury to the head of the pancreas we have to perform normal biliary flow. Here we report a rare case of intrapancreatic rupture of the common bile duct without high degree of pancreatic injury after blunt injury. Cholecystectomy and choledochojejunostomy were performed.

Accidents, Traffic↗