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At least 667 records · Page 37Linked to original sources
PubMed1991

[Choledochal cyst as an unexpected intraoperative finding].

In adulthood, choledochal cysts often surprisingly are discovered during cholecystectomy. Abdominal ultrasonography incorrectly identified the cyst as a dilated or septated gallbladder. Once suspected preoperatively, confirmation of the diagnosis is obtained by ultrasonography or computerized axial tomography, which define its relationship to the vascular structures in the porta. The rapidity and accuracy of ultrasonography favour its use as the initial investigative procedure. Direct cholangiography is the preferred modality for accurate definition of the type of choledochal cyst, ductal strictures, intrahepatic ductal configuration, and polypoid filling defects suggesting cholangiocarcinoma. The well known risk of development of ascending cholangitis as well as cystic cancer, mainly in the adult, indicates the excisional operation for preventing these complications. Cyst excision and Roux-en-Y hepaticojejunostomy is the definitive treatment of choice.

Adult↗
PubMed1991

[Surgical laser papillosphincterotomy].

The still rather limited application of laser in biliary surgery is pointed out, to experience gained so far, including personal one, laser is being used in extirpation of the gall bladder, for treatment of the bladder bed, for choledochotomy and for papillosphincterotomy. Laser papillosphincterotomy was performed in a 65-year-old female patient--the first case in this country. This method has some advantages--adequate hemostasis, absence of reactive edema, early re-establishment of bile flow, adhesion of the incision edges.

Acute Disease↗
PubMed1991

Stapling techniques to facilitate resection of the head of the pancreas.

Thirteen patients underwent duodenocephalopancreatectomy (DCP) with the mechanical staplers to divide the pancreatic neck and to secure haemostasis of the retroportal pancreatic lamina. The stapling techniques used on the pancreas are described. In nine patients with DCP the stapled distal pancreas was anastomosed to the jejunum with Roux-en-Y drainage; one pancreatic complication and no deaths were observed. In four other patients undergoing DCP who were at high risk for severely compromised general conditions, reconstruction of the digestive tract was simplified by leaving the stapled distal pancreas definitively closed: pancreatic complications were recorded in two cases, with no deaths. Mechanical staplers considerably facilitated resection of the neck of the pancreas and of the retroportal pancreatic lamina. All 13 patients who underwent DCP with the use of stapler techniques on the pancreas, including four high-risk patients, were discharged to convalesce on an oral diet after a median postoperative hospital stay of 23 days (range 16-90 days).

Adult↗
PubMed1991

[Cysts of the common bile duct in children].

From 1975 to 1989 operations were carried out in the clinic by various methods on 30 children with cysts of the common bile duct. Hepaticoor choledochojejunostomy after Roux is the operation of choice in cysts of the choledochus. However, recurrent cholangitis caused by jejunobiliary reflux was encountered in some patients in the postoperative period. The accumulated clinical experience has also shown that the Roux type operation does not guarantee a successful functional result. To prevent reflux of the intestinal contents into the biliary tract after Roux's anastomosis, the authors used an antireflux valve on the excluded loop of the jejunum. Experimental study was undertaken of the theoretically substantiated antireflux valve on an excluded loop of the type of a "nonspilling inkpot" with a shortened loop. The creation of an antireflux valve in the form of an invaginated segment prevents jejunobiliary reflux and therefore provides the possibility for reducing significantly the length of the excluded loop in Roux's biliodigestive anastomoses. The obtained positive results confirm the rationality of this construction which does not need additional time for the operation. Since 1987 four children have been operated on by this method in the clinic. The length of the excluded loop was reduced from 30 to 15 cm. Postoperative complications linked with reflux into the biliary system were not encountered.

Adolescent↗
PubMed1991

Preliminary experience with the Hutson-Russell loop cutaneous choledochojejunostomy.

In 1984, the use of a choledochojejunocutaneous fistula was described to allow balloon dilation of benign biliary strictures. Later, the use of the technique to obtain repeated access to the biliary tree in a larger series of patients was reported. The experience provided a foundation for the application of the technique in nine patients at Wilford Hall United States Air Force Medical Center. Represented were a variety of benign and malignant disorders. Six patient reports are offered from this preliminary experience to demonstrate the range of problems lending themselves to the use of the Hutson-Russell loop. Suggestions for present and future applications of the versatile choledochojejunocutaneous loop are included.

Adult↗
PubMed1991

[Obstructive jaundice in proximal pancreatitis after sclerosing of a bleeding duodenal ulcer].

Two weeks after successful endoscopic sclerotherapy of a bleeding duodenal ulcer a fifty-year old male patient developed a benign enlargement of the head of the pancreas and obstructive jaundice. He underwent exploratory laparotomy with choledocho-jejunostomy because there was no evidence of malignant disease. The enlargement of the head of the pancreas and obstructive jaundice are considered to be symptoms of a pancreatitis as a complication of the endoscopic sclerotherapy.

Choledochostomy↗
PubMed1990

[Surgical treatment of strictures of the hepaticocholedochus in patients with primary extrahepatic portal hypertension].

An analysis of their experience with treatment of 14 patients has shown that treatment of prolonged strictures of hepaticocholedochus in patients with extrahepatic portal hypertension by conservative measures is not sufficiently effective. The optimum surgical treatment is operation for reestablishment of the bile outflow. Hepaticojejunostomy is most reliable. The use of the gallbladder for anastomosis is not expedient. The operations are technically difficult and are often followed by complications.

Adult↗
PubMed1990

[Therapeutic decision in gallstone disease: from the surgical viewpoint].

Cholecystectomy, hitherto the "golden standard" in gallstone treatment, and all the other alternative methods must pass the test of applicability, morbidity, mortality, rate of success and recurrence. According to these criteria, cholecystectomy (removing not only the stones but also the offending gallbladder)--in particular with the advent of the laparoscopic approach--is the therapy of choice.

Cholecystectomy↗
PubMed1991

[Determination of surgical risk in patients with acute cholecystitis].

On the basis of rich clinical experience and analysis of the case records of 445 patients who underwent operation in 1982-1988, the author calculates the risk of the operation in patients with acute cholecystitis according to the severity of their condition, the concomitant diseases and complications, the complex nature of the intervention which will be undertaken, the surgeon's rating, and other factors. The high efficacy of the calculations shown.

Acute Disease↗
PubMed1991

[Br-IDA in the evaluation of papillo-sphincterotomy and choledochoduodenostomy].

Twenty-three patients who had undergone surgery for non-neoplastic pathologies of the terminal choledochus were studied using 99mTc Br-IDA. This method is used to study patients operated for PST of CDS because: 1) is not invasive and does not cause allergies; 2) it allows a physiological evaluation of biliary flow to be obtained; 3) it is not influenced by the patient's body structure, by the presence of intestinal gas or costo-chondral calcification; 4) the radiation dose absorbed by the patient is very low; 5) it does not require any special preparation of the patient. Papillosphincterotomy was performed in 16 patients and choledochoduodenostomy in 7 patients. Follow-up varied between a minimum of two and maximum of eight years. The morphology of the biliary tract remained normal in all cases or was only slightly dilated. Captation and excretion time remained within normal values. Marker activity in the duodenum appeared early in all cases. A duodenogastric reflux was only observed in one patient among those undergoing PST, whereas it was observed almost constantly following CDS.

Adult↗
PubMedDate not supplied

[The use of the Kehr tube in choledochal calculi (our experience)].

Surgical therapy of the main bile duct is an important aspect of liver disease. The authors examine the advisability of using a Kehr drain in benign and malignant disease of the main bile duct, and draw the conclusion that, with precise indications, this technique still has an important role to play in the resolution of biliary tract disease.

Choledochostomy↗