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PubMed1990

[Quantification of duodenogastric reflux in symptomatic patients with choledochoduodenostomy using intravenous continuous perfusion of 99mTc-HIDA as duodenal marker].

The purpose of the present study was to determine whether the measurement of intravenously administered 99mTc-HIDA in samples of gastric juice can be used as a reliable marker of duodenogastric reflux. Ten normal volunteers and 10 patients with a laterolateral choledocho-duodenostomy complaining of dyspepsia but no biliary pain, were given a continuous i.v. infusión of 99mTc-HIDA. The isotope concentration was then measured in samples of gastric juice. We found that duodeno-gastric reflux was significantly higher (p less than 0.001) in patients with choledochoduodenostomy and dyspepsia than in normal volunteers.

Choledochostomy↗
PubMed1990

[Spontaneous remission of retroduodenal sac fundus syndrome (sump syndrome)].

The Sump syndrome is an infrequent complication of a choledochoenterostomy (choledochoduodenostomy or choledochojejunostomy) performed for recurrent stone disease: a sump or pit develops at the retroduodenal section of the choledochus between the enterostomy and papilla where stones, lithogenic bile and gastrointestinal contents accumulate. This may lead to abdominal pain, pancreatitis and cholestasis and/or cholangitis when sludge obstructs the enterostomy. Surgical treatment has been replaced by endoscopic papillotomy. The major interest of this experience was that regarding migration of the stones to intestine, the spontaneous resolution could be documented in two patients; in other two cases, because of contraindications in one case and for refusing therapy in another, the stones still remain at the retroduodenal choledochus. In a follow up of two to eight years there is a favorable evolution without any surgical or endoscopic treatment of the papilla.

Aged↗
PubMed1990

Side-to-side choledochoduodenostomy: a reappraisal based on a study of 70 patients.

We experienced a total of 70 side-to-side choledochoduodenostomy cases and 80% of them were indicated for gallstone disease patients. There were no early postoperative complications, but intrahepatic gallstones developed in 2 cases. The size of the stoma and the width of the common duct were reduced about 30% within 3 postoperative months. Although clinical cholangitis did not occur in the presence of an adequate stoma, histological cholangitis was constantly seen throughout 10-year-follow-up period. Strictness of operative indications, and periodical and long term follow-up study of postoperative patients are mandatory to obtain better clinical results.

Bile Ducts, Intrahepatic↗
PubMed1990

[Late results of the surgical treatment of patients with biliary calculi].

The authors analyse the late results of surgical treatment of 463 patients who underwent operation for stones in the bile ducts. The late results were found to be determined by the character of the affection of the bile excreting system and the rational choice of the operative method. The indications and contraindications for various methods of treating cholelithiasis were determined more precisely from study of the late results.

Adult↗
PubMed1990

"Spontaneous sump syndrome": Successful treatment by duodenoscopic sphincterotomy.

"Sump syndrome" is a rare complication of side-to-side choledochoenterostomy operations which develops in the distal, nonfunctioning limb of the common bile duct where lithogenic bile, gastrointestinal contents, and debris accumulate. We report here a patient who developed spontaneous sump syndrome as a result of the formation of choledochoduodenal fistula, and who presented with multiple pyogenic liver abscesses. The patient's symptoms and liver abscesses resolved completely after treatment by endoscopic sphincterotomy and antibiotics. This case demonstrates that sump syndrome may occur spontaneously, that it can be a cause for pyogenic liver abscess formation, and that it may be treated effectively by endoscopic sphincterotomy.

Biliary Fistula↗
PubMed1990

Choledochoscopy in management of retained biliary stones and recurrent lesions.

Postoperative choledochofiberscopy was performed in 188 patients with retained biliary stones and recurrent lesions. The following entrances to the biliary tract for choledochoscopy were used: the T-tube tract (129 patients), an afferent jejunal limb of a choledochojejunostomy (43), the jejunostomy tube tract of an efferent limb (12), an U-tube tract (2), and a ductal fistula after segmental liver resection (2). 380 choledochoscopic sessions were carried out, 2 sessions on the average for each patient. The overall success rate of stone removal was 90.5%. No mortality was related to this procedure. Eleven patients developed fever and chills after manipulations but all responded to antibiotics. Two patients had perforation of the T-tube tract during the removal of stones and were reoperated on for abdominal drainage. They recovered eventually. Stone extraction with a flexible choledochoscope is a proven procedure. For residual intrahepatic stones, however, a satisfactory entrance into the biliary tree should be provided for subsequent stone removals. We believe that the jejunostomy tube tract of an efferent limb of an afferent jejunal limb of a choledochojejunostomy is a useful entrance for choledochoscopy because it is permanent in meeting therapeutic demands.

Adolescent↗
PubMed1990

[Latero-lateral choledochoduodenostomy in benign pathology of the common bile duct. A prospective study].

Biliodigestive derivations for benign diseases of the biliary tract are currently accepted in case of extended to recurrent choledochal stenosis, excessive dilation of the choledochus, impacted ampullary stones. This paper concerns 19 subjects that underwent laterolateral choledochoduodenostomy (CDS) according to the Roesner technique over the period January 1986 through December 1987 in order to evaluate long-term functional results of this operation. Hepatic serum enzymes and bilirubin were determined at intervals of two weeks during the first three months and of four weeks until the sixth month postoperatively. At this time a battery of controls was performed, namely standard plain X-ray of the abdomen, hepatobiliary sequential scintigraphy with HIDA, endoscopic examination of the anastomosis. The level of serum enzymes was then determined at 18 months postoperatively and scintigraphy was repeated as well. Based on the results of this study and the review of the recent literature, our opinion is that CDS has shown as a safe procedure with good long-term results in the treatment of benign disease of the biliary tract, mostly if high-risk aged subjects are concerned.

Aged↗
PubMed1990

[Proposal for a polyvalent Simplified Acute Physiology Score of severity in biliary tract surgery].

The SAPS score proposed by Le Gall, was used in 128 patients undergoing biliary surgery between January 1987 and April 1988. The score is based on the laboratory data for the first day. The cumulative post-operative complication rate was established during hospital stay and at one month after discharge. There is a highly significant correlation between the SAPS score, the morbidity and the mean hospital stay. From this study it seems valuable to use this score in surgery reports.

Adult↗
PubMed1990

[Clinical results of transduodenal sphincteroplasty and choledochoduodenostomy in acute cholecystitis].

In acute cholecystitis of the 460 patients, in 126, besides the cholecystectomy, the transduodenal sphincteroplasty (79) and supraduodenal choledochoduodenostomy (47) were performed. The postoperative lethality was 6.3 and 4.2%, respectively, mean duration of treatment of the patients at the hospital after the operation - 18.5 and 23.5 days. The excellent and good long-term results were noted in 78 and 73% of the patients examined. A conclusion is drawn, that sphincteroplasty and choledochoduodenostomy in complicated acute cholecystitis is more preferable, than choledochotomy and external drainage of the common bile duct.

Acute Disease↗
PubMed1990

[A method of pancreato-duodenal resection and total duodeno- pancreatectomy].

During 1975-88 the staff of the Vishnevskiĭ+ Institute of Surgery performed 95 pancreatoduodenal resections (PDR) and 23 total duodenopancreatectomies (TDPE) in malignant tumors of the head of the pancreas (49), major duodenal papilla (30), terminal choledochus (12), duodenum (12), and in 15 patients with chronic pancreatitis. In 13 cases PDR and TDPE were undertaken as a second operation after creation of biliodigestive anastomoses: after laparoscopic cholecystostomy in 24 and after various abdominal operations in 20 cases. In 30 cases PDR was carried out with the formation of a pancreaticojejunal+ anastomosis, by the longitudinal techniques in 7 of them, in 47 cases with occlusion of the pancreatic duct, and in 6 with the formation of a "occlusive" pancreaticojejunal anastomosis++ suggested by the authors. PDR was performed in 3 cases with maintenance of the stomach and in 4 in combination with vagotomy. The mortality rate was 20% after PDR and 39.1% after TDPE.

Choledochostomy↗
PubMed1990

[Postoperative mortality in surgery of cholelithiasis: a retrospective analysis from the years 1972-1980].

In a retrospective study (1972-1980) we analyzed the postoperative mortality of 2916 consecutive cholecystectomies or interventions on the common bile ducts respectively. The mean age of the patients was 54 years (17-92 years), 63% were older than 60 years; 74% were women. We show that age, histology, intervention, stone localization, sex and concomitant internal diseases influenced the early postoperative mortality. The overall mortality was 0.7% (21 patients), 0.7% in the under 60 years old patients, 1.8% in the older aged group. The mortality in chronic cholecystitis was 0.5%, in acute cholecystitis 2.6%. After simple cholecystectomy we observed a mortality of 0.3%, after cholecystectomy and common bile duct intervention 2.5% (p less than 0.001), and after intervention on the common bile ducts 7.3%. Stones only in the gallbladder were associated with a mortality of 0.3%, cholecysto- and choledocholithiasis with 2.8% and choledocholithiasis alone with 7.3%. The mortality in men was significantly (p less than 0.001) higher as in women (1.2 against 0.6%). In 76% of the deceased we diagnosed preoperatively a concomitant internal disease.

Adolescent↗