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PubMed1989

[Indications for and comparisons between transduodenal papillostomy and choledochoduodenostomy].

Biliary lithiasis is still a subject of great interest. The aim of surgical treatment is removing common bile duct stones and assuring a good biliary outflow. In this study the authors report their experience in the surgical treatment of common bile duct stones and the indications for transduodenal papillostomy (PST) and latero-lateral choledochoduodenostomy (CDA). The results are similar to those in the international literature and are surely good for both the procedures. Papillostomy is the procedure of choice, unless there are specific contraindications, in the treatment of common bile duct lithiasis for the following reasons: good immediate and long-term results, low incidence of postoperative complications, prevention of recurrent lithiasis. Choledochoduodenostomy, when clearly indicated, offers good results and, when the anastomosis is large enough, also has a low incidence of postoperative complications. Finally PST and CDA are not alternative procedures but present precise indications. The authors stress the possibility of combining these two techniques, in selected cases, with good results.

Ampulla of Vater↗
PubMedDate not supplied

Obstructive jaundice secondary to intra-biliary rupture of hepatic hydatid cyst.

Of 58 cases of obstructive jaundice treated in a three year period, six were due to the intrabiliary rupture of hydatid cysts of the liver. Eosinophilia of more than 10%, raised alkaline phosphatase, positive indirect haemagglutination test were noted in all six cases. Plain X-ray of the abdomen, ultrasound, endoscopic retrograde cholangio-pancreatography and CT scan were useful modalities for definite pre-operative diagnosis. All patients had operative treatment which consisted of cyst drainage, partial pericystectomy, curettage of the remaining cavity which was stitched with tube drain, cholecystectomies, choledochotomy and T-tube drainage. They all recovered satisfactorily and without complications in a follow-up period of two years.

Adult↗
PubMed1989

[Secondary and residual choledocholithiasis. Our experience].

A retrospective study was made of 780 patients who underwent surgery of the biliary tract for lithiasis between 1973 and 1984; of them, 110 (14.1%) presented secondary choledocholithiasis and 14, residual choledocholithiasis. The decade of highest incidence of choledocholithiasis was 60 to 70 years; the proportion of women-men was 2:1. The predominant symptom was biliary colic, which occurred in 99% of patients; jaundice appeared in 65% of cases. In 5.6% of patients choledocholithiasis was complicated with suppurative cholangitis. The operation most frequently practiced was choledochotomy with extraction of calculi and closure on a Kehr tube, performed in 50% of patients, followed by transduodenal sphincteropapillotomy in 31% of patients. In 32 patients complications occurred during the immediate postoperative period, representing a morbidity of 22.5% and a mortality of 3.2%. The most frequent complications were of infectious nature.

Adolescent↗
PubMed1989

[Comparative evaluation of various approaches to the surgical treatment of cholelithiasis in patients of a high-risk group].

The authors undertook comparative analysis of the results of surgical treatment of 247 patients with cholelithiasis who were referred to the high risk group on the basis of consideration for the various complications and concomitant diseases. The control group consisted of 160 patients treated by the routine methods. The main group was made up of 87 patients, 28 of them were subjected to various endoscopic interventions on the major duodenal papilla and terminal part of the choledochus. The number of operations on the choledochus and major duodenal papilla using endoscopic interventions has increased from 27.5% to 48.3%, while the number of complications reduced from 27.4% to 15.2% and mortality--from 6.3% to 1.1%. Endoscopic operations, which cause little injury, considerably improve the results of treatment of cholelithiasis in patients of the high risk group.

Age Factors↗
PubMed1989

[Proposal for anatomo-functional instrumental control of dysfunctional bilio-digestive Roux-en-Y anastomosis].

Various techniques are used for the anatomo-functional study of bilio-digestive anastomoses on jejunal loop autonomized according to Roux. Here a transparietojejunal endoscopic investigation is proposed that permits direct sight of the anastomosis, biliary sampling for cultural examination and dilatative type therapeutic manoeuvres, biopsies or extractions of residual stones from the bile ways that would not otherwise be possible without further surgery. A clinical case is reported.

Adult↗
PubMed1989

[Completion of choledochotomy].

An analysis of 144 operations using external drainage of the common bile duct per 926 cholecystectomies and using T-shaped drains (in 90 patients drains of vulcanized latex [Revultex] proposed by the authors were used) has brought the authors to a conclusion that the temporary external drainage of the common bile duct is the method of choice for the completion of choledochotomy, when it is not possible to carefully visually control the hepatocholedochus lumen. The T-shaped cast latex drains are thought to be most adequate for the operations.

Adult↗
PubMed1989

[Surgical treatment of duodenal ulcer complicated by mechanical jaundice].

Operations were performed on 41 patients with duodenal ulcer which was the cause of obstruction of the bile ducts. Many patients also suffered from other chronic and acute complications of peptic disease of a long duration. Preliminary laparoscopic decompression of the gallbladder was conducted whenever possible. When the operative intervention was undertaken in obstructive jaundice preference was given to resection of the stomach or organ-preserving operations which were combined with correction of the bile draining ducts.

Adult↗
PubMed1989

Factors affecting mortality in patients over 70 years of age submitted to surgery for gallbladder or common bile duct stones.

Chile is the country with the highest incidence of gallstone disease in the world. Nearly 44% of the women and 25% of the men over 20 years of age have gallstones. Biliary tract surgery accounts for about 35% of all the operations performed in Chilean general hospitals. The present paper aims at assessing the risk factors associated with a higher mortality in patients over 70 years of age subjected to elective or emergency surgery for gallstones or common bile duct stones. No specific factors of mortality were found in the group of elderly patients subjected to elective cholecystectomy. There was also no correlation between types of cholecystitis and postoperative mortality. However, acute suppurative cholangitis made the postoperative mortality rate increase almost 20-fold in patients with common bile duct stones. The mortality also shows a steep increase (up to 12%) if cholecystectomy is performed in acute cholecystitis. Cholecystostomy seems to be associated with a low mortality risk and hence should be appropriate in exceptionally high-risk patients, but is not considered useful by the authors in necrotic or gangrenous cholecystitis, or in cases with common bile duct stones and cholangitis. Postoperative mortality in patients submitted to cholecystectomy alone seems to depend exclusively on the concomitant presence of medical complications, mainly of a respiratory and cardiovascular nature. Septic complications are important causes of postoperative mortality in emergency cholecystectomy. Patients at high surgical risk are those suspected of cholangitis, those over 80 years of age, and those suffering from Charcot's triad, anemia, uremia, leukocytosis, hyperbilirubinemia or hypoprothrombinemia; in these, an endoscopic procedure could be chosen.

Age Factors↗
PubMed1989

Indications and results of choledochoduodenostomy in benign biliary tract diseases.

During a 12-year period ending December 1987, 17,200 operations for biliary tract disease were performed at the Dept. of Surgery of the University of Chile. Choledochoduodenostomy was performed in 140 of these patients operated upon for benign biliary tract and/or gallbladder diseases. The indications for this procedure were choledocholithiasis, stenosis of the sphincter of Oddi, compression of the extrahepatic biliary duct, stenosis of the distal biliary duct and duodenal diverticula. The postoperative course was uncomplicated in 126 patients (90%). The mortality rate was 4.2%. Although the mortality was somewhat greater in patients with acute cholangitis, the difference was not significant, and no significant relation could be established with other factors that might affect mortality. Choledocholithiasis is the main cause of benign obstruction of the biliary tract in Chile. This is also the most frequent indication for external choledochoduodenostomy and is a promising method even in the presence of an infection of the biliary duct.

Adult↗
PubMed1989

[Hepato-cholescintigraphy using technetium Tc 99m diethyl IDA in the follow-up of biliodigestive anastomoses].

The results of a study conducted on 24 patients given biliodigestive shunts are reported. Follow-up involved cholescintigraphy using 99m-IDA technetium. This examination provided valuable information about the morphodynamics of biliary flow and when the biliary peak and intestinal appearance times were lengthened, it was also able to identify significant obstructions. The technique is considered highly significant.

Aged↗
PubMed1989

[Choledochoduodenostomy in choledocholithiasis and benign strictures of the common bile duct].

The methods of external and of internal drainages of the bile ducts are alternatives in choledocholithiasis and benign strictures of the choledochus. In the Central Research Institute of Gastroenterology, 349 operations were performed on the common bile duct, stones were found in the choledochus in 259 (74.2%) cases and benign strictures of the terminal part of the choledochus and the major duodenal papilla in 103 (29.5%) cases. Ninety-five operations were secondary or reconstructive in character. A precise diagnosis of affection of the biliary tract can be established only during an operation or by retrograde cholangiopancreatography. External drainage of the common bile duct was conducted in 229 (65.6%) cases. Choledochoduodenostomy was undertaken in 105 patients (55 were operated on for the first time and 50 underwent operation on the biliary tract for a second time). Endoscopic papillosphincterotomy was successful in 28 cases with short strictures of the choledochus and choledocholithiasis. The stones were removed from the ducts with instruments or were expelled spontaneously at days 2 to 5.

Choledochostomy↗
PubMed1989

[Characteristics and results of the treatment of cholelithiasis in elderly patients].

The results of surgical treatment of cholelithiasis in 708 patients over 65 years of age are discussed and compared with those obtained in a group of 2.021 younger patients who underwent operation in 1975-86 for stones in the gallbladder and bile ducts. The authors discuss the morbidity according to the patient's age, frequency of combination of stones in the bile ducts and acute inflammation of the gallbladder, and mortality depending on the age and the type of the operation. It was found that the incidence of acute inflammation of the gallbladder, choledocholithiasis, obstructive jaundice, and cholangitis increased progressively with age.

Age Factors↗
PubMed1989

[Stenosis of the major duodenal papilla].

Endoscopic retrograde cholecystocholangiopancreatography and subsequent manometry in 1,018 patients with diseases of the biliary tract showed signs of stenosis of the major duodenal stenosis in the absence of concrements in the biliary system in 25 (2.45%) of them. On the basis of the results of such examination and the clinical and laboratory findings, the authors suggest that patients with benign stenosis of the major duodenal papilla should be divided into two groups: Group 1, with compensated stenosis and Group 2, with decompensated stenosis of the major duodenal papilla. Depending on the degree of the stenosis, they suggest the following endoscopic organ-preserving surgical interventions: endoscopic papillomyotomy and sparing endoscopic papillosphincterotomy.

Adult↗