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PubMed1983

[Relation between changes in the bile composition of choledocholithiasis patients and the method of draining the bile ducts].

The important role of the early reestablishment of the enterohepatic bile circulation for normalization of its composition and recovery of functioning the hepatic cell is shown on the basis of examination of the biochemical composition with choledocholythiasis complicated by mechanical jaundice in the pre- and postoperative period in dynamics. Draining of the hepatocholedochus with an original double cribrate transcapillary drain was widely used in the clinic.

Adult↗
PubMed1984

Choledochoduodenostomy for choledocholithiasis. Indications and functional results.

Choledochoduodenostomy in the prevention and treatment of patients with common bile duct stones has been frequently discussed during several years. The introduction of endoscopic sphincterotomy, with excellent results and low morbidity necessitate further examination of the indications for and the value of this procedure as an adjunct to choledocholithotomy. Twenty patients with a mean age of 73 years have been operated on with choledocholithotomy and subsequent choledochoduodenostomy. In 7 of the patients the anastomosis was performed at a primary operation, in 11 at a secondary and in 2 at a third operation. Seven of the patients had primary bile duct stones, while thirteen had multiple stones, either unextractable or with a doubtful clearance. There was no postoperative mortality and only one early complication, a pneumonia. Eighteen of the 20 patients are free of symptoms postoperatively and have normal liver function tests and verified open anastomoses. Two patients had recurrent postoperative cholangitis, one due to a stricture in the anastomosis, which was reoperated, and one due to multiple retained stones intrahepatically despite an open anastomosis. In conclusion choledochoduodenostomy is easy to perform with low morbidity even in old-aged, high-risk patients. It is a safe and effective method in the prevention of retained or recurrent stones.

Aged↗
PubMed1982

Incidence of bile infection in patients with choledocholithiasis.

Five hundred twenty-two patients who underwent choledochotomy because of biliary lithiasis are discussed herein to assess the relationship of different factors such as advanced age, previous surgery, length of clinical history, to the incidence of bile infection. It has been shown that bile infection is higher in patients of advanced age, previous surgery, and longstanding biliary lithiasis, and that it is also associated with a high incidence of common bile duct dilatation, a high incidence of common bile duct pathological changes, and a high incidence of common bile duct primary stones. From our findings in this study it is postulated that bile infection is a result of biliary stasis, and that for those patient poor drainage of the biliary tree due to dilatation and laxity of the bile duct is a predominant feature. The evidence for the above hypothesis after our barium meal studies seems clear, and thus a drainage procedure supplementary to choledochotomy appears to be warranted for those patients and is highly recommended from the results of this study.

Aged↗
PubMed1982

A prospective randomized study of recurrent choledocholithiasis.

To assess the value of choledochoduodenostomy versus sphincteroplasty and T-tube drainage for the treatment of recurrent choldocholithiasis, 120 patients with this condition who underwent, through a randomized process, choledochoduodenostomy, group A, 40 patients; sphincteroplasty, group B, 40 patients, are presented in this study. Results revealed that, in the patients of group A, no death occurred, and that the low early morbidity rate was 10 per cent with a shorter hospital stay. Also, no patients underwent further operation for reasons related to the disease or the operation. In contrast, with regard to the patients in group B, the mortality was 5 per cent; the early morbidity rate, 25 per cent, and the late reoperation rate, 12.5 per cent. Similarly, for the patients in group C, the mortality was 2.5 per cent; the early morbidity rate, 30 per cent, and the reoperation rate, 22.5 per cent. These differences in mortality, early morbidity and reoperation rates between the patients in group A and those in group B and C are significant, p less than 0.001. From our results, choledochoduodenostomy is recommended for patients having clinical and operative findings which were used as criteria for eligibility in the present study.

Adult↗