[Simplified combination bypass or single biliodigestive anastomosis in nonresectable pancreatic carcinoma?].
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Cholecystostomy↗
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End-to-end duodenojejunal bypass for unresectable periampullary carcinoma.
Palliative operation plays an important part in the treatment of periampullary carcinoma. However, gastric bypass such as the widely practiced side-to-side gastrojejunostomy frequently fails to provide adequate drainage. Here we attempted to fashion an end-to-end duodenojejunostomy in the hope of establishing physiological continuity of the stomach and duodenum. Biliary bypass with side-to-side choledochojejunostomy is performed simultaneously. Eight patients underwent this surgery. In seven of these, radical resection proved to be impossible, and in one the duodeno-biliary decompression was attempted before the radical operation. Early results were satisfactory in all patients. They began to eat liquid meals within a week, and were discharged uneventfully within the third postoperative week, when they were able to eat a regular diet. No ulcer developed in any of the patients. Plasma gastrin levels following a test meal was significantly lower after the operation, but plasma CCK-N and GIP levels showed no statistical difference prior to and after surgery. This duodenojejunal bypass is recommended as a means of improving the quality of the remaining life of the patients.
Aged↗
Balloon dilatation through the subcutaneously placed afferent limb of a hepaticojejunostomy in patients with resected Klatskin tumors.
It is generally conceded that palliation for proximal bile duct tumors (Klatskin) is exceptional if obstruction and the resultant infections can be prevented. Our experience with balloon dilatations thru the subcutaneously placed afferent limb of a choledocho or hepatico jejunostomy in patients with benign strictures suggests that this approach will be effective in patients with malignancies and thus provide long-term control of the obstruction without the need for external tubes. This is a report on one patient who, following a resected Klatskin tumor with positive margins, was treated with transhepatic internal external stents and was converted to a subcutaneous limb following numerous bouts of cholangitis. A schedule for repeat dilatations thru the jejunal limb was established. The patient has remained afebrile with a normal bilirubin and a moderately elevated alkaline phosphatase. Recurrent tumors or postirradiation strictures in patients with resected Klatskin tumors can be effectively controlled by repeated balloon dilatation without the need for external stents.
Aged↗
[Choledochoduodenostomy in the treatment of benign disease of the common bile duct: evaluation of long-term results].
The Authors report their experience in the treatment of 36 patients managed by side-to-side choledochoduodenostomy for common bile duct disease and followed for a period of five years. The main indication to surgery was a choledochal dilatation more than 1.5 cm. The surgical technique consisted in a single layer side-to-side choledochoduodenostomy with absorbable suture according to Roessner. There was no operative mortality and few post surgical complications (six patients, 15.78%) were registered; 25 patients (69.45%) were completely asymptomatic at five years, while in six cases (16.66%) significant symptoms were observed. In one case a biliary gastropathy with no metaplasia was documented.
Aged↗
[Cholelithiasis and diabetes].
The occurrence rate of diabetes was analyzed in 3370 consecutive patients admitted and surgically treated for biliary lithiasis at the I Department of Surgery-University of Rome "La Sapienza"-between 1959 and 1993. The incidence of such association was found to be overlapping with that of normal population. The natural history and the outcome of patients surgically treated for biliary lithiasis do not seem to be burdened by a concurrent diabetes. Diabetes was in turn found to be correlated with a more frequent presence of stones in the biliary tract. Possible causes of this correlation are discussed. The need in these patients of a more accurate diagnostic approach and specific therapeutic solutions is stressed.
Adult↗
A retrospective analysis of 6,387 cholecystectomies.
This is the largest retrospective analysis of biliary tract surgery ever reported involving 6,378 patients operated on during a three year period, 1990-1992. During this time interval, the frequency of laparoscopic procedures has increased dramatically. The use of laparoscopic procedures was associated with a significant decrease in the total length of hospital stay and total charges as compared to the open procedures. Because of laparoscopic surgery's increased acceptance, we propose that the frequency of laparoscopic surgery of the biliary tract should be used as a quality control measure.
Aged↗
Transduodenal sphincterotomy for stenosing papillitis and massive choledocholithiasis after Billroth II gastrectomy.
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Ampulla of Vater↗
[The diagnosis and treatment of focalized pancreatitis: report of 16 cases].
We report 16 patients of focalized pancreatitis. All patients presented mass in the head of pancreas and obstructive jaundice (13 patients), characterized by spontaneous mass shrinkage and jaundice subsidence within two weeks after admission without any surgical intervention. Sonography, ERCP, exploration and intraoperative biopsy are of value in differentiating FP from carcinoma. Six patients received conservative therapy. Operations aimed to drain the commonbile duct and pancreatic duct (T tube drainage of commonbile duct, choledochojejunostomy, pancretojejunostomy) were performed in 7 patients. Pancretoduodenectomy were performed in 3 patients on tentative diagnosis of carcinoma in the head of the pancreas. Follow-up in 12 patients showed satisfactory results.
Choledochostomy↗
[Spontaneous rupture of the esophagus after surgery].
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Acute Disease↗
[The surgical treatment of choledocholithiasis].
In 241 patient choledocholithiasis the transduodenal sphincteroplasty (TDSP) and in 118--choledochoduodenostomy (CDS) was conducted. The incidence of specific postoperative complications after TDSP was 10.3%, after CDS--10.2%, postoperative mortality accordingly was 6.2% and 6.8%, the hospital stay duration from the time of operation performance till the discharge of patient from hospital--16.8 and 21 day on the average. Authors speculate the TDSP as a method of choice of operative choledocholithiasis treatment.
Acute Disease↗
[The pathomorphological changes in the common bile duct in suppurative cholangitis].
Pathomorphological investigation of suboperative material in 56 patients with purulent cholangitis was conducted to determine the character and peculiarities of the wall structure changes of common biliary duct. In 20 (36%) observations the histological changes were like in acute, and in 36 (64%)--like in chronic inflammation. Comparing the character of changes of the duct wall and the excised gallbladder it was determined that they are unique and presents the morphological substrate of disease. Since histological changes mainly correlate with the malady clinical course it must be taken into account while choosing operative procedure.
Acute Disease↗
[A combination of a duodenal diverticulum and the postcholecystectomy syndrome].
The surgical treatment results of 68 patients with duodenal diverticulum were analyzed, 21 of whom the various interventions on biliary tracts for cholelithic disease and her complications earlier were conducted. Postcholecystectomy syndrome origin was connected with non-diagnosed and non-eliminated duodenal peripapillary diverticulum. The clinical peculiarities, diagnostic algorithm and the complex of preoperative preparation, surgical treatment and complications prophylaxis are adduced. The necessity of associated terminal common bile duct portion correction plus diverticulectomy or intestine exclusion according to A. G. Zemlianoĭ was suggested.
Adult↗
[A rare case of choledocholithiasis with an atypical clinical course].
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Acute Disease↗
[Thymogen immunocorrection in the surgical treatment of complicated forms of cholelithiasis].
On the basis of experimental and clinical investigations the authors showed immunity depression in complicated forms of cholelithiasis. Thymogene appeared to be efficient for immunocorrection that permitted to lower the frequency of postoperative complications and lethality.
Acute Disease↗
[Ways of improving results of gastro-pancreatoduodenal resection in tumors of the bilio-pancreatoduodenal area].
The results of treatment of 86 patients who had been subjected to gastro-pancreatoduodenal resection in the period from 1975 to 1992 were studied. The patients were divided into two groups. The main cause of postoperative mortality in the first group was the development of pancreonecrosis and incompetence of the pancreatico-enteral anastomosis. Hypothermia of the pancreatic duct and introduction of 5-fluorouracil into the pancreatic duct reduced postoperative mortality among patients of the second group from 34.9% to 13.9%. It is shown that this method may be applied in wide surgical practice.
Adult↗
Choledochal cyst: a report of two cases.
Two cases of choledochal cyst in two female Saudi paediatric patients seen in the last five years are presented. Both presented with recurrent abdominal pain of long duration with no associated palpable abdominal mass or jaundice. They are of Type I, classification showing cystic dilation of the common bile duct. Findings on sonography and computed tomography (CT) included a cystic mass in the porta hepatis separate from the gallbladder, non-dilation of intra-hepatic bile ducts and the presence of stones in the cyst in the older child. Both patients underwent operation with intraoperative cholangiography which demonstrated anomalous junction of the pancreatic duct with the common bile duct--a factor implicated in the aetiology of the disease condition.
Child↗
[Experimental-clinical substantiation of the use of atraumatic suture material "metallatravm" in the surgery of bile ducts].
High efficacy of home sutural material "Metallatravm" application while biliary anastomoses creation was proved in experiment on 180 white rats. One-layer extramucosal interrupted suture application proved as a long-term one. In 35 patients with biliary ducts obstruction high efficacy of applied material was noted. Ligature cholelithiasis and stenosis recurrences were not observed.
Anastomosis, Surgical↗
[Surgical treatment of choledocholithiasis complicated by obstructive jaundice].
Cholecystectomy was conducted in 820 patients. In 115 (14,0%) of them it was combined with interventions performed on extrahepatic biliary ducts for choledocholithiasis and obstructive jaundice. Patients aged from 20 to 90 years. There were 30 men and 85 women. Choledocholithotomy with subsequent inspection of the common biliary duct (CBD) distal portion was considered as the operation of choice. Operation was concluded with external drainage of CBD, choledochoduodenal anastomosis formation and transduodenal papillosphincterotomy conduction. Of the patients operated on 6 (5,2%) have died.
Adult↗