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At least 865 records · Page 48Linked to original sources
PubMed1994

A comparison of operation, endoscopic retrograde cholangiopancreatography, and percutaneous transhepatic cholangiography in biliary complications after hepatic transplantation.

BACKGROUND: Biliary complications (BC) remain a significant cause of morbidity and mortality after orthotopic liver transplantation (OLT). STUDY DESIGN: In an effort to determine the incidence of BC after OLT and the success of management options, 157 hepatic transplants performed from January 1987 to July 1991 were reviewed. RESULTS: The incidence of BC was 25 percent, with a one year mortality rate of 43.5 percent compared with 23.4 percent for patients in a control group (p < 0.05). Most BC occurring before postoperative day 30 presented as leaks, with a one year mortality rate of 50 percent (p < 0.03 versus control group). Biliary complications presenting after postoperative day 30 presented as strictures, with a one year mortality rate of 36.8 percent (p = NS versus control group). Endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTHC), and operative treatment were analyzed to determine relative patency rates after intervention for BC. The analysis showed that ERCP and PTHC were equivalent, with a one year patency rate of 45 percent. Operative treatment had a patency rate of 89 percent (p < 0.05 compared to ERCP and PTHC). CONCLUSIONS: The results from ERCP and PTHC may be useful for delineation of rejection versus BC after OLT. However, operative treatment is significantly more effective for definitive treatment of BC after OLT.

Adult↗
PubMed1994

Quantification of duodenogastric reflux in patients with choledochoduodenostomy.

BACKGROUND: Frequently, patients present with symptoms after cholecystectomy (pain or discomfort in the upper part of the abdomen, postprandial fullness, bile vomiting, among others). Duodenogastric reflux has been associated with these symptoms in some patients. Therefore, this study was done to investigate this relationship. STUDY DESIGN: We evaluated duodenogastric reflux (DGR) in ten healthy patients, in ten patients who had asymptomatic simple cholecystectomy, in ten patients who had asymptomatic cholecystectomy with supraduodenal choledochoduodenostomy (CD), and in ten patients who had cholecystectomy plus CD followed by discomfort in the upper abdomen, postprandial fullness and bile vomiting, but no colicky pain or acute cholangitis. Duodenogastric reflux was quantified using continuous intravenous infusion of technetium-99m labeled hepatoiminodiacetic acid (99mTc-HIDA) and subsequently determining its concentration in gastric juice. RESULTS: All of the patients who underwent operation, whatever the technique used, had higher reflux rates than those in the control group (p < 0.001). Moreover, reflux rates were comparable in the patients who underwent simple cholecystectomy compared with patients in the asymptomatic cholecystectomy plus CD group. Conversely, when patients with cholecystectomy plus CD presented with discomfort in the upper part of the abdomen as well as bile vomiting, they had higher reflux rates than patients who underwent simple cholecystectomy (p < 0.001) and asymptomatic patients with associated CD (p < 0.001). CONCLUSIONS: Our results suggest that DGR must be involved in the genesis of these dyspeptic symptoms.

Abdominal Pain↗
PubMed1993

Choledochal cyst: personal experience in the management of choledochal cyst.

Choledochal cysts are uncommon in Zambia, but are frequently misdiagnosed and consequently mistreated. It is recommended that anastomotic drainage of the cyst into the duodenum or jejunum should be done as a first stage procedure on severely sick patients seen in rural hospitals, prior to their transfer to major hospitals where definitive procedure such as end to end anastomosis of the common bile duct or Roux-en Y choledochojejunostomy can be performed. Our experience of five cases seen over seven years is reported.

Adolescent↗
PubMed1994

The nature of complications following liver biopsy in transplant patients with Roux-en-Y choledochojejunostomy.

Liver biopsy is an important diagnostic tool in the management of patients following orthotopic liver transplant. We evaluated complications following percutaneous liver biopsy in a group of liver transplant patients who had Roux-en-Y choledochojejunostomies fashioned as part of their biliary reconstruction during liver transplantation. Complications were divided into two major groups: septic complications (including fever, symptomatic bacteremia, cholangitis, infected hematoma and hypotension related to sepsis) and bleeding (defined as hypotension requiring volume expansion greater than 500 cm3 or blood transfusion, hemothorax, intrahepatic or peritoneal hemorrhage and hemobilia occurring within 1 wk of liver biopsy). One hundred ninety-two biopsies were performed in 46 patients with choledochojejunostomies, and 118 biopsies were carried out in an age- and sex-matched control group of patients with choledochocholedochostomy biliary anastomosis. There were no septic complications in the choledochojejunostomy patients and one (0.32%) septic complication in the choledochocholedochostomy patients (NS). Eight bleeding complications occurred (2.6%) in eight patients (8.3%). Five (2.6%) occurred in five (10.8%) of the choledochojejunostomy patients, vs. three (2.5%) in three (6.5%) choledochocholedochostomy patients (NS). None of the bleeding complications required surgical intervention or was fatal. We conclude that liver biopsy in posttransplant patients with Roux-en-Y choledochojejunostomies is a safe procedure and that the incidences of complications were similar in our two groups. The negligible incidence of septic complications in the choledochojejunostomy patients does not appear to warrant the administration of prophylactic antibiotics, as has been previously suggested.

Adult↗
PubMed1994

Combined percutaneous balloon dilation and extracorporeal shock wave lithotripsy for treatment of biliary stricture and common bile duct stones.

We report a case of cholangitis, liver abscess, and common bile duct stones in a patient with a benign stricture at a choledochojejunal anastomosis, 3 yr after a complicated duodenohemipancreatectomy. Because surgical reintervention seemed inappropriate, a percutaneous transhepatic balloon dilation was performed after temporary internal-external biliary drainage. Extracorporeal shockwave lithotripsy (ESWL) was successfully applied to fragment all common bile duct stones, with subsequent spontaneous evacuation of all stone fragments through the dilated bilioenteric anastomosis. Only one similar case report has been published before (1), though with a different sequence of therapeutic modalities. Moreover, according to our literature review, this is the first report of ESWL of common bile duct stones by means of the Dornier Compact Lithotriptor (Dornier, Germany) with electromagnetic shockwave source.

Anastomosis, Roux-en-Y↗
PubMed1993

[Endoscopic biliodigestive anastomosis with the use of magnets (experimental and clinical study)].

A new type of endoscopic operations--cholecystodigestive and choledocho-hepaticoduodenoanastomoses with the use of magnetic elements are suggested as an alternative to the traditional palliative methods of treatment of obstructive jaundice with the level of obstruction below the opening of the cystic duct. Two variants of establishing postponed compression cholecystogastroanastomoses were developed in experiments on a model of obstructive jaundice in 50 unbred dogs, a variant of cholecystoentero- and enteroenteroanastomoses with the use of endoscopic techniques, which may be conducted in clinical practice. To restore internal bile drainage the following operations were carried out on 16 patients: colecystogastroanastomosis (4), cholecystoduodenonastomosis (1), choledochoduodenoanastomosis (10), hapaticoduodenoanastomosis (1). These operations were performed in patients with irresectable obstructions of the terminal part of the choledochus and a high operative risk.

Aged↗
PubMed1993

Laparoscopic suture technique after common bile duct exploration.

Performing both laparoscopic cholecystectomy and choledocholithotomy during the same operative procedure for both suspected and unsuspected stones is an attractive alternative to preoperative endoscopic retrograde cholangiopancreatography and stone removal or to conversion of the laparoscopic procedure to open common duct exploration. During laparoscopic exploration, intracorporeal suture and knot-tying may be tedious. We thus developed a technique of suture of the choledochus that avoids the use of knots and avoids placing metal clips in contact with the common bile duct. This technique was accurate, fast, and easily controlled in eight of 21 patients, and no major complications or mortality occurred.

Cholecystectomy, Laparoscopic↗
PubMed1993

Cholecysto-choledochal fistula--Mirizzi syndrome (type II) in a Nigerian.

Mirizzi syndrome is an uncommon cause of obstructive jaundice in which the common hepatic duct is obstructed by stones trapped within the neck of the cystic duct of the gall-bladder. In long standing cases the calculi may erode through into the common duct and may in fact, impact in the resulting fistula. This syndrome with its later progression is a rare complication of calculous disease of the gall-bladder worldwide. While it is perhaps encountered in the developing countries where cholelithiasis is not as prevalent as in the affluent countries, there has not been much documentation. This article reports on a Nigerian patient with a fistulous complication of Mirizzi syndrome (Type II) managed by cholecystectomy and choledochoduodenostomy and also presents a discussion of the condition.

Biliary Fistula↗
PubMed1993

Bilio-enteric anastomoses: results in benign and malignant conditions.

Twenty bilio-enteric anastomoses were performed or managed from May 1990 to December 1992. Recurrent pyogenic cholangitis (RPC) and pancreatic cancer were the commonest conditions which required drainage procedures. Roux-en-Y hepatico-jejunostomy (RHJ) was performed in 9 patients, 4 for RPC, one for pancreatic cancer, another for a cholangiocarcinoma, 2 following excision of choledochal cyst and one hepatico-jejunostomy was part of a Whipple reconstruction. Roux-en-Y side to side choledocho-jejunostomy (CDJ) was performed in one patient. Choledocho-duodenostomy (CDD) was performed in 6, 4 for obstructive jaundice due to choledocholithiasis, one for RPC and one in a choledochal cyst. One patient operated elsewhere presented with complications after a CDD. Palliative cholecysto-jejunostomy (CYJ) was carried out in 4 patients with pancreatic malignancy. All benign conditions were treated by hepatico-jejunostomy and choledocho-duodenostomy, while three patients with malignant conditions were treated by hepatico-jejunostomy. Permanent subcutaneous access loops were provided when recurrent problems were anticipated, 4 in RPC and one after subtotal resection of a cholangiocarcinoma. Based on this study, we found Roux-en-Y hepatico-jejunostomy a versatile drainage procedure, which was useful in both benign and malignant diseases.

Adolescent↗
PubMed1994

[Long-term results of organ-preserving operation in chronic calculous cholecystitis].

Since 1976 forty-six patients with chronic calculous cholecystitis were subjected to an organ-preserving operation-cholecystocholedochostomy (Pribram's operation modified by G. L. Ratner). The late results were studied in 44 cases, they were found to be good in 30, satisfactory in 6, and poor in 8 patients. In analyzing the causes of recurrent calculogenesis in 8 patients it was concluded that the recurrence was promoted by small stones in and inflammation of the gallbladder, concomitant pancreatitis, and a distended choledochus. The operation for cholecystocholedochostomy in chronic calculous cholecystitis is indicated in mildly changed functioning gallbladder containing occasional large stones and in nondistended common bile duct.

Adult↗
PubMed1993

[A rational procedure for the treatment of patients with chronic calculous cholecystitis complicated by choledocholithiasis].

The results of surgical treatment of 156 patients with chronic calculous cholecystitis complicated by choledocholithiasis have been analysed. In 62 patients, cholecystectomy in combination with choledocholithotomy was performed. Ninety four patients underwent additional drainage operations on the terminal common bile duct. Endoscopic papillosphincterotomy was performed in 90% of cases, other drainage interventions (choledochoduodenostomy and transduodenal papillosphincterotomy)--in 10%.

Cholecystectomy↗