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PubMed1995

[The combination of chronic calculous cholecystitis and diabetes mellitus].

A total of 206 patients with chronic calculous cholecystitis (CCC) are subjected to operation in the surgical clinic of the Military Hospital--Plovdiv over the period 1991-1994 = Diabetes mellitus as a concomitant disease is discovered in 21 cases (10.20 per cent). All of them have pain syndrome complaints, and during cholecystectomy concrements in the gallbladder are found. As shown by the results, the combination CCC and DM leads to aggravation of the disease. Destructive changes in the gallbladder in this combination are detected in 28.5 per cent, whereas in patients free of DM they amount to 10.5 per cent. Presumably, removal of the gallbladder contributes to eliminate the persisting stress factor in terms of the insular apparatus of the pancreas. Assessment of the long-term results shows that the positive therapeutic effect of the operation is permanent.

Adult↗
PubMed1995

[Phlegmon-exacerbated chronic calculous cholecystitis and its surgical treatment].

A series of 165 patients presenting chronic calculous cholecystitis (CCC), operated in the surgical clinic of the Military Hospital--Plovdiv over the period 1991 through 1994, are analyzed. In twenty patients (10 men and 10 women) the disease a clinical course characterized by phlegmonous-purulent cholecystitis. All patients are subjected to operative management, and in all the clinical diagnosis is confirmed intraoperatively. Empyema of the gallbladder with concrements and purulent secretion is discovered in nine cases, and fragility of the gallbladder wall-in four. The histomorphological study reveals phlegmonously exacerbated CCC in 12 patients, walls totally replaced by granulation tissue--in three, and necrotic mucosa--in five. The early results of operative treatment are estimated as good. The long-term results are likewise very good. The positive effect of treatment is lasting, and persists for many years.

Adult↗
PubMedDate not supplied

[Choledochal calculosis due to a suture thread].

The authors recently observed a patient suffering from recurrent choledochal, postcholecystectomy calculosis caused by suture thread. Given the relative rarity of this pathology, the difficulty of preoperative diagnosis and the possible confusion with other anatomoclinical syndromes, they take this opportunity to make a number of diagnostic and therapeutic comments in the light of the latest literature on this subject.

Cholecystectomy↗
PubMed1996

[Laparoscopic therapy of choledocholithiasis].

The introduction of laparoscopic cholecystectomy has led to controversial discussions about the proceeding in case of coincident common bile duct stones. In our unit choledocholithiasis has been treated laparoscopically since November 1991. Basic requirement has been a routine intraoperative cholangiography. 67 patients with common bile duct stones were treated until January 1995. All patients underwent a follow up and the results were compared to other concepts. In 40 cases common bile duct stones were eliminated via cystic duct and in 27 cases by choledochotomy. The choledochus was drained routinely for postoperative x-ray control. In 9 cases we found residual concrements: 7 patients required postoperative endoscopic papillotomy and in 2 cases the calculi where eliminated with a dormia basket introduced via drainage tube. In one case surgical management was changed to laparotomy. Postoperative complications occurred in 8 cases. One patient suffering from bacterial peritonitis underwent laparotomy on the 9th postoperative day; one with bleeding from the cystic artery was treated by relaparoscopy. One patient developed a liver abscess and two patients a bilioma requiring ultrasound guided drainage. A superficial wound infection in one patient and a biliary leakage after removal of the drainage in two patients healed spontaneously. Due to an intact papilla with less stress to the patient, as well as a complication rate comparable with other published therapeutic concepts, this strategy can be recommended as a valuable alternative procedure.

Cholangiography↗
PubMedDate not supplied

[Primary choledocholithiasis after side-to-side choledochojejunostomy].

Primary choledocholithiasis represents a quite unusual sequela of biliary tract surgery. Primary stones originate in the common bile duct and are soft, smooth, with a yellowish or brown-reddish colour, reproducing the shape of the duct in which arise. The Authors report a review of the cases observed in the division of General and Vascular Surgery-Department of Surgery and Surgical Emergencies of the University of Perugia. From January 1988 to December 1993, 577 laparotomic biliary tract operations were performed, and in 8 cases a re-operation was needed. Among the latter, particularly interesting were 2 cases of primary choledocholithiasis occurred in two patients with bilio-digestive anastomosis previously performed, i.e. two side-to-side Roux-en-Y or Braun loop choledochojejunostomies, respectively. Therefore, primary lithiasis following a choledochojejunostomy occurred when the bilio-digestive anastomoses were performed with the indication of a curative re-operation on the biliary tract. On the contrary, most choledochojejunostomies are performed as a palliative procedure in patients presenting a low survival rate not allowing to develop a Sump Syndrome and a consequent choledocholithiasis, which are long-term complications.

Biliary Tract Surgical Procedures↗
PubMedDate not supplied

Third segment cholangio-jejunostomy in the treatment of unresectable klatskin tumors.

BACKGROUND/AIMS: Cholangiocarcinoma of the hepatic hilum is a seldom curable lesion when detected and several methods of palliation have been suggested. Bismuth has proposed an intrahepatic cholangiojejunostomy on the third segment of the liver, which in his experience obtains effective biliary drainage with better quality of life compared with other forms of palliation. PATIENTS AND MATERIALS: We have used this technique in nine cases. We evaluate results, mortality and morbidity, in comparison with other authors' reported series. RESULTS: In the early postoperative period one patient died, two patients suffered from immediate postoperative complications, and jaundice resolved completely in six patients. Long term survival was influenced by the underlying disease. CONCLUSION: Our findings support Bismuth preference for this technique of surgical palliation for non resectable tumors of the biliary tract.

Aged↗
PubMed1996

[Method of laparoscopy in ventral hernia].

A new method of laparoscopy have been designed: a laparoscope is introduced through a ventral hernia. The method can be used in patients with contraindications for a regular laparoscopy. Umbilical hernia with the hernia orifice less than 3 cm is a contraindication for "herniolaparoscopy". The method was used in 32 patients, including 17 patients with the acute cholecystitis. In 12 patients besides of umbilical hernia there were other contraindications, including postoperative scarring, obesity etc. There were no any complications with the use of the new method. In all cases pneumoperitoneum was preserved till the end of a procedure.

Acute Disease↗
PubMed1996

[Liver abscess caused by Lactobacillus acidophilus].

Lactobacillus acidophilus is usually considered to be non pathogenic. We report a case of liver abscess due to Lactobacillus acidophilus in a 39 year-old man with chronic pancreatitis complicated by both endocrine and exocrine insufficiency, and with a choledoco-duodenostomy. Lactobacillus acidophilus was isolated in blood and liver samples. Complete recovery of the liver abscess occurred after antibiotherapy. We suggest that the abnormally low duodenal pH secondary to pancreatic insufficiency may have promoted both Lactobacillus acidophilus adhesion and multiplication in this patient. The choledoco-duodenostomy may then have promoted biliary tract colonisation.

Adult↗
PubMedDate not supplied

Non-invasive evaluation of the biliary tree with magnetic resonance cholangiopancreatography: initial clinical experience.

Magnetic resonance cholangiopancreatography is a new, non-invasive imaging technique for visualization of the biliary ducts. Magnetic resonance cholangiopancreatography was performed on 136 patients (20-87 years old) with a superconductive magnet at 0.5T (Philips Gyroscan T5). Volumetric images on coronal planes were acquired; a T2 weighted turbo spin echo sequence (TR = 3000; TE = 700; number of excitations = 8; echo train length = 128; Acquisition time = 5'48") with respiratory compensation was performed. Images were reconstructed on coronal planes rotated at different angles using the MIP algorithm. When neoplastic disease was detected additional images on axial planes (SE Tlw: TR/TE 300/10 and turbo spin echo T2w: TR/TE 3000/120) were acquired. Magnetic resonance cholangiopancreatography allowed images of diagnostic value to be obtained in all cases. In choledocholithiasis, the technique had a sensitivity of 91.6%, specificity of 100% and overall diagnostic accuracy of 96.8%. Of the 48 patients with stenotic lesions, 16 cases were correctly characterized as benign and 30 as malignant. Two cases of focal chronic pancreatitis were misdiagnosed as pancreatic head carcinoma. In patients submitted to bilioenteric anastomosis, the technique was able to detect dilation of intrahepatic ducts, stenosis and associated stones in the 8 positive cases. In all 11 patients with chronic pancreatitis, dilated Wirsung duct and the stenotic tracts were revealed. In conclusion, magnetic resonance cholangiopancreatography can be considered as a technique able to completely replace diagnostic endoscopic retrograde cholangiopancreatography. However, further studies are necessary for a better evaluation of potential advantage and disadvantages.

Bile Duct Neoplasms↗
PubMed1996

Subcostal gridiron incision for biliary surgery.

This retrospective study audited all the extrahepatic biliary operations performed through a subcostal muscle splitting incision between January, 1979 and June, 1995. Of the 400 patients subjected to biliary surgery 340 (85%) were females and 60 (15%) males. One hundred and eighty (45%) patients presented with symptoms of acute and 220 (55%) with chronic cholecystitis. Most (95%) of the operations were performed electively. Simple cholecystectomy was performed in 320 (80%) patients and 72 (18%) had common bile duct exploration for stones. Of these 67 had choledochoduodenostomy and 5 a polythene tube drainage of common bile duct. The overall morbidity of the procedure was 13.5% of which 3.5% were procedure related complications and 10.0% general complications. Only two deaths occured during the study giving a mortality of 0.5%. This technique has greatly reduced the hospital stay, the amount of blood loss during operation and post operative pain. No patient had incisional hernia or wound dehiscence and all the patients were back to work early. The results of this study suggest that this incision may be used with advantage elsewhere.

Aged↗