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At least 19 recordsLinked to original sources
PubMed1998

Present role of classic open choledochostomy in the surgical treatment of patients with common bile duct stones.

Open choledochostomy still represents an important step of biliary surgery, even during the era of laparoscopic surgery. Although its application has decreased with the widespread use of endoscopic retrograde cholangiopancreatography (ERCP) and papillotomy, still there are some patients in whom it is necessary to perform open choledochostomy and place a T-tube. The morbidity and mortality rates depend mainly on the presence or absence of an acute suppurative cholangitis, rather than the performance of the choledochostomy. In patients with mild cholangitis or those no cholangitis and less than 60 years of age, the mortality rate is lower than that observed after ERCP. This procedure is still an important technique for surgeons dedicated to biliary surgery, and therefore several technical aspects of common bile duct exploration are important to remember.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2005

Long-term curative effects of combined hepatocholangioplasty with choledochostomy through an isolated jejunum passage on hepatolithiasis complicated by stricture.

BACKGROUND: Hepatocholangioplasty combined with choledochostomy was designed through an isolated jejunum passage in 1988. This study was undertaken to evaluate its long-term curative effects in 163 patients. METHODS: The 163 patients with hepatolithiasis complicated by stricture were treated with this procedure from 1988 to 2003. RESULTS: Among these patients, 19 patients with postoperative hepatolithiasis complicated by acute cholangitis were treated successfully with percutaneous paracentesis drainage through the isolated jejunum passage and without operation, 36 patients had postoperative residual or recurrent stones (35 patients had stones removed through the stoma and one underwent relaparotomy because of stenosis of the common bile duct along with stone in canceration). The clearance rate of stones after the isolated jejunum passage was 97%; 35 patients (21%) complicated with stricture due to hepatolith were treated with combined hepatocholangioplasty and choledochostomy. Follow-up for 1 to 15 years showed no recurrent stricture of the biliary tract. The operation also successfully prevented reflux cholangitis and other serious complications after Roux-en-Y cholangio-jejunostomy. CONCLUSION: Hepatocholangioplasty combined with choledochostomy through an isolated jejunum passage may significantly improve the long-term curative effects of hepatolithiasis with stricture.

Anastomosis, Surgical↗
PubMed1987

Serum and bile digoxin levels in patients subjected to cholecystectomy with or without choledochostomy.

Digoxin levels were measured perspectively in the serum of 12 patients subjected to cholecystectomy and in serum and bile (Kehr) of 15 patients who underwent cholecystectomy plus choledochostomy in order to assess adequate digitalization. All patients were volunteers with no cardiac problems. In the cholecystectomy group serum digoxin levels increased in all patients from the second to the fourth postoperative day (P = 0.0001), while in patients with choledochostomy both serum and bile digoxin levels displayed wide variations. This last finding was associated with signs reflecting inadequate digitalization, probably due to significant digoxin losses through the choledochostomy.

Aged↗
PubMed1978

Bacterial contamination of the biliary tree after choledochostomy.

Secondary exogenous contamination of bile after choledochostomy could be an important cause of long-term morbidity if infection persists after removal of the T tube. Surprisingly, documentation of the frequency of conversion of sterile to infected bile after choledochostomy has rarely been recorded. Patients undergoing exploration and T-tube drainage of the common bile duct between July 1966 and January 1975, in whom intraoperative and postoperative cultures of bile were available, were studied. Postoperative cultures were obtained from five to forty days after operation. Of ninety-five patients available for study, contamination developed postoperatively in previously sterile bile in 44 per cent. The common duct bile contained bacteria at operation in 42 per cent and remained sterile throughout in 14 per cent. The most common secondary contaminants were klebsiella group and Escherichia coli. The fate of the contaminating organisms in a biliary tree without anatomic abnormalities is unknown. Two cases are presented which suggest that persistent infection may linger in the biliary tree for many years and give rise to pigment calculi. Since bacterial cannot be eradicated so long as a foreign body remains in the common duct and because such bacteria may cause symptoms even in an anatomically normal biliary tree, we suggest that a closed system of biliary drainage be employed and that appropriate antibiotic therapy be instituted for seven to ten days after removal of the T tubes.

Aged↗
PubMed2003

Cholecysto-choledochostomy plus construction of subcutaneous cholecystic tunnel in treatment of choledocholith.

OBJECTIVE: To avoid the pitfalls of choledochotomy with T-tube drainage in the treatment of choledocholith. METHODS: A novel operation was designed as cholecysto-choledochostomy plus construction of subcutaneous cholecystic tunnel. After the common bile duct was cut open and stones were removed, the gallbladder was appropriately dissociated and the cholecystic ampulla was incised. Then, the incision of the cholecystic ampulla was anastomosed to the opened common bile duct, and the cholecystic fundus was fixed out of the abdominal muscular stratum. RESULTS: Twenty-one patients with choledocholith underwent this operation successfully and recovered well without postoperative complications. One of them was diagnosed as having recurrent stones in 2 years and 3 months after operation. Consequently, the subcutaneous cholecystic tunnel was opened under local anesthesia to remove successfully the stones with choledochoscope. CONCLUSION: This operation provides a convenient way to remove postoperative recurrent stones with choledochoscope and avoid receliotomy.

Adult↗
PubMed1996

[Cholelithiasis. Post-choledochostomy intraductal pressure (without and with sphinctero-infundibulostomy].

In 72 patients operated on for lithiasis of the main biliary duct (MBD), the intraductal pressure was measured through the choledochostomy T-tube. This measure was done, both in upright and lying positions, fasting and after lunch. Two groups were considered: A (of 52 cases) and B (of 20 cases). In both groups a choledochotomy was performed, and only in group B a long, although partial, sphincterotomy was also done. Three patients in group B had the upper part of the sphincter of Oddi (SO) dilated by big stones. 1) When groups A and B were compared, no significant differences of pressures in MBD was found. 2) Highly significant differences (p = 0.0001) were always found when paired data related to positions were compared: in the upright position pressures in MBD were higher than on the lying position. Group A, during fasting (9.90 +/- 4.1 cm H2O, in upon position, and 7.76 +/- 3.6 when lying) and group B, also at fasting (8.95 +/- 3.0 in the upright position and 6.57 +/- 3.0, when lying). The three patients included in group B with big stones impacted in the upper part of SO, showed low pressures in MBD, specially one (2 and 1 cm H2O, upright lying positions), but the group is too small have statistical significance. We conclude that the long but partial sphincterotomy does not modify significantly the pressures in MBD whether upright or lying, and when paired data related to positions were compared, upright pressures were always higher than on the lying position (p = 0.0001).

Choledochostomy↗
PubMed1984

Long term consequences of bacterial colonization of the biliary tract after choledochostomy.

We studied 48 patients--36 who underwent cholecystectomy and choledochotomy-choledochostomy for cholesterol gallstones and 12 patients as controls who underwent different types of extrabiliary operations. In our material, we observed that, in a high proportion of instances, infected bile during the early postoperative period remained contaminated for six months postoperatively--in an obviously unobstructed bile duct. In patients in whom Escherichia coli was isolated both early and late postoperatively, a statistical significancy was found. This phenomenon consists of a favorable condition for precipitation of calcium bilirubinate, triggering new pigment stone formation.

Bacteria↗
PubMed1978

Effect of cholecystoduodenostomy and choledochostomy in pancreatic carcinogenesis.

The pancreatic carcinogen N-nitrosobis(2-oxopropyl)-amine was administered to Syrian golden hamsters after cholecystoduodenostomy and choledochostomy to investigate a possible bile reflux mechanism as a factor in pancreatic carcinogenesis. The induced lesions were similar in morphology, multiplicity, and distribution to those of animals in other studies without surgery. Hence the findings contraindicate the importance of biliary reflux in pancreatic tumor induction. Other possible mechanisms are discussed.

Adenocarcinoma↗