To further improve the standard of diagnosis and treatment of acute biliary tract infections in China, the Branch of Biliary Surgery, Society of Surgery, Chinese Medical Association has revised the guidelines for the diagnosis and treatment of acute biliary tract infections (2011).The guidelines describe the risk factors of acute biliary tract infections, propose diagnostic methods and severity classification criteria, and define the treatment of acute biliary tract infections and the standardized application of antibiotics. The treatment of acute biliary tract infection should be combined with surgical care, antimicrobial therapy and systemic management, and should be completed under the guidance of experienced surgical specialist. Reasonable selection of diagnosis and treatment measures, accurate understanding of surgical procedures and standardized use of antibiotics can achieve maximum treatment result for acute biliary tract infection.
Anti-Bacterial Agents/therapeutic use* ; Biliary Tract ; Biliary Tract Surgical Procedures ; China ; Cholangitis/surgery* ; Humans

A two-year retrospective study (January 1995 to December 1996) of 328 patients who underwent outpatient postoperative choledochoscopy is reported, 299 patients (91.2%) had retained biliary stones and 90 patients (30.1%) had stones located at the common bile duct. One hundred fourteen patients (46.8%) had primary stones. One hundred fourteen patients (38.1%) with multiple stones found at several locations required an average of 2 postoperative choledochoscopic sessions for complete clearance of biliary tree. Our overall clearance rate was 87 per cent. Only 8 patients (2.54%) had morbidities consisting of hemobilia and pain. (Author)

Human ; Hemobilia ; Common Bile Duct ; Cholelithiasis ; Biliary Tract ; Biliary Tract Surgical Procedures ; Pain

With the accelerated aging society in China, the incidence of biliary surgical diseases in the elderly has increased significantly. The clinical characteristics of these patients indicate that improving treatment outcomes and realizing healthy aging are worthy of attention. How to effectively improve the treatment effect of geriatric biliary surgical diseases has attracted widespread attention. This paper reviews and comments on the hotspots and difficulties of biliary surgery in older patients from six aspects: (1) higher morbidity associated with an aging society, (2) prevention and control of pre-operative risks, (3) extending the indications of laparoscopic surgery, (4) urgent standardization of minimally invasive surgery, (5) precise technological progress in hepatobiliary surgery, and (6) guarantee of peri-operative safety. It is of great significance to fully understand the focus of controversy, actively make use of its favorable factors, and effectively avoid its unfavorable factors, for further improving the therapeutic effects of geriatric biliary surgical diseases, and thus benefits the vast older patients with biliary surgical diseases. Accordingly, a historical record with the highest age of 93 years for laparoscopic transcystic common bile duct exploration has been created by us recently.
Humans ; Aged ; Aged, 80 and over ; Biliary Tract Surgical Procedures ; Gallstones ; Laparoscopy ; Treatment Outcome ; Aging ; Retrospective Studies

Biliary Tract Surgical Procedures ; China ; Colorectal Surgery ; Herniorrhaphy ; Humans ; Laparoscopy ; Liver ; surgery ; Pancreas ; surgery ; Stomach ; surgery ; Thyroid Gland ; surgery

No abstract available.
Biliary Tract Surgical Procedures ; Catheterization ; Duodenoscopy ; Constriction, Pathologic ; Dilatation ; Common Bile Duct ; Bile Ducts ; Duodenum ; Liver ; Cholangiography ; Mucous Membrane

OBJECTIVE: To explore the feasibility and efficacy of laparoscopic transcystic drainage and common bile duct exploration in the treatment of patients with difficult biliary stones. METHODS: Between April 2020 and December 2021, eighteen patients with difficult biliary stones received laparoscopic transcystic drainage (C-tube technique) and common bile duct exploration. The clinical characteristics and outcomes were retrospectively collected. The safety and effectiveness of laparoscopic transcystic drainage and common bile duct exploration were analyzed. RESULTS: Among the eighteen patients with difficult biliary stones, thirteen patients received traditional laparoscopic transcystic drainage, and the remaining five received modified laparoscopic transcystic drainage. The mean surgical duration were (161±59) min (82-279 min), no bile duct stenosis or residual stone was observed in the patients receiving postoperative cholangiography via C-tube. The maximum volume of C-tube drainage was (500±163) mL/d (180-820 mL/d). Excluding three patients with early dislodgement of C-tube, among the fifteen patients with C-tube maintained, the median time of C-tube removal was 8 d (5-12 d). The duration of hospital stay was (12±3) d (7-21 d) for the 18 patients. Five C-tube related adverse events were observed, all of which occurred in the patients with traditional laparoscopic transcystic drainage, including two abnormal position of the C-tube, and three early dislocation of the C-tube. All the 5 adverse events caused no complications. Only one grade one complication occurred, which was in a patient with modified laparoscopic transcystic drainage. The patient demonstrated transient fever after C-tube removal, but there was no bile in the drainage tube and the subsequent CT examination confirmed no bile leakage. The fever spontaneously relieved with conservative observation, and the patient recovered uneventfully with discharge the next day. All the 18 patients were followed up for 1-20 months (median: 9 months). Normal liver function and no recurrence of stone were detected with ultrasonography or magnetic resonance cholangiopancreatography (MRCP). CONCLUSION Laparoscopic transcystic drainage combined with common bile duct exploration is safe and feasible in the treatment of patients with difficult biliary stones. The short-term effect is good. Modified laparoscopic transcystic drainage approach may reduce the incidence of C-tube dislocation and bile leak.
Humans ; Retrospective Studies ; Biliary Tract Surgical Procedures/adverse effects* ; Gallstones/etiology* ; Drainage/methods* ; Laparoscopy/adverse effects* ; Common Bile Duct/surgery*

OBJECTIVETo summarize the experience of laparoscopic common bile duct exploration.

METHODSThe clinical data of 587 cases who underwent laparoscopic common bile duct exploration from June 1992 to May 2006 were analyzed.

RESULTSThe surgery was successful in 585 cases (99.7%), 2 cases were converted to open common bile duct exploration. The duration of operation was 60 approximately 230 min (averaged 85 min), the complications consisted of biliary fistula (n=13), injury of the duodenum (n=1), abscess of drainage tube orifice (n=1), titanium clip discharging out from T tube (n=3), residual common bile duct stones (n=35). The patients could take food and walk on the second postoperative day and average postoperative hospital stay was 4.6 days.

CONCLUSIONSLaparoscopic common bile duct exploration is a safe and effective procedure in treating the calculus of bile duct.

Adult ; Aged ; Aged, 80 and over ; Biliary Tract Diseases ; surgery ; Biliary Tract Surgical Procedures ; methods ; Common Bile Duct ; surgery ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Treatment Outcome

Bile Duct Neoplasms ; surgery ; Bile Ducts ; pathology ; surgery ; Bile Ducts, Intrahepatic ; pathology ; surgery ; Biliary Tract Diseases ; surgery ; Biliary Tract Surgical Procedures ; methods ; trends ; Cholecystectomy, Laparoscopic ; methods ; trends ; Cholelithiasis ; surgery ; Humans

Hepatobiliary complications, such as stone recurrence, recurrent cholangitis, liver abscess, secondary biliary cirrhosis, and cholangiocarcinoma may occur after treatment for hepatolithiasis. However, few previous studies have addressed the risk factors and long-term outcomes after initial treatment. Eighty-five patients with newly diagnosed hepatolithiasis, actively treated for hepatolithiasis, constituted the cohort of this retrospective study. Patients were treated by hepatectomy or nonoperative percutaneous transhepatic cholangioscopic lithotomy. Long-term complications, such as recurrent cholangitis, liver abscess, secondary biliary cirrhosis, and cholangiocarcinoma, and their relationships with clinical parameters were analyzed. The mean follow-up period was 57.4 months. The overall hepatobiliary complication rate after the treatment was 17.6%. Multivariate analysis of suspected risk factors showed that complications were associated with age (HR, 1.046; CI, 1.006-1.089), bile duct stricture (HR, 4.894; CI, 1.295-18.495), and residual stones (HR, 3.482; CI, 1.214-9.981). In conclusion, several long-term hepatobiliary complications occur after hepatolithiasis treatment, and regular observation is necessary in patients with concomitant biliary stricture or residual stones.
Adult ; Aged ; Aged, 80 and over ; Bile Ducts, Intrahepatic/*surgery ; Biliary Tract ; *Biliary Tract Surgical Procedures ; Cholestasis, Intrahepatic/*surgery ; *Endoscopy ; Female ; Gallstones/*surgery ; Hepatectomy ; Humans ; Liver/surgery ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Treatment Outcome

OBJECTIVETo prevent and manage biliary complications after orthotopic liver transplantation (OLT).

METHODSNinety-five patients of OLT performed at our institute from February, 1999 to December 2002 were retrospectively analysed. Recipient operation was performed using standard method combined with veno-venous bypass in 12 patients and piggyback method in 78 patients and living-related liver transplantation in 5 patients. Biliary reconstruction was performed by end-to-end choledochocholedochostomy (C-C) over a T-tube in 55 patients and without a T-tube in 36 patients while the remaining 4 patients underwent Roux-en-Y choledochojejunostomy (CRY). C-C and CRY were performed by the interrupted or continuous suture with 5 - 0 or 6 - 0 Vicryl or PDS. Routine examination of liver function, Doppler ultrasonography and cholangiography were performed during the follow-up period.

RESULTSBiliary complications occurred in 7 patients (7.3%). Two patients with bile leakage at the anastomotic site developed biliary peritonitis on the seventh and tenth postoperative day and needed reoperation. One patient developed anastomotic biliary stricture one month after the operation and was cured by endoscopic stenting. Two patients developed bile leakage after T-tube removal. One of the two patients was treated conservatively and the other underwent a exploratory laparotomy to ligate the T-tube tract and drain the peritoneal cavity. One patient died of biliary vast syndrome five months after OLT and one patient died of biliary tract necrosis secondary to hepatic artery thrombosis on the tenth postoperative day. One - 42-month (mean 11.4 months) follow-up revealed no biliary stricture in 74 patients. No biliary stone and biliary sludge were detected by Doppler ultrasound and/or cholangiography. Serological examinations proved that liver grafts functioned well in these patients.

CONCLUSIONSTo prevent biliary complications, it is crucial to protect biliary mucosa and arterial blood supply of the common bile duct while harvesting the graft and to obtain perfect mucosa-to-mucosa apposition of no-tension end-to-end anastomosis of the bile duct. Endoscopic dilation and stenting are effective for post-OLT extrahepatic biliary stricture.

Adult ; Aged ; Biliary Tract Diseases ; etiology ; prevention & control ; therapy ; Biliary Tract Surgical Procedures ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Liver Transplantation ; adverse effects ; methods ; Male ; Middle Aged ; Postoperative Complications ; etiology ; prevention & control ; therapy ; Retrospective Studies ; Young Adult