Objective To explore the causes for the bile duct injury in gallbladder bed and investigate its diagnosis and management. Methods The data of 37 cases of bile duct injury in the gallbladder bed after cholecystectomy between January 1988 and March 1998 were retrospectively analyzed. Results According to the operative records, 17 among the 37 cases had leakage from Luschka bile duct, 4 from the cholecystohepatic duct and 3 from the right lobular hepatic duct and its branches. The sources of the leakage were not identified in other 17 cases. The injured sites were sutured and drained or drained alone in 30 cases. The other 4 cases without drainage were percutaneously under the ultrasonographic guidance because of an intra abdominal bile collection. The remaining 3 cases were surgically treated again for aggravation of the illness in them. Conclusions During performance of cholecystectomy, surgeons should pay close attention to the bile duct in the gallbladder bed for its vulnerable position. Careful inspection of the gallbladder bed should be a routine procedure after the operation. Once the bile leakage was recognized in the gallbladder bed, intraoperative drainage must be performed.

Objective To summarize the complication of clinical characteristics, factors causing misdiagnosis, and diagnosis of large intestine tuberculosis (LIT). Methods The data of twenty cases of LIT misdiagnosed preoperatively in our hospital were analyzed retrospectively. The difficulties of LIT diagnosis and management were studied and analyzed. Results Abdominal pain, mass, and the alteration of stool habit were the most common symptoms. LIT was most commonly confused with malignant tumor, Crohn's disease, and periappendicular abscess. Ten of 17 patients, who were performed exploratory laparotomy, were misdiagnosed as tumor or Crohn's disease. Most of our cases were not definitively diagnosed until the histopathologic examination after surgery. Three cases were diagnosed by other methods. Gastrointestinal X ray series, colonoscopy, endoscopic fine needle aspiration cytology(FNAC) and laparoscopic exploration may improve the diagnosis. Exploratory laparotomy with biopsy was the final procedure for diagnosis. Final diagnosis mainly depends on histology. Conclusions LIT lacks special clinical manifestations and has a high misdiagnosis rate. But if correct diagnosis is established, most patients can be cured and unnecessary exploratory laparotomy can be avoided. Six months antituberculosis treatment is effective for LIT whether the lesion is excised or not.

Objective To sum up the experience in the diagnosis and treatment of pancreatic duct stone developed as a result of long-term chronic pancreatitis. Methods The clinical data of 11 patients with pancreatolithiasis treated in our hospital from 1996 to 2002 were retrospectively analyzed. Results The main clinical manifestations included abdominal pain, back pain as well as exocrine and endocrine functional disturbance. The disease can be diagnosed by B-mode ultrasonography, CT and ERCP. Nine of 11 cases were treated by pancreaticojejunostomy, 1 case suffering from concurrent carcinoma of the head of the pancreas received pancreaticodudenectomy and 1 case underwent distal pancreatetomy. Ten patients who were followed up were free of pain . Conclusions B-mode ultrasonography is the best choice for the diagnosis of panceatolithiasis, and pancreaticojejunostomy should always be attempted for cases with duct dilatation .

Objective To evaluate surgical management of pancreatic duct stones.Methods From 1997 to 2007, 24 cases of pancreatic duct stones underwent surgical treatment, the clinical data were retrospectively analyzed. Results In this study, 17 cases underwent lithotomy by longitudinal pancreatic duct incision, Roux-en-Y anastomosis(side-to-side) of pancreatic duct to jejunum, extra drainageof the main pancreatic duct was done in two cases, hepaticojejunostomy in three cases, pancreaticcystojejunostomy in one case. One case suffered from postoperative bleeding at pancreatic ojejunostomy, one from stress ulcer, and both were cured by conservative treatment. Three cases underwent pancreaticeduodenectomy, anastomosis bleeding occurred in one patient, and was cured by conservative method. One case underwent duodenum-preserving resection of the head of the pancreas, 2 cases underwent distal pancreatectomy, one case underwent lithotomy by pancreatic duct incision and primary closure, no postoperative complications occurred among those patients. 21 cases were followed up, results were excellentin 17 patients. Conclusions Lithotomy by longitudinal pancreatic duct incision, Roux-en-Y anastomosisof pancreatic duct to jejunum is the main and effective surgical procedure, while duodenum preserving pancreatic head resection and lithotomy by pancreatic duct incision and primary closure are also rational for the treatment of pancreatic duct stones.

ObjectiveTo investigate the feasibility and efficacy of using the hepatoduodenal ligament tension-reduced operation (tension-reduced operation in short) for iatrogenic bile duct injury where the bile duct was severely defective. MethodsBetween March 2006 and May 2009, the authors treated 6 patients with iatrogenic bile duct injury (Bismuth type Ⅱ : 5 patients and type Ⅲ : 1 patient). A no. 7 black silk thread was used to hold the hilar plate tissues and the seromuscular layer of the bulbous part of the duodenum closer together and knots were tied. This method brought the porta hepatis and the duodenal bulb closer together and the hepatoduodenal ligament was shortened. An end to end anastomosis could then be made between the two broken ends of the defective bile duct without tension. ResultsSix patients suffered from bile duct injury and they recovered fully after the tensionreduced operation. There was no complication on follow-up. ConclusionsThe tension-reduced operation was efficacious in the treatment of iatrogenic bile duct injury. This technique should be popularized and more widely used.

OBJECTIVETo investigate the rationality and feasibility of primary closure of the common bile duct after choledochotomy for common bile duct calculi.

METHODSFrom January 1990 to June 2001, 386 patients with the evidence of stones in the common bile duct underwent choledochotomy. Among them, 215 received primary closure of the common bile duct (group A) and 171 T-tube drainage (group B). The patients with emergency operations were excluded. Intraoperative choledochoscopy or cholangiography was routinely performed to rule out the possibility of retained stones. The duct was meticulously stitched using 0/3 to 0/5 absorbent sutures for primary closure. A T-tube was placed in the subhepatic space in the patients of both groups.

RESULTSPostoperative bile leakage was seen in 9 patients of group A and in 5 of group B, respectively (P > 0.05), and no reoperations were necessary. After surgery, the average time and volume of transfusion was 4.9 days and 9.1 liters in group A, versus 7.3 days and 12.8 liters in group B (P < 0.01). The patients in group B had a longer postoperative hospital stay than the those in group A (average 17.6:10.0 days, P < 0.01). T-tube removal resulted in bile peritonitis in 5 patients at day 16, 17, 19, 21 and 22 after surgery in group B, and 3 patients required repeated surgery.

CONCLUSIONSPrimary closure of the common bile duct after choledochotomy is safe, effective, and inexpensive in selected patients with common bile duct calculi, and should be regarded as an alternative procedure.

Adult ; Aged ; Biliary Tract Surgical Procedures ; methods ; Choledocholithiasis ; surgery ; Common Bile Duct ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Pancreatic duct stone is a sequel of chronic pancreatitis and may be found in the main ducts,side branches or parenchyma.These stones obstruct the pancreatic ducts and produce ductal hypertension,which leads to pain,the cardinal feature of CP.Surgical operation has been the preferred treatment of pancreatic duct stones in many domestic and external pancreatic medical centers.Lithotomy by longitudinal pancreatic duct incision and Roux-en-Y anastomosis of pancreatic duct to jejunum is the main and effective surgical procedure,while micro-surgery was also rational for the treatment of pancreatic duct stones.However,further studies with a larger sample size and longer follow-up duration are needed to improve the surgical technique and verify our initial results.