There have been some differences between the manifestations of biliary tract diseases in the Korean population and those in the populations of western countries, and these differences have been varying recently. A clinical analysis of 1000 patients who had been treated surgically for biliary diseases at the Department of General Surgery, St. Benedict Hospital, during the period of 10 years from January 1986 to December 1995 was done, and the results were compared with those of previous reports. The following subjects emerged as points of variance : 1) The incidence of the each biliary tract disease, 2) In calculous biliary disease, the location of the stone and the chemical composition of the stone, 3) Parasitic biliary disease, 4) The sex ratio and the age distribution, 5) The duration of illness, 6) Common symptoms and signs and their frequency, 7) Positive laboratory findings and the availability of radiologic diagnoses, 8) Common organisms in the bacterial culture, 9) The management of biliary diseases, and 10) Postoperative complications and the mortality rate. The clinical manifestations of biliary diseases have changed gradually and have been influenced by multiple factors: improvements inf living, education, and the environment, advances in diagnostic and therapeutic methods, etc.. Although these changes are due to the influences of westernization, they should also exhibit Korean-unique charecteristics. Also, we l expect further improvements in the future, and keep in mind those different points, there should be further suitable management, depending on changing features.
Age Distribution ; Biliary Tract Diseases* ; Biliary Tract* ; Diagnosis ; Education ; Humans ; Incidence ; Mortality ; Postoperative Complications ; Sex Ratio

Biliary Tract Diseases ; Humans ; Liver Diseases ; Liver Transplantation/adverse effects* ; Postoperative Complications/etiology* ; Retrospective Studies

Biliary Tract Diseases ; complications ; surgery ; Humans ; Hypertension, Portal ; complications ; etiology ; surgery ; Liver Cirrhosis ; complications ; surgery ; Perioperative Care

Traditionally, open choledochotomy with T-tube choledochostomy had been considered as the "gold standard" for choledocholithiasis. Recently, the frequency of performing the open choledochotomy with T-tube choledohostomy has decreased due to the progression of several less invasive procedures and laparoscopic technques, but until now open choledochotomy with T-tube choledochostomy is the most popular procedure in choledocholithiasis. Therefore we reviewed 126 cases who were treated with open choledochotomy with T-tube choledochostomy from January 1987 to June 1996 at our institution in order to inspect the several problematic points especially after T-tube removal. The results are summarized as follows, 1) The sex ratio of male to female was 1:1.29, and the average age was 59.6 years old. 2) 119 cases (94.4%) were biliary tract stone disease and 7 cases (5.6%) were non-calculous benign biliary tract disease. The most common etiologic disease was GB and CBD stone (37.3%). 3) Most of postoperative T-tube cholangiography was performed within 14 days (84.1%). 4) The number of patients containing some residual stone at postoperative T-tube cholangiography was 29 cases (23%). 14 of these patients were treated by Dormia-basket stone removal and its success rate was 85.7%. 5) The T-tube was removed within 2 months in 109 cases (86.5%). 6) The number of complications after T-tube removal were 8 cases (6.3%). All of them had bile peritonitis symptomes, and three of them were treated by reoperation. 7) The postoperative complications were noted in 27 cases (21.4%). and the most frequent complication is wound infection (25.8%). The postoperative mortality was noted in 1 case (0.8%).
Bile ; Biliary Tract ; Biliary Tract Diseases ; Cholangiography ; Choledocholithiasis ; Choledochostomy* ; Female ; Humans ; Male ; Mortality ; Peritonitis ; Postoperative Complications ; Reoperation ; Sex Ratio ; Wound Infection

Stool examination is believed to be the most reliable method for detecting Clonorchis sinensis (CS) eggs. However, it has limited value for diagnosing clonorchiasis when the biliary tract is obstructed or when there is a light infection. We evaluated the infection states of CS in patients with biliary tract diseases using a bile sample. From January 2001 to August 2003, 238 patients who had undergone endoscopic biliary drainage were prospectively included in the study. The patients' bile samples were obtained directly from the nasobiliary drainage tube and then analyzed to detect CS eggs. The overall CS egg positive rate was 28.2% (35.4% in males, 19.4% in females). The egg positive rate was similar in all age groups examined: 26.7% in 30-39 years, 25.0% in 40-49 years, 24.4% in 50-59 years, 30.2% in 60-69 years, 35.3% in 70-79 years, and 25.0% in 80 years of age and over. There were no significant differences in the egg positive rate between the disease groups: 32.6% in bile duct cancer, 38.5% in gallbladder cancer, and 26.4% in gallstone diseases. Our results show that the CS infection rate was very high, regardless of the age, gender, and type of diseases of the patients. Although the study population was limited to patients with biliary tract diseases, it is assumed that clonorchiasis is still an endemic disease in Ulsan, Korea.
Korea/epidemiology ; Humans ; Clonorchis sinensis/embryology/*isolation & purification ; Clonorchiasis/complications/*diagnosis ; Biliary Tract Diseases/*complications ; Bile/*parasitology ; Animals

BACKGROUND: Laparoscopic cholecystectomy has become the gold-tandard treatment for symptomatic gallbladder diseases. The evaluation and the treatment of common duct pathology is an essential component in the surgical management of biliary tract disease. The purpose of the present study was to identify the value and the importance of laparoscopic cholangiography compared to endoscopic retrograde cholangiography (ERC) in a laparoscopic cholecystectomy and to suggest the role of laparoscopic cholangiography in the management of patients undergoing laparoscopic cholecystectomy. METHODS: A laparoscopic cholecystectomy was attempted in two hundred six consecutive patients treated at Hallym University between January 1993 and December 1996. Patients were divided into three groups: In group I, 167 patients were examined with preoperative ERC while in group II, 17 patients were examined with laparoscopic cholangiography; Group III included 22 patients who were not examined with preoperative ERC or laparoscopic cholangiography. RESULTS: The average age was 52.78 years in group I, 45.62 years in group II, and 49.22 years in group III. The average operative time was 76.88 minutes in group I, 131.47 minutes in group II, and 85.22 minutes in group III. The operative time in group II was longer than that in group I (p<0.001). The duration of postoperative hospitalization was 4.9 days in group I and 4.11 days in group II, but this difference was not statistically significant (p=0.166). Conversion to an open cholecystectomy was 17/167 (10%) in group I, 1/17 (5%) in group II and 5/22 (22%). No complications or deaths occurred that were due to laparoscopic cholangiography. The postoperative complications in group I/II/III included bile leakage (3/0/2), bleeding in the bed of the gallbladder (5/0/0), wound bleeding (2/1/1), recurrent common duct stones (2/0/0), subcutaneous emphysema (4/1/0), shoulder pain (12/3/0), and wound infections (15/2/1). CONCLUSIONS: Although cholangiography may not be indicated for all patients undergoing a laparoscopic cholecystectomy, it will eventually be required. We conclude that laparoscopic cholangiography, as well as ERC, is a good method for evaluating the biliary tree. Laparoscopic cholangiography is clinically useful in patients who have negative ultrasonography and a dilated bile duct. Also, laparoscopic cholangiography has many advantages, especially at a teaching hospital: it outlines the anatomy of the extrahepatic biliary tree, identifies anomalies of surgical importance in time before iatrogenic damage is inflicted, detects stones in the cystic duct, discovers unsuspected stones, and develops experience with the technique. However, it is technically diffult to cannulate cystic duct and extends the operating time.
Bile ; Bile Ducts ; Biliary Tract ; Biliary Tract Diseases ; Cholangiography* ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cystic Duct ; Gallbladder ; Gallbladder Diseases ; Hemorrhage ; Hospitalization ; Hospitals, Teaching ; Humans ; Operative Time ; Pathology ; Postoperative Complications ; Shoulder Pain ; Subcutaneous Emphysema ; Ultrasonography ; Wound Infection ; Wounds and Injuries

Biliary Tract Diseases ; diagnosis ; pathology ; therapy ; Biliary Tract Surgical Procedures ; adverse effects ; Cholestasis ; diagnosis ; Diagnosis, Differential ; Gallbladder ; pathology ; Gallbladder Diseases ; diagnosis ; Hot Temperature ; Humans ; Liver ; pathology ; Medicine, Chinese Traditional ; methods ; Postoperative Complications ; diagnosis ; therapy ; Syndrome

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

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

No abstract available.
Biliary Tract Diseases/*surgery ; Cholangiopancreatography, Endoscopic Retrograde/*adverse effects ; Endosonography/*adverse effects ; Female ; Humans ; Obstetric Surgical Procedures/*adverse effects ; Pancreatic Diseases/*surgery ; Pregnancy ; Pregnancy Complications/*surgery