The indication of laparoscopic procedure is continuously extending in the field of hepato-biliary-pancreatic surgery. Laparoscopic cholecystectomy has become a standard treatment for the disease of the gallbladder. Its application has widened to include conditions that once considered to be relative contraindications of laparoscopic cholecystectomy such as acute cholecystitis, complicated cholecystitis, previous operation history, and old age. Recently, a laparoscopic CBD exploration has been used for the treatment of CBD stone disease with good results. This operation may obviate the risk of immediate and long-term problem of sphincterotomy of the Ampulla of Vater resulting from endoscopic extraction of the CBD stone. For the biliary tract disease, pioneering operation of the laparoscopic IHD exploration and Roux-en-Y choledochojejunostomy have been successfully performed in our country. In terms of laparoscopic pancreatic surgery, a cystogastrostomy and a distal pancreatectomy are feasible operations. However, its indication is limited to benign or pre-malignant diseases. A pancreaticoduodenectomy with a laparoscopic technique is still not recommended. For the laparoscopic surgery of the liver, it has been initially applied to unroofing of a liver cyst or wedge resection. However, anatomic liver resections were successfully performed. The parenchymal dissection of the liver has been possible with the development of innovative laparoscopic equipments. Liver resection can be done with a laparoscopy-assisted method or a totally laparoscopic method. With accumulation of experience and the development of equipments, laparoscopic surgery has become a major operative tool in the hepato-biliary-pancreatic disease with an advantage of minimal invasiveness.
Ampulla of Vater ; Biliary Tract Diseases ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Choledochostomy ; Gallbladder ; Laparoscopy ; Liver ; Pancreatectomy ; Pancreatic Diseases ; Pancreaticoduodenectomy ; Surgical Procedures, Minimally Invasive*

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

INTRODUCTIONLaparoscopic cholecystectomy is currently the gold standard for removal of symptomatic gallbladders. The push in recent years toward reducing the number of ports required to perform this surgery has led to the development of single-incision laparoscopic cholecystectomy (SILC). We report our early experience with SILC and assess its feasibility and safety.

METHODSA prospective study was conducted of the first 100 patients who presented with complaints of biliary colic and underwent laparoscopic cholecystectomy via the single-port technique at our institution. SILC was performed via a single-port device such as a flexible umbilical port that could accommodate up to three surgical instruments. The port was inserted into a transumbilical incision around 15-20 mm long. Data on operative details and postoperative outcomes were collected and evaluated.

RESULTSThe mean operation time was 67.8 minutes. Six patients needed conversion, requiring extra 5-mm ports to complete the surgery. No serious intraoperative complications, such as bile duct injury or bile leakage, were encountered. Cosmesis from the scar hidden within the umbilical fold was excellent.

CONCLUSIONOur initial results of single-port laparoscopic cholecystectomy are promising, with no complications being seen in this early series. However, the drawbacks include the higher cost of equipment and a steeper learning curve. Further evaluation is required to assess the risks and benefits of this approach when compared with conventional laparoscopic cholecystectomy.

Aged ; Biliary Tract Diseases ; diagnosis ; surgery ; Cholecystectomy, Laparoscopic ; instrumentation ; methods ; Colic ; diagnosis ; surgery ; Equipment Design ; Gallbladder Diseases ; diagnosis ; surgery ; Gastroenterology ; methods ; Humans ; Laparoscopes ; Middle Aged ; Prospective Studies ; Risk ; Surgical Procedures, Operative ; methods ; Treatment Outcome

BACKGROUND/AIMS: Diagnostic or thepapeutic endoscopic retrograde cholangiopancreatography (ERCP) is the mainstream for the pancreaticobiliary disease. However, the ERCP related complications are serious and sometimes fatal to the patients. We have reviewed our experiences of the operative management for the ERCP injury. METHODS: Medical records of 13 patients who underwent laparotomic surgical intervention for various ERCP injuries from March 1996 to August 2002 at Department of Surgery, the Catholic University of Korea were reviewed. RESULTS: The age range of the patients was from 28 to 85 years. There were 5 females and 8 males. 6 patients showed the duodenal perforations and 4 patients suffered from bleedings around the ampulla of Vater. One of the 4 bleeding patients had huge expanding submucosal hematomas throughout the entire duodenum. We found massive retroperitoneal extraluminal air density in one patient but we could not find any leakage of the contrast media during the upper gastrointestinal series, however, this patient complained aggravated peritoneal irritation sign, so we explored the abdomen. Most of the patients had free abdominal or retroperitoneal air shadows (n=7) on plain chest or abdominal X-ray. We diagnosed the uncontrolled bleeding from the sphincterotomy site using the gastroduodenal fiberscopes in 3 patients. On the computed tomogaphic images, one patient showed a huge duodenal hematoma, another one had a retroperitoneal fluid collection and another one revealed a retroperitoneal air shadow. One patient showed aggravated pancreatitis on the serial CT scan and finally the patient developed a hemorrhagic necrotizing pancreatitis, then we explored the abdomen and tried peripancreatic drainage but we lost the patient in 19 postoperative day due to sepsis. The other 12 patients survived by the various surgical procedures. For the 6 patients, we performed duodenotomic sphincteroplasty, tube duodenostomy and biliary drainage with T-tube. One patient survived with Whipple's procedure, one patient improved by the pyloric exclusion and one patient cured with the duodenal diverticulization. Other procedures were primary repair of the duodenum, transduodenal sphincteroplasty and just cholecystectomy and T-tube choledochostomy. CONCLUSION: There was tendency to uneventful improvement of patients by the early detection and urgent laparotomic surgical intervention of the ERCP complication.
Abdomen ; Ampulla of Vater ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholecystectomy ; Choledochostomy ; Contrast Media ; Drainage ; Duodenostomy ; Duodenum ; Female ; Hematoma ; Hemorrhage ; Humans ; Korea ; Male ; Medical Records ; Pancreatitis ; Sepsis ; Sphincterotomy, Transhepatic ; Thorax ; Tomography, X-Ray Computed

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

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

The laparoscopic cholecystectomy, performed for the first time in France in 1987, has been accepted as in many countries the method of choice when performing a cholecystectomy. The trend toward minimally invasive surgery has prompted general surgeons to try it instead of open cholecystectomy. We performed 1000 laparoscopic cholecystectomies at the Department of General Surgery of Eulji Medical College Hospital from January 1992 to April 1997. The outcome data have been analyzed retrospectively. Moreover, we have compared the case histories of 13 patients who received cholecystostomy with those of 43 patient who did not. We also present preliminary results for an interval laparoscopic cholecystectomy which was a preceded by percutaneous cholecystostomy. The results are as follows: 1) The mean age was 54.3 years ranging from 17 to 86; there were 402 males and 598 females. 2) Of the 1000 patients, 123 patients (12.3%) had a history of abdominal surgery. 3) More than half of the patients(560 patients, 56.0%) underwent operations within 6 months of the onset of symptoms. 4) A preoperative endoscopic retrograde cholecystoscopy was performed on 220 patients (22.0%), and of these, 93 patients received endoscopic sphincterotomies because of bile duct stones. 5) The majority of patients(744 patients, 74.4%) had laparoscopic cholecystectomies which lasted 40 minutes or less. 6) More than half (54%) of the removed gallbladders showed grade II inflammation. 7) Drains were used in 142 patients (14.2%). 8) Postoperative complications were encountered in 48 patients (4.8%). 9) Postoperative oral intake was resumed within 24 hours in most patients. 10) Most patients(854 patients, 85.4%) were discharged within 3 days of the operation. 11) The pathologic diagnosis was chronic nonspecific inflammation in most cases (823 cases, 82.3%). 12) The most common microorganism in the bile was E. coli. 13) Patients who received a cholecystostomy had many benefits: a shorter operation time, a low rate of open cholecystectomy, early oral intake. 14) For the 1160 patients who underwent a cholecystectomy during the same period, the rate of open cholecystectomy was 13.8%.
Bile ; Bile Ducts ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cholecystostomy* ; Diagnosis ; Female ; France ; Gallbladder ; Humans ; Inflammation ; Male ; Postoperative Complications ; Retrospective Studies ; Sphincterotomy, Endoscopic ; Surgical Procedures, Minimally Invasive

INTRODUCTION: The acute abdomen define as an acute abdominal condition which needs immediate decision for treatment. The retrospective study was conducted to evaluate the characteristic of the acute abdomen in Hansen's disease. MATERIALS AND METHODS: An analysis was made of the records of 53 patients in surgical department at the National Soocdo Hospital from January, 2003 through December, 2005 for 3 years. RESULTS: The sex ratio of male to female was 1:1.04, and the mean age was 75.1 years. The most prevalent age group was in between 71 to 75 years of age(24.5%). Common diseases of acute abdomen were gastrointestinal bleeding(28.3%), acute appendicitis(17.0%), biliary tract disease(15.1%), intestinal obstruction(15.1%) in order of frequency. The operation rate was 32.1%(17 case). As for operative procedure, appendectomy was done in 9 cases, cholecystectomy was done in 3 cases, subtotal gastrectomy was done in 2 cases , palliative gastrectomy and gastric primary closure with omental patch and adhesiolysis with small bowel primary closure was done in 1 case each. The overall mortality rate was 24.5%(13 case). CONCLUSION: Gastrointestinal bleeding and intestinal obstruction was more frequent than other old age group. The operation rate was low, and the mortality rate was high. This study suggests that more active and surgical treatment need in acute abdomen of Hansen's disease patients.
Abdomen, Acute* ; Appendectomy ; Biliary Tract ; Cholecystectomy ; Female ; Gastrectomy ; Hemorrhage ; Humans ; Intestinal Obstruction ; Leprosy* ; Male ; Mortality ; Retrospective Studies ; Sex Ratio ; Surgical Procedures, Operative

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

BACKGROUND: Residual stones after biliary tract surgery are a formidable task for the surgeon. Choledocholithiasis and hepatolithiasis are more common in East Asia, including Korea, compared with the West, and retained and recurrent stones remain a major problem after the surgical treatment of biliary tract stones; thus, various attempts to reduce the rate of retained and recurrent stones are important in the treatment of biliary tract stones. METHODS: A retrospective analysis was done on 815 cases of patients with biliary tract stones who had undergone an operation at the Department of Surgery, Chung-ng University Hospital, during the 13 years from January 1984 to December 1996. RESULTS: The male-to-female sex ratio was 1 : 2, and the most common age group was the 7th decade. The most common symptoms and physical findings were right upper quadrant pain in 620 cases (76.1%), and right upper quadrant tenderness in 511 cases (62.1%). The most common laboratory findings were elevated alkaline phosphatase (88.3%), followed by elevated sGPT and elevated sGOT. Bile cultures and sensitivity tests were done in 815 cases and were positive in 682 cases (83.7%). The most common bacteria were E.coli in 252 cases (37.0%). The locations of the stones were gallbladder (GB) and common bile duct (CBD) in 420 cases (51.5%), the CBD in 160 cases (19.6%), the CBD and intrahepatic duct (IHD) in 108 cases (13.3%). The most common operative procedure was a cholecystectomy with T-ube insertion, 525 cases (64.4%). Postoperative complications developed in 208 cases (25.6%), and the most common postoperative complication was wound infection, 72 cases (8.8%). The operative mortality was 2.9%, and most common cause of death was sepsis (10 cases). CONCLUSIONS: The authors conclude that interventional therapy, as an initial treatment for residual stones, is a satisfactory treatment where possible. If there are residual stones in spite of the interventional therapy, a reoperation or hepatectomy is required.
Alanine Transaminase ; Alkaline Phosphatase ; Aspartate Aminotransferases ; Bacteria ; Bile ; Biliary Tract* ; Cause of Death ; Cholecystectomy ; Choledocholithiasis ; Common Bile Duct ; Far East ; Gallbladder ; Hepatectomy ; Humans ; Korea ; Mortality ; Postoperative Complications ; Reoperation ; Retrospective Studies ; Sepsis ; Sex Ratio ; Surgical Procedures, Operative ; Wound Infection