Humans ; Ascites/etiology* ; Liver Cirrhosis/complications* ; Cholecystectomy/adverse effects*

Laparoscopic cholecystectomy has now rapidly replaced open cholecystectomy. Rarely a calculus may arise from a metallic surgical clip migrated into the common bile duct (CBD) after this surgical procedure was performed. We report a 50-year-old man with CBD stone formed around a surgical clip, who had undergone a laparoscopic cholecystectomy because of acute calculous cholecystitis 14 months before. Abdominal CT revealed a single stone in mildly dilated CBD. A high density core within the CBD stone, was suspected to be a surgical clip. The stone was removed using a retrieval balloon catheter and basket after endoscopic sphincterotomy.
Cholecystectomy, Laparoscopic/adverse effects/*instrumentation ; Choledocholithiasis/*etiology ; *Foreign-Body Migration ; Humans ; Male ; Middle Aged ; Surgical Instruments/*adverse effects

OBJECTIVETo evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on the quality of recovery during the early period after laparoscopic cholecystectomy and the dosage of anesthetic and analgesic.

METHODSOne hundred patients who received laparoscopic cholecystectomy with gradeⅠand Ⅱ of American Society of Anesthesiologists (ASA) criteria were randomly assigned into an observation group and a control group according to random number table, 50 cases in each group. The patients in the two groups were treated with conventional endotracheal intubation anesthesia, anesthesia induction and maintenance. The patients in the observation group were treated with TEAS (2 Hz/100 Hz, 8 to 12 mA) at bilateral Hegu (LI 4) and Neiguan (PC 6), as well as Zusanli (ST 36) and the non-acupoint 2 outboard from Zusanli (ST 36) from 30 min before anesthesia induction to the end of operation. The patients in the control group were applied by stimulation electrode in the corresponding points without electrical stimulation. The dosage of intraoperative remifentanil and the analgesic dosage of dezocine for postoperation were recorded. The recovery time, extubation time, the changes of heart rate (HR) and mean arterial pressure (MAP) during extubation were recorded. The quality of recovery was assessed by the quality of recovery-40 questionnaire (QoR-40) 1 day before surgery (T)，and 4 h (T), 8 h (T), 24 h (T), 48 h (T) after surgery. The patient's cognitive function was assessed by mini-mental state examination (MMSE) scale at the 5 time points. The incidences of postoperative nausea and vomiting were recorded at T through T.

RESULTSThe dosages of intraoperative remifentanil and dezocine in the observation group were less than those in the control group; the recovery time and extubation time were shorter than those in the control group; the HR of extubation was lower than that in the control group (all <0.05). There was no statistic difference about MAP between the two groups (>0.05). Compared with T, the total scores of QoR-40 decreased in the two groups at T, T, T (all <0.05), and the total scores in the observation group were higher than those in the control group (all <0.05). The emotional state, physical comfort, psychological support, self-care ability, pain scores at T in the observation group and at T, T, T in the control group were lower than those at T (all <0.05). The emotional state, physical comfort, psychological support, self-care ability, pain scores in the observation group were higher than those in the control group at T, T, T (all <0.05). Compared with T, the MMSE scores in the two groups decreased at T and T (all <0.05). At T, T, T, the MMSE scores in the observation group were higher than those in the control group (all <0.05). At T and T, the incidence rates of nausea and vomiting were 22.0% (11/50), 12.0% (6/50) respectively in the observation group, which were lower than 32.0% (16/50) and 24.0% (12/50) in the control group (both <0.05). At T and T, the incidence rates of nausea and vomiting were 6.0% (3/50), 2.0% (1/50) respectively in the observation group, which were not significantly different from 8.0% (4/50) and 4.0% (2/50) in the control group (both >0.05).

CONCLUSIONTEAS can improve the quality of recovery during the early period after laparoscopic cholecystectomy and reduce the dosage of anesthetic and analgesic.

Humans ; Diverticulum, Colon/surgery* ; Cholecystectomy/adverse effects* ; Tomography, X-Ray Computed

The use of non-absorbable suture materials for cystic duct ligation after cholecystectomy can expose patients to the risk of recurrent stone formation in the common bile duct (CBD). However, in Korea suture materials have rarely been found to act as a nidus for common bile duct calculus formation. Recently, we experienced a case in which suture material, that had migrated from a previous cholecystectomy site into the CBD, probably served as a nidus for common bile duct stone formation. The stone was confirmed by endoscopic retrograde cholangiopancreatography (ERCP) and removed successfully using a basket. The authors report a case of surgical suture migration and discuss its subsequent role as a stone forming nucleus within the CBD in a patient who underwent open cholecystectomy; and include a review of the literature.
Aged ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy/*adverse effects ; Foreign Bodies/*complications ; Foreign-Body Migration/*complications ; Gallstones/*etiology/surgery ; Humans ; Male ; Risk Factors ; Surgical Instruments ; Sutures/*adverse effects

Surgical clips can migrate into the biliary tract and act as a nidus for stone formation. We report a case of common bile duct stone developed due to a surgical clip in a 48-year-old man. Endoscopic retrograde cholangiogram revealed a common bile duct stone a with metallic clip in it. He had laparoscopic cholecystectomy 10 years ago. The stone was removed endoscopically. The use of resorbable clips during laparoscopic cholecystectomy is recommended to avoid this type of complication.
Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic/adverse effects/*instrumentation ; Choledocholithiasis/*etiology/radiography/therapy ; *Foreign-Body Migration ; Humans ; Male ; Middle Aged ; Surgical Instruments/*adverse effects

The present case is one of gallstone obstructive ileus due to gallstones 3 yr after laparoscopic cholecystectomy. It is interesting because of the sex of the patient, the fact that ileus occurred 3 yr after cholecystectomy and that the localization of the obstruction was an old side-to-side ileoileal anastomosis due to a diverticulectomy following intussusception of Meckels' diverticulum at the age of 3.
Adult ; Anastomosis, Surgical/*adverse effects ; Child, Preschool ; Cholecystectomy, Laparoscopic/*adverse effects ; Gallstones/*complications ; Humans ; Ileum/pathology/*surgery ; Ileus/*etiology ; Intestinal Obstruction/*etiology ; Male ; Meckel Diverticulum/surgery

Simulating physiological neuronal and hormonal conditions during digestive and interdigestive periods, the study identified the changes of the motility of biliary system including bile duct and sphincter of Oddi (SO) before and after cholecystojejunostomy. Thirty-five rabbits were divided into five groups randomly. The experimental groups received the venous injection of CCK 10 ng/kg, erythromycin 10 mg/kg, atropine 3 micrograms/kg and L-NAME 10 mg/kg respectively. Each rabbit underwent manometry through introducing a three-lumen catheter via the papilla retrogradely, using the low-compliance papillary infusion system. Then the gallbladder and the upper segment of the jejunum was anastomosed and the manometric procedures repeated after one week. SO basal pressure was increased, contraction amplitude decreased, contraction time shortened after cholecystojejunostomy. L-NAME, CCK and erythromycin could all excite SO. L-NAME could increase basal pressure and contraction amplitude, CCK increase basal pressure contraction amplitude and frequency, and erythromycin increase contraction amplitude, respectively. But comparing with that before cholecystojejunostomy, the increasing extent was decreased. The tensional and spontaneous contractions of the SO were under the control of the neural and hormonal mechanism. The anastomosis of gallbladder and jejunum and the drainage of bile made the tensional contraction stronger, but the spontaneous contraction weakened after the operation due to the decreases of the sensitivity of SO to hormonal factors. The clinical symptoms may not be relieved when the patients with SO dysfunction accepted cholecystojejunostomy.
Animals ; Cholecystectomy ; adverse effects ; Common Bile Duct ; physiopathology ; Female ; Gallbladder Emptying ; physiology ; Jejunostomy ; adverse effects ; Male ; Manometry ; methods ; Muscle Contraction ; Postoperative Period ; Rabbits ; Random Allocation ; Sphincter of Oddi ; physiopathology

Although ceftriaxone can be used safely in most instances, it can sometimes induce biliary sludge or stone formation. Most of the patients remain asymptomatic and children are more susceptible to develop this condition, but adults can be affected as well. Because sludge or stones disappear after discontinuing ceftriaxone, this condition is referred to as ceftriaxone-associated pseudolithiasis. A 54-year-old woman was admitted to a local clinic for management of ileus. During admission, she had received ceftriaxone and metronidazole, and had been on nil per os for the past 6 days. She was then referred to our hospital for cholecystectomy due to persistent right upper quadrant pain. Although imaging studies showed gallbladder sludge, pseudolithiasis was suspected because of ceftriaxone administration history and prolonged fasting. After careful watch-and-wait, the condition resolved spontaneously after ceftriaxone discontinuation. Our clear understanding on ceftriaxone-associated gallbladder pseudolithiasis allowed us to avoid an unnecessary cholecystectomy. Herein, we report the case of a 54-year-old woman with ceftriaxone-associated gallbladder pseudolithiasis that was successfully managed by ceftriaxone discontinuation alone.
Adult ; Aged ; Anti-Bacterial Agents/*adverse effects ; Ceftriaxone/*adverse effects ; Cholecystectomy ; Cholecystolithiasis/*diagnosis/epidemiology/etiology ; Female ; Gallbladder/ultrasonography ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed

Simulating physiological neuronal and hormonal conditions during digestive and interdigestive periods, the study identified the changes of the motility of biliary system including bile duct and sphincter of Oddi (SO) before and after cholecystojejunostomy. Thirty-five rabbits were divided into five groups randomly. The experimental groups received the venous injection of CCK 10 ng/kg, erythromycin 10 mg/kg, atropine 3 micrograms/kg and L-NAME 10 mg/kg respectively. Each rabbit underwent manometry through introducing a three-lumen catheter via the papilla retrogradely, using the low-compliance papillary infusion system. Then the gallbladder and the upper segment of the jejunum was anastomosed and the manometric procedures repeated after one week. SO basal pressure was increased, contraction amplitude decreased, contraction time shortened after cholecystojejunostomy. L-NAME, CCK and erythromycin could all excite SO. L-NAME could increase basal pressure and contraction amplitude, CCK increase basal pressure contraction amplitude and frequency, and erythromycin increase contraction amplitude, respectively. But comparing with that before cholecystojejunostomy, the increasing extent was decreased. The tensional and spontaneous contractions of the SO were under the control of the neural and hormonal mechanism. The anastomosis of gallbladder and jejunum and the drainage of bile made the tensional contraction stronger, but the spontaneous contraction weakened after the operation due to the decreases of the sensitivity of SO to hormonal factors. The clinical symptoms may not be relieved when the patients with SO dysfunction accepted cholecystojejunostomy.
Cholecystectomy/*adverse effects ; Common Bile Duct/*physiopathology ; Gallbladder Emptying/*physiology ; Jejunostomy/*adverse effects ; Manometry/methods ; Muscle Contraction ; Postoperative Period ; Random Allocation ; Sphincter of Oddi/*physiopathology