No abstract available.
Choledochostomy*

Postoperative biliary stricture is a relatively rare but serious complication of biliary surgery. Although Rouxen-Y hepaticojejunostomy or choledochojejunostomy are well-established and fundamental therapeutic approaches, their postoperative morbidity and mortality rates have been reported to be up to 33% and 13%, respectively. Recent studies suggest that percutaneous transhepatic intervention is an effective and less invasive therapeutic modality compared with traditional surgical treatment. Compared with fluoroscopic intervention, percutaneous with cholangioscopy may be more useful in biliary strictures, as it can provide visual information regarding the stricture site. We recently experienced two cases complete membranous occlusion of the bilioenteric anastomosis and successfully treated both patients using percutaneous transhepatic cholangioscopy.
Choledochostomy ; Cholestasis ; Constriction, Pathologic ; Humans ; Postoperative Complications

PURPOSE: The feasibility of a rat choledochojejunostomy (CJ) training model was investigated, as an introductory model to microsurgery for general surgeons. METHODS: Roux-en-Y CJ was performed on 20 rats. Interrupted 10-0 prolene sutures were used to perform CJ. The animals were observed for 7 days and sacrificed and examined. RESULTS: The rats were divided into 2 groups of 10 based on surgical order. The CJ time showed a significant decrease from 36.2 ± 5.6 minutes in group 1 to 29.4 ± 5.7 minutes in group 2 (P = 0.015). The bile leakage rate was 40% in group 1 and 10% in group 2. The survival time was 5.4 ± 2.2 days in group 1 and 7 days in group 2 (P = 0.049). CONCLUSION: The rat CJ training model is a feasible introductory model for general surgeons with no previous experience in microsurgery.
Animals ; Bile ; Choledochostomy* ; Microsurgery ; Polypropylenes ; Rats* ; Sutures

BACKGROUNDIt is difficult and time-consuming for carrying out conventional hand-sewn bilioenteric anastomosis, especially for small bile duct anastomosis and laparoscopic procedure. In order to simplify it, we have developed a novel procedure of sutureless bilioenteric anastomosis with an intraluminal degradable stent. This study aimed to evaluate the feasibility and safety of this technique with cholangioduodenostomy in dog model.

METHODSA patent intraluminal degradable stent tube for sutureless choledochoduodenostomy in dog model was made with polylactic acid in diameter of 3 mm or 4 mm. Thirty-eight dogs were randomly divided into to a stent group (SG, n = 20) and a control group (CG, n = 18). Dogs in the SG underwent sutureless choledochoduodenostomy with intraluminal stent, while the CG underwent conventional choledochoduodenostomy (single layer discontinuous anastomosis with absorbable suture). Dogs of each group were divided into 4 subgroups according to time of death (1, 3, 6, and 12 months postoperatively) to evaluate the healing of anastomosis. Operation time, intraoperative tolerance pressure of anastomosis, rate of postoperative bile leakage, bursting pressure of anastomosis were compared between the two groups. Anastomosis tissue was observed afterwards by pathology evaluation, hydroxyproline content, serum bilirubin, liver enzyme level and magnetic resonance cholangio-pancreatography (MRCP) to assess the stricture.

RESULTSAll procedures were completed successfully. The surgical time of the SG was significantly less than the CG (SG: (19.2 ± 4.3) minutes, vs. CG: (29.2 ± 7.1) minutes, P = 0.000). One bile leakage was occurred in either group. No significant difference of intraoperative tolerance pressure of anastomosis, rate of bile leakage and postoperative bursting pressure of anastomosis, anastomotic stricture, hydroxyproline content, serum bilirubin and liver enzyme level was found between the two groups. MRCP showed no anastomosis stricture and obstruction during months of follow-up.

CONCLUSIONThe technique of sutureless choledochoduodenostomy with a degradable intraluminal stent is feasible and a safe procedure in this dog model.

PURPOSE: The purpose of this study was to develop a porcine training model for laparoscopic choledochojejunostomy (CJ) that can act as a bridge between simulation models and actual surgery for novice surgeons. The feasibility of this model was evaluated. METHODS: Laparoscopic CJ using intracorporeal sutures was performed on ten animals by a surgical fellow with no experience in human laparoscopic CJ. A single layer of running sutures was placed in the posterior and anterior layers. Jejunojejunostomy was performed using a linear stapler, and the jejunal opening was closed using absorbable unidirectional sutures (V-Loc 180). RESULTS: The average operation time was 131.3 +/- 36.4 minutes, and the CJ time was 57.5 +/- 18.4 minutes. Both the operation time and CJ time showed a steady decrease with an increasing number of cases. The average diameter of the CBD was 6.4 +/- 0.8 mm. Of a total of ten animals, eight were sacrificed after the procedure. In two animals, a survival model was evaluated. Both pigs recovered completely and survived for two weeks, after which both animals were sacrificed. None of the animals exhibited any signs of bile leakage or anastomosis site stricture. CONCLUSION: The porcine training model introduced in this paper is an adequate model for practicing laparoscopic CJ. Human tissue simulation is excellent.
Animals ; Bile ; Choledochostomy* ; Constriction, Pathologic ; Humans ; Laparoscopy ; Running ; Sutures ; Swine

Percutaneous transhepatic biliary drainage (PTBD) is an established procedure for biliary obstruction. However, duodenobiliary or jejunobiliary reflux of the intestinal contents through a PTBD catheter sometimes causes recurrent catheter obstruction or cholangitis. A 64-year-old female patient with a history of choledochojejunostomy was referred to our department with acute cholangitis due to choledochojejunal anastomotic obstruction. Emergent PTBD was performed, but frequent obstructions of the catheter due to the reflux of intestinal contents complicated the post-PTBD course. We therefore introduced a catheter with an antireflux mechanism to prevent jejunobiliary reflux. A commercially available catheter was modified; side holes were made at 1 cm and 5 to 10 cm (1 cm apart) from the tip of the catheter, and the catheter was ligated with a nylon thread just proximal to the first side hole. Using this novel "antireflux PTBD technique," jejunobiliary reflux was prevented successfully, resulting in a longer patency of the catheter.
Catheter Obstruction ; Catheters ; Cholangitis ; Choledochostomy ; Dioxolanes ; Drainage ; Female ; Fluorocarbons ; Gastrointestinal Contents ; Humans ; Nylons

Choledochal cysts in neonates and young infants take two forms: the choledochal cyst associated with biliary atresia (CCBA) and the choledochal cyst in the absence of biliary atresia (CC). Infants in both groups usually have similar clinical symptoms at presentation, but management and prognosis are different. While early portoenterostomy is required for CCBA, cyst excision with hepaticojejunostomy or choledochojejunostomy is usually performed for CC. The former shows a relatively poor prognosis, and the latter shows a better prognosis. Two infants who presented with clinical features of neonatal cholestasis, and clinically suspected to have choledochal cysts, were found on imaging studies and surgery to have extrahepatic bile duct atresia in association with choledochal cysts.
Bile Ducts, Extrahepatic ; Biliary Atresia* ; Choledochal Cyst* ; Choledochostomy ; Cholestasis ; Humans ; Infant ; Infant, Newborn ; Prognosis

BACKGROUND/AIMS: The long-term results of Roux-en-Y procedure as a treatment for choledochal cyst or cholelithiasis were compared and analyzed. METHODS: A retrospective analysis was carried out for 70 patients (38 type 1 or type 4A choledochal cysts, 33 cholelithiasis) with ages ranging from 17 to 74 years who had undergone hepaticojejunostomy or choledochojejunostomy in a Roux-en-Y manner, with or without hepatectomy. RESULTS: Late complications related to the surgical procedure include cholangitis, recurrent stone, malignancy, abscess, and peptic ulcer disease. The late complication rate was 37.8% in the choledochal cyst group, and 27.3% in the cholelithiasis group. Cholangitis were found in 8.1% of the choledochal cyst group, and in 12.1% of the cholelithiasis group. Recurrent stones were found in 10.8% and 18.2%, respectively. A malignant tumor was found in each group, and both of them were not resectable. Peptic ulcers or erosions were found in 5 patients (13.5%) of the choledochal cyst group, but no one in the cholelithiasis group (p=0.056). CONCLUSION: Late complications after Roux-en-Y procedure in choledochal cyst or cholelithiasis are not uncommon and relatively serious. Long-term follow-up for the patients is mandatory, with attention being given to not only biliary symptoms, but also symptoms related to peptic ulcer disease.
Abscess ; Cholangitis ; Choledochal Cyst* ; Choledochostomy ; Cholelithiasis* ; Follow-Up Studies ; Hepatectomy ; Humans ; Peptic Ulcer ; Retrospective Studies

PURPOSE: We recently experienced 3 consecutive cases of bile peritonitis due to tract rupture following T-tube removal at about 6 weeks after choledocholithotomy with using a new tube (1.1% silica-filled rubber). These unexpected cases of bile peritonitis have raised questions related to the tube material factor for the rupture. The aim of this study was to compare three kinds of T-tubes [ (100% silicone (SIL), 1.1% silica-filled rubber (SFR), and 100% rubber (RUB) ] from the point of view of fistula maturation as is related to the physicochemical properties of the tube materials. METHODS: SIL, SFR and RUB tubes were implanted into the subcutaneous space in rats. Histologically, the degree of fistula maturation was estimated by an inflammation score, the thickness of inflammation and the fibrosis. The physical properties of the tube materials were estimated by their modulus and elasticity. RESULTS: SFR and RUB tube had no statistically significant difference for the thickness of the inflammation and fibrosis. Yet there were difference in their modulus and elasticity. The modulus, elasticity, thickness of the inflammation and the fibrosis were difference in the SIL versus SFR and the SIL versus RUB. CONCLUSION: There were no statistically significant differences in the degree of fistula maturation between the SFR and RUB tubes. The rubber tube tended to show a more severe inflammatory reaction and better maturation of the fistula. Moreover, the flexibleness of the RUB tube make easy to experience collapse of the tube. The degree of maturation mostly depends upon the chemical property of the tube materials. However, the tract rupture that happens is due to the physical properties rather than the chemical properties of the tube. We recommend RUB for the T-tube to prevent the tube related complication such as tract rupture.
Animals ; Bile ; Choledochostomy ; Elasticity ; Fibrosis ; Fistula* ; Inflammation ; Latex ; Peritonitis ; Rats ; Rubber ; Rupture ; Silicones

BACKGROUND: The treatment of intrahepatic stones is difficult because of frequent recurrence and residual stones. There are several suggested methods of treatment which include surgical bile-uct exploration with or without biliary drainage, an endoscopic procedure, transhepatic cholangiolithotomy, and hepatic resection. METHODS: We reviewed the therapeutic results in 96 patients who had hepatolithiasis and received surgery at Soon Chun Hyang University Chunan Hospital during the 10 years from June 1987 to June 1997. We divided them into 2 groups: one was the group of patients receiving a hepatic resection with or without a drainage procedure (resection group), and the other was the group of patients receiving only a T-ube choledochostomy or drainage procedure (nonresection group). RESULTS: The male-to-female ratio was 1:1.74, and the most prevalent age group was the 5th decade (31.3%). The most common symptoms were epigastric pain (61%) and RUQ pain (60%), and the locations of stones were the right intrahepatic duct in 10 cases (10.4%), the left intrahepatic duct in 47 cases (49%), and both intrahepatic duct in 39 cases (40.6%). Operative methods were a resection in 29 cases and a nonresection in 67 cases. The incidence of residual stones were 31.0% in the hepatic resection group and 68.6% in the nonresection group. The postoperative complication rate was 20.6% in hepatic resection group and 38.8% in the nonresection group, and the follow-p study showed the good results (Good & Fair) for 92.5% of the hepatic resection group and 66.7% of the nonresection group. CONCLUSION: The hepatic resection with or without drainage is an adequate treatment for hepatolithiasis. It can eradicate localized intrahepatic calculi, irreversible biliary stricture, an atrophied segment, and, possibly, an associated cholangiocarcinoma, with good results in clinical evaluation.
Calculi ; Cholangiocarcinoma ; Choledochostomy ; Chungcheongnam-do ; Constriction, Pathologic ; Drainage ; Humans ; Incidence ; Postoperative Complications ; Recurrence