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

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

Xanthogranulomatous cholecystitis(XGC) is a rare, benign, destructive, inflammatory process of the gallbladder that is believed to be a variant of chronic cholecystitis. The gross and microscopic appearances are characteristic with multiple intramural nodules composed of foamy histiocytes and inflammatory cells. Clinically, radiologically and morphologically, XGC sometimes is confused with a malignant neoplasm. In a retrospective twelve year study, 20 cases of XGC were found in 2007 gallbladders (0.99%) and we have been reviewed the characteristic features of it. In 8 patients(40%) XGC sufficiently resembled carcinoma of the gallbladder for the radiological study and surgeon. Gallstones were found in 14 cases(70%). Associated malignancy were 2 cases : one in distal CBD and one in head of pancreas but, there was no coexisted carcinoma of the gallbladder. Complete cholecystectomy was done in 12 cases(60%) and partial cholecystectomy was performed in 7 cases(35%). One underwent T-tube choledochostomy only for suspectd carcinoma of the gallbladder, which subsequently proved to be XGC. In conclusion, appearances often mimicked carcinoma of the gallbladder at laparotomy with xanthogranulomatous tissue extending to adjacent structures. So the possibility should be considered that an `inoperable tumor' of the gallbladder may be in fact XGC, a benign condition that frozen-section biopsy may confirm. If XGC was suspected at operation or confirmed at frozen-section biopsy, coincident carcinoma may still be present. Management of XGC should therefore include choloecystectomy and excision of adjacent xanthogranulomatous tissue and any fistula.
Biopsy ; Cholecystectomy ; Cholecystitis* ; Choledochostomy ; Fistula ; Gallbladder ; Gallstones ; Head ; Histiocytes ; Laparotomy ; Pancreas ; Retrospective Studies

Endoscopic retrograde cholangiopancreatography (ERCP) has become the first-line therapy for bile duct drainage. In the hands of experienced endoscopists, conventional ERCP results in a failed cannulation rate of 3% to 5%. This failure can occur more commonly in the setting of altered anatomy or technically difficult cases due to either duodenal or biliary obstruction. In cases of ERCP failure, patients have traditionally been referred for either percutaneous transhepatic biliary drainage (PTBD) or surgery. However, both PTBD and surgery have higher than desirable complication rates. Within the last decade, endoscopic ultrasound-guided biliary drainage (EUS-BD) has become an attractive alternative to PTBD after failed ERCP. Many groups have reported on the feasibility, efficacy and safety of this technique. This article reviews the indications for ERCP and the currently practiced EUS-BD techniques, including EUS-guided rendezvous, EUS-guided choledochoduodenostomy and EUS-guided hepaticogastrostomy.
Bile Ducts ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochostomy ; Dioxolanes ; Drainage ; Fluorocarbons ; Hand ; Humans

A 61-year-old man had a F-18 FDG PET/CT scan for evaluation of a common bile duct cancer identified on CT. The PET/CT image showed a hypermetabolic mass in the common bile duct, and a focal area of increased F-18 FDG uptake in segment IV of the liver, which corresponded to a hypoattenuated lesion on non-enhanced CT, and was consistent with hepatic metastasis. The patient underwent choledochojejunostomy with hepatic resection, and pathologic findings were compatible with an eosinophilic abscess in the liver. This case demonstrates that F-18 FDG uptake by an eosinophilic abscess can mimic hepatic metastasis in a patient with a malignancy.
Abscess ; Choledochostomy ; Common Bile Duct ; Eosinophils ; Humans ; Hydrazines ; Liver ; Liver Abscess ; Middle Aged ; Neoplasm Metastasis