Gallstone disease is a common association in patients with haematological splenomegaly. When indicated, simultaneous splenectomy and cholecystectomy should be performed and traditionally this is accomplished by open surgery. We report a 17 year old thalassaemic girl with splenomegaly complicated by gallstone pancreatitis. We treated her with a combination of needlescopic cholecystectomy and laparoscopic splenectomy as well as delivering the huge spleen via a pfannenstiel incision to hide the scar. We believe this technique is an acceptable alternative mainly for rapid delivery of the spleen and to minimize visible scars hence improving cosmesis.
Cholecystectomy, Laparoscopic/*methods ; Cholelithiasis/etiology ; Cholelithiasis/*surgery ; Splenectomy/*methods ; Splenomegaly/etiology ; Splenomegaly/*surgery ; beta-Thalassemia/*complications

We report a case of gallbladder stone receiving three-dimensional (3D) laparoscopic cholecystectomy, which allowed 3D visualization of the laparoscopic operative field and faithfully displayed the 3D anatomic structures of the abdominal organs and the gallbladder triangle. The operation was successfully completed in 32 min without intraoperative complications. 3D laparoscopic surgery allows more precise operation with reduced complications and helps to shorten the operative time, and is suitable for more complex laparoscopic surgery.
Abdominal Cavity ; Cholecystectomy, Laparoscopic ; Cholelithiasis ; surgery ; Gallstones ; Humans ; Intraoperative Complications

Cholecystectomy, Laparoscopic ; methods ; Cholelithiasis ; surgery ; Female ; Humans ; Middle Aged ; Situs Inversus ; complications

OBJECTIVETo evaluate the optimal timing of hepatectomy for intrahepatic lithiasis complicated with acute cholangitis.

METHODSOne hundred and twenty-six patients with hepatolithiasis who had a history of acute cholangitis and underwent hepatectomy were reviewed retrospectively. According to the period between the surgery and last attack of acute cholangitis, 126 patients were divided into 3 groups: > 3 months (group A, n = 73), 1 approximately 3 months (group B, n = 28), < 1 month (group C, n = 25). The operation time, blood loss, hospital stay, postoperative complications and stone residual rate were compared among the groups.

RESULTSThe intraoperative blood loss of C group was (644.0 +/- 625.7) ml, which was significantly higher than those of A and B group [(409.2 +/- 250.7) ml and (423.2 +/- 237.1) ml, respectively]. The numbers of patients who needed transfusion and the amount of blood transfusion in group C were also higher than those of group A and B. The incidence rate of complications, residual stone in group C were all markedly higher than those of group A and B. The period of hospital stay in group C was much longer than that in group A and B.

CONCLUSIONSThe optimal timing of hepatectomy for hepatolithiasis complicated with acute cholangitis is at least one month after subsidence of cholangitis.

Adult ; Aged ; Bile Ducts, Intrahepatic ; Cholangitis ; complications ; Cholelithiasis ; complications ; surgery ; Female ; Hepatectomy ; methods ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Time Factors

OBJECTIVETo evaluate the treatment of recurrent acute cholangitis with hepatolithiasis.

METHODSWe retrospectively analyzed the clinical data of patients with recurrent acute cholangitis who were treated in Peking Union Medical College Hospitals emergency department from January 1998 to December 2008.

RESULTSTotally 408 patients underwent surgery, of which 167 patients received emergency operations and 241 underwent selective operations after medication and interventional treatment. The incidence of complications was 6.4% among those who received emergency operations and 3.2% among selective operations. The 30-day mortality rate of selective operations was zero.

CONCLUSIONAlong with the progress of percutaneous cholangiographic drainage and endoscopic retrograde cholangiopancreatography, selective operations have been increasingly applied for acute cholangitis with notably low complications and postoperative death.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cholangitis ; etiology ; surgery ; Cholelithiasis ; complications ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo assess the clinical effects of combined endoscopic-laparoscopic technique for one-stage treatment of cholelithiasis with concomitant choledocholithiasis.

METHODSA retrospective analysis was conducted of the clinical data of 30 patients (Group A) with cholelithiasis and choledocholithiasis receiving one-stage laparoscopic cholecystectomy (LC) combined with intraoperative encoscopic retrograde cholangio-pancreatography (ERCP) and 32 patients (Group B) receiving LC combined with 1aparoscopic common bile duct exploration. The operative time, blood loss, conversion to open surgery rate, time to postoperative ambulation, calculi residual rate, hospitalization cost and length of hospital stay were analyzed comparatively.

RESULTSThere were statistically differences between the two groups in hospitalization cost and length of hospital stay (P<0.05) but not in the other indices (P>0.05).

CONCLUSIONCombined endoscopic-laparoscopic techniques can be a safe and feasible option for one-stage treatment of concomitant cholelithiasis and choledocholithiasis to allow rapid postoperative recovery with a shortened hospital stay.

Adult ; Aged ; Cholangiopancreatography, Endoscopic Retrograde ; methods ; Cholecystectomy, Laparoscopic ; methods ; Choledocholithiasis ; complications ; surgery ; Cholelithiasis ; complications ; surgery ; Combined Modality Therapy ; Female ; Humans ; Laparoscopy ; methods ; Length of Stay ; economics ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies

OBJECTIVETo summarize the experience of surgical treatment of primary hepatolithiasis.

METHODSTo analyze the clinical data, operation choice, postoperative complications of 2465 cases of primary hepatolithiasis retrospectively.

RESULTSOf the patients, 2034 received external drainage (82.5%) and 431 received internal drainage (17.5%) and 586 were performed adjunctive partial hepatectomy (23.8%). The postoperative complications were found in 211 cases (8.6%) and 17 cases (0.7%) died after the operation. One thousand seven hundred and sixty-seven cases (71.7%) have been followed up for 2 to 25 years, among them therapeutic effect of 1518 cases (85.9%) was excellent or good, 315 cases (17.8%) had residual stone and 115 cases (6.5%) recurred.

CONCLUSIONSIt could decrease the incidence rate of complications, residual stone and recurrence in the patients with hepatolithiasis after surgical therapy to pinpoint the situs of the lithiasis and biliary stricture and managed properly before the surgery.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bile Ducts, Intrahepatic ; Child ; Cholelithiasis ; surgery ; Drainage ; Female ; Follow-Up Studies ; Hepatectomy ; Humans ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Retrospective Studies

OBJECTIVE: To evaluate the risk of hepatectomy by detecting liver functional reserve preoperatively for patients with primary hepatolithiasis. METHODS: The clinical data of 134 patients with primary hepatolithiasis who underwent hepatectomy were reviewed. In terms of evaluation methods for preoperative liver functional reserve they were divided into a Child-Pugh group (group CP) and an indocyanine green group (group ICG). The preoperative and intraoperative parameters, and the incidence of postoperative complications were analyzed. RESULTS: Liver failure was more common in group CP (12.85%) than that in group ICG (1.56%, P<0.05). The overall complication rate in group CP (37.14%) was higher than in group ICG (18.75%, P<0.05). CONCLUSION ICG15 retention test is more accurate in evaluating liver functional reserve than Child-Pugh scoring system. It may predict the postoperative liver failure in patients with primary hepatolithiasis undergoing hepatectomy, decrease postoperative complications, and increase operation safety.
Adult ; Bile Duct Diseases ; surgery ; Bile Ducts, Intrahepatic ; surgery ; Cholelithiasis ; surgery ; Female ; Hepatectomy ; adverse effects ; Humans ; Liver Failure ; etiology ; prevention & control ; Liver Function Tests ; Male ; Middle Aged ; Patient Selection ; Postoperative Complications ; prevention & control ; Preoperative Care ; Retrospective Studies ; Risk Factors

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is considered a high-risk procedure in patients with previous acute coronary syndrome (ACS); however, clinical studies are rare in the literature. The aim of this study was to investigate the safety and efficacy of ERCP in patients with previous ACS. METHODS: We retrospectively reviewed the medical records of patients with previous ACS who underwent ERCP between January 2007 and August 2012. The clinical characteristics, ERCP diagnoses, treatment results, and complications were analyzed. RESULTS: Fifty patients underwent ERCP an average of 41.6 months after ACS. The most common indication for ERCP was calculous cholangitis. After deep biliary cannulation, endoscopic sphincterotomy, biliary stone removal and endoscopic biliary drainage were successfully performed. Immediate postsphincterotomy bleeding occurred in seven patients, which was successfully controlled using endoscopic therapy. Elevation of cardiac troponin I levels were observed in three patients (6%) before ERCP, and all of these patients were diagnosed with pancreatobiliary disease combined with recurrent ACS, which was treated with coronary artery stent insertion (n=2) and balloon angioplasty (n=1). CONCLUSIONS: Therapeutic ERCP is effective and safe in patients with previous ACS. Cardiac troponin I elevation should be considered a warning sign for recurrent ACS in patients who undergo ERCP.
Acute Coronary Syndrome/*blood/complications/therapy ; Aged ; Aged, 80 and over ; Ampulla of Vater/*surgery ; Angioplasty, Balloon, Coronary ; Carcinoma/*surgery ; Cholangiopancreatography, Endoscopic Retrograde/*methods ; Cholangitis/etiology/*surgery ; Cholelithiasis/complications/*surgery ; Common Bile Duct Neoplasms/*surgery ; Drainage ; Female ; Humans ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Risk Assessment ; Sphincterotomy, Endoscopic ; Stents ; Troponin I/*blood

Aged ; Cholecystectomy, Laparoscopic ; methods ; Cholelithiasis ; complications ; diagnosis ; surgery ; Clinical Laboratory Techniques ; Coronavirus Infections ; complications ; diagnosis ; Elective Surgical Procedures ; methods ; Follow-Up Studies ; Humans ; Infection Control ; methods ; Male ; Pandemics ; Patient Safety ; Pneumonia, Viral ; complications ; diagnosis ; Postoperative Care ; methods ; Risk Assessment ; Singapore ; Treatment Outcome