OBJECTIVE: To explore the feasibility and efficacy of laparoscopic transcystic drainage and common bile duct exploration in the treatment of patients with difficult biliary stones. METHODS: Between April 2020 and December 2021, eighteen patients with difficult biliary stones received laparoscopic transcystic drainage (C-tube technique) and common bile duct exploration. The clinical characteristics and outcomes were retrospectively collected. The safety and effectiveness of laparoscopic transcystic drainage and common bile duct exploration were analyzed. RESULTS: Among the eighteen patients with difficult biliary stones, thirteen patients received traditional laparoscopic transcystic drainage, and the remaining five received modified laparoscopic transcystic drainage. The mean surgical duration were (161±59) min (82-279 min), no bile duct stenosis or residual stone was observed in the patients receiving postoperative cholangiography via C-tube. The maximum volume of C-tube drainage was (500±163) mL/d (180-820 mL/d). Excluding three patients with early dislodgement of C-tube, among the fifteen patients with C-tube maintained, the median time of C-tube removal was 8 d (5-12 d). The duration of hospital stay was (12±3) d (7-21 d) for the 18 patients. Five C-tube related adverse events were observed, all of which occurred in the patients with traditional laparoscopic transcystic drainage, including two abnormal position of the C-tube, and three early dislocation of the C-tube. All the 5 adverse events caused no complications. Only one grade one complication occurred, which was in a patient with modified laparoscopic transcystic drainage. The patient demonstrated transient fever after C-tube removal, but there was no bile in the drainage tube and the subsequent CT examination confirmed no bile leakage. The fever spontaneously relieved with conservative observation, and the patient recovered uneventfully with discharge the next day. All the 18 patients were followed up for 1-20 months (median: 9 months). Normal liver function and no recurrence of stone were detected with ultrasonography or magnetic resonance cholangiopancreatography (MRCP). CONCLUSION Laparoscopic transcystic drainage combined with common bile duct exploration is safe and feasible in the treatment of patients with difficult biliary stones. The short-term effect is good. Modified laparoscopic transcystic drainage approach may reduce the incidence of C-tube dislocation and bile leak.
Humans ; Retrospective Studies ; Biliary Tract Surgical Procedures/adverse effects* ; Gallstones/etiology* ; Drainage/methods* ; Laparoscopy/adverse effects* ; Common Bile Duct/surgery*

Hilar cholangiocarcinoma has an extremely poor prognosis and is usually diagnosed at an advanced stage. Palliative management plays an important role in the treatment of patients with inoperable hilar cholangiocarcinoma. Surgical, percutaneous, and endoscopic biliary drainage are three modalities available to resolve obstructive jaundice. Plastic stents were widely used in the past; however, self-expanding metal stents (SEMS) have become popular recently due to their long patency and reduced risk of side branch obstruction, and SEMS are now the accepted treatment of choice for hilar cholangiocarcinoma. Bilateral drainage provides more normal and physiological biliary flow through the biliary ductal system than that of unilateral drainage. Unilateral drainage was preferred until recently because of its technical simplicity. But, with advancements in technology, bilateral drainage now achieves a high success rate and is the preferred treatment modality in many centers. However, the choice of unilateral or bilateral drainage is still controversial, and more studies are needed. This review focuses on the endoscopic method and discusses stent materials and types of procedures for patients with a hilar cholangiocarcinoma.
Bile Duct Neoplasms/*surgery ; Bile Ducts, Intrahepatic/*surgery ; Cholangiocarcinoma/*surgery ; Cholangiopancreatography, Endoscopic Retrograde ; Drainage/adverse effects/instrumentation/*methods ; *Endoscopy/adverse effects/instrumentation ; Humans ; Prosthesis Design ; Stents ; Treatment Outcome

This study aimed to examine the clinical efficacy of minimally invasive percutaneous catheter drainage (PCD) versus open laparotomy with temporary closure in the treatment of abdominal compartment syndrome (ACS) in patients with early-stage severe acute pancreatitis (SAP). Clinical data of 212 patients who underwent PCD and 61 patients who were given open laparotomy with temporary closure in our hospital over the last 10-year period were retrospectively analyzed, and outcomes were compared, including total and post-decompression intensive care unit (ICU) and hospital stays, physiological data, organ dysfunction, complications, and mortality. The results showed that the organ dysfunction scores were similar between the PCD and open laparotomy groups 72 h after decompression. In the PCD group, 134 of 212 (63.2%) patients required postoperative ICU support versus 60 of 61 (98.4%) in the open laparotomy group (P<0.001). Additionally, 87 (41.0%) PCD patients experienced complications as compared to 49 of 61 (80.3%) in the open laparotomy group (P<0.001). There were 40 (18.9%) and 32 (52.5%) deaths, respectively, in the PCD and open laparotomy groups (P<0.001). In conclusion, minimally invasive PCD is superior to open laparotomy with temporary closure, with fewer complications and deaths occurring in PCD group.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Catheterization ; adverse effects ; methods ; Decompression, Surgical ; adverse effects ; methods ; Drainage ; adverse effects ; methods ; Female ; Humans ; Intra-Abdominal Hypertension ; complications ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; adverse effects ; methods ; Pancreatitis ; complications ; surgery ; Postoperative Complications

OBJECTIVETo investigate therapeutic strategy on septic arthritis after arthroscopic anterior cruciate ligament reconstruction.

METHODSThe clinical data of 6 cases of septic arthritis after arthroscopic anterior cruciate ligament reconstruction in our department from March 2005 to February 2014 were analyzed. All the patients were male,ranging in age from 18 to 36 years old. After operation, the knee joint became painful and swollen, and ESR and CRP were both increased. Culture of joint fluid allowed the recovery of staphylococcus epidermidis. The patients were dealt with arthroscopic debridement and infusion-drainage. The clinical results were evaluated by Lysholm rating system and range of motion.

RESULTSThe infection of all the patients was controlled. The ESR and CRP both recovered to normal level. The score of Lysholm rating system ranged from 85 to 95,and the range of motion was 120 to 135 degree.

CONCLUSIONArthroscopic debridement combined with infusion-drainage is effective in septic arthritis after arthroscopic anterior cruciate ligament reconstruction.

Adolescent ; Adult ; Anterior Cruciate Ligament Reconstruction ; adverse effects ; Arthritis, Infectious ; therapy ; Arthroscopy ; methods ; Blood Sedimentation ; C-Reactive Protein ; analysis ; Debridement ; methods ; Drainage ; Humans ; Male

OBJECTIVETo evaluate the effects of primary duct closure and T-tube drainage in laparoscopy choledochotomy to treat the common bile duct stones.

METHODSThe enrollment of the patients was in accordance with 6 criteria. 55 patients with cholecystolithiasis and secondary common bile duct stones from January 2000 to February 2003 were treated with laparoscopic choledochotomy. The patients were randomly divided into two groups: primary duct closure group and T-tube drainage group. Their all data were recorded and studied prospectively,and patients were followed up after discharge.

RESULTSThere were 27 patients and 28 patients in primary duct closure group and T-tube drainage group respectively. The operation time and the results of following up between the two groups had no significant difference. Compared with T-tube drainage group, primary duct closure group had less the total quantity of postoperative transfusion and hospital costs, shorter postoperative hospital stay. The incidence of postoperative complications in primary duct closure group was 11.1% (3/27), and all of them were biliary complications. The incidence of postoperative complications in T-tube drainage group was 28.6% (8/28), and seven of them were biliary complications. The incidence of severe complications that needed reoperations was 10.7% (93/28), and all of them were caused by T-tubes. There was no mortality in two groups.

CONCLUSIONSThe primary duct closure in laparoscopic choledochotomy can avoid the deficiency of T-tube drainage, and it is feasible and safe and lower complications in treating the common bile duct stones, so we advocate it in appropriate cases.

Adolescent ; Adult ; Aged ; Child ; Choledocholithiasis ; surgery ; Choledochostomy ; methods ; Drainage ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Laparoscopy ; Male ; Middle Aged ; Suture Techniques ; Treatment Outcome

OBJECTIVETo compare the outcomes and complications of 3D versus 2D laparoscopic radical prostatectomy ( LRP) in the treatment of prostate cancer.

METHODSWe retrospectively reviewed 18 cases of prostate cancer treated by 3D LRP and another 32 by 2D LRP. We compared the general data, intraoperative blood loss, postoperative drainage time and hospital stay, Gleason scores, and incidence of complications between the two groups of patients.

RESULTSAll the operations were successful and none was transferred to open surgery. The two groups of patients were similar in terms of age, body mass index, Gleason scores, and clinical stages. However, compared with the 2D LRP group, the 3D LRP group showed significantly shorter operation time ([180.2 ± 69.1] vs [118.3 ± 55.1] min, P < 0.01), less blood loss ([236.5 ± 60.6] vs [89.1 ± 35.2] ml, P < 0.01), less postoperative drainage time ([7.1 ± 1.1] vs [5.3 ± 2.1] d, P < 0.01), shorter postoperative hospital stay ([20.2 ± 5.5] vs [14.4 ± 7.2] d, P < 0.01), and lower incidence of perioperative complications (3.1% vs 0, P < 0.01). The incisal margin was pathologically negative in both groups and urinary incontinence was found in neither at 6 months after surgery (P > 0.05).

CONCLUSION3D LRP, with its advantages of shorter operative time, faster recovery, and better outcomes than 2D LRP in the treatment of prostate cancer, deserves general application in lower-level hospitals.

Blood Loss, Surgical ; Body Mass Index ; Drainage ; Humans ; Laparoscopy ; adverse effects ; methods ; Length of Stay ; Male ; Neoplasm Grading ; Operative Time ; Prostatectomy ; adverse effects ; methods ; Prostatic Neoplasms ; pathology ; surgery ; Recovery of Function ; Retrospective Studies ; Urinary Incontinence ; etiology

Radiofrequency ablation (RFA) is a minimally invasive, image-guided procedure for the treatment of hepatic tumors. While RFA is associated with relatively low morbidity, sporadic bronchobiliary fistulae due to thermal damage may occur after RFA, although the incidence is rare. We describe a patient with a bronchobiliary fistula complicated by a liver abscess that occurred after RFA. This fistula was obliterated after placement of an external drainage catheter into the liver abscess for eight weeks.
Adult ; Biliary Fistula/*etiology/*surgery ; Bronchial Fistula/*etiology/*surgery ; Carcinoma, Hepatocellular/*surgery ; Catheter Ablation/*adverse effects ; Drainage/*methods ; Female ; Humans ; Liver Abscess/etiology/surgery ; Liver Neoplasms/*surgery

Percutaneous pericardiocentesis guided by two-dimensional echocardiography was introduced in 1983 as an alternative to electrocardiographically or fluoroscopically guided puncture for the management of pericardial effusion. The objective of this study was to investigate echocardiographically (echo) - guided pericardiocenteses performed at Yonsei Cardiovascular Center from January 1, 1993 to December 31, 2003, and also to determine whether patient profiles, etiology, and practice patterns have changed over this 11-year period. The medical records of 272 patients were examined and a follow-up survey was conducted. Patient clinical profiles, etiology, echocardiographic findings, and procedural details were determined for 2 periods: January, 1993 through December, 1997 (period 1) ; and January 1998 through December, 2003 (period 2). During the 11-year study period, 291 therapeutic, echo-guided pericardiocenteses with pericardial catheter drainage were performed in 272 patients. The number of pericardiocentesis in period 2 was increased compared with period 1 (191 cases vs. 100 cases). The mean age at pericardiocentesis increased from 49 +/-17 years in period 1 to 55+/-16 years in period 2 (p< 0.05). The procedural success rate was 99% overall with a major complication rate of 0.7% (2 cases of right ventricular free wall perforation which required emergency operation). Only one procedure-related mortality (< 30 days) was noted. Malignancy was the leading cause of a pericardial effusion requiring pericardiocentesis (45.6%). The incidence of pericardial effusion following cardiothoracic surgery and percutaneous coronary intervention procedures accounted for nearly 20% of all pericardiocenteses performed. Echo-guided pericardiocentesis has become a safe, standard practice for clinically significant pericardial effusion, in line with the changes of patients profiles over the 11 years of the study.
Adult ; Aged ; Cardiac Tamponade/therapy/ultrasonography ; Drainage ; *Echocardiography ; Female ; Human ; Male ; Middle Aged ; Pericardial Effusion/*therapy/*ultrasonography ; Pericardiocentesis/adverse effects/*methods ; Retrospective Studies ; Treatment Outcome

Recent progress in chemotherapy has prolonged the survival of patients with malignant biliary strictures, leading to increased rates of stent occlusion. Even we employed metallic stents which contributed to higher rates and longer durations of patency, and occlusion of covered metallic stents now occurs in about half of all patients during their survival. We investigated the complication and patency rate for the removal of covered metallic stents, and found that the durations were similar for initial stent placement and re-intervention. In order to preserve patient quality of life, we currently recommend the use of covered metallic stents for patients with malignant biliary obstruction because of their removability and longest patency duration, even though uncovered metallic stents have similar patency durations.
Biliary Tract Diseases/*surgery ; Coated Materials, Biocompatible ; Device Removal ; Drainage/methods ; Endoscopy ; Foreign-Body Migration/surgery ; Humans ; Metals ; Postoperative Complications/surgery ; *Stents/adverse effects

OBJECTIVETo explore the clinical effects of pedicled omentum covering and wrapping the ureteral anastomosis to prevent ureteral anastomotic leakage after surgery of abdominal and pelvic tumors.

METHODSClinical data of 64 patients with ureteral anastomosis after surgery of abdominal and pelvic tumors treated in our department from May 2005 to May 2012 were retrospectively analyzed. They were assigned into 2 groups. There were 23 patients of ureteral anastomosis combined with pedicled omentum surrounding and wrapping the anastomotic site (optimization group), and 41 cases of ureteral anastomosis alone (control group). The clinical data of all the 64 patients were reviewed and the therapeutic effects of the two treatment approaches were compared.

RESULTSAt one week after the operation, there were 8 cases (34.8%, 8/23) with ureteral anastomotic fistula in the optimization group and 31 cases (75.6%, 31/41) in the control group (P = 0.010). In the postoperative days 1-3, the average drainage everyday from abdominal tube around the anastomotic site was 260.4 ml and 320.8 ml, respectively (P = 0.446). The average drainage volume everyday was 80.5 ml and 160.5 ml from the postoperative day 4 to day 7 (P = 0.015). The average time of removal of the peritoneal cavity drainage tube was 18.5 d in the optimization group and 32.6 d postoperatively in the control group (P = 0.015).

CONCLUSIONSCovering and wrapping the ureteral anastomosis with pedicled omentum can promote the rapid adhesion of surrounding tissues to reduce urine leakage and postoperative complications, and shorten the surgical treatment cycle.

Abdominal Neoplasms ; surgery ; Aged ; Anastomosis, Surgical ; adverse effects ; Anastomotic Leak ; etiology ; prevention & control ; Drainage ; methods ; Female ; Humans ; Male ; Middle Aged ; Omentum ; surgery ; Pelvic Neoplasms ; surgery ; Retrospective Studies ; Ureter