Female ; Gallbladder Neoplasms ; complications ; Humans ; Middle Aged ; Skin Neoplasms ; secondary

PURPOSE: This study was to evaluate the safety and conversion rate of laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGBD) in patients with a complicated acute cholecystitis (GB empyema, gangrenous cholecystitis and pericholecystic abscess) according to the timing of LC. METHODS: One hundred and four patients, who underwent a laparoscopic cholecystectomy after PTGBD between March 2004 and December 2006, were analyzed. Thirty-four patients underwent LC within 7 days after PTGBD (early group, n=34) and 38 patients underwent LC between 14 and 39 days after PTGBD (delayed group, n=38). Thirty-two patients were excluded because of gallbladder cancer (n=2), simple acute cholecystitis (n=12), a history of previous abdominal surgery (n=5), and LC between 8 and 13 days after PTGBD (n=13). RESULTS: There was no significant difference in age (early group, 58.4+/-11.2; delayed group, 61.0+/-12.1), diagnosis, duration of symptoms, WBC counts, interval of admission and PTGBD, improvement of symptoms after PTGBD, American Society of Anesthesiologists (ASA) score, prior medical history, post-PTGBD and postoperative complications, and operation time. The rate of conversion to an open laparotomy was 14.7% (5/34) in the early group and 2.6% (1/38) in the delayed group (statistically not significant). CONCLUSION: The timing of LC after PTGBD for a complicated acute cholecystitis does not influence the rate of conversion to an open laparotomy, surgery time and complication. However, a delayed LC after PTGBD tends to decrease the rate of conversion to an open laparotomy.
Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cholecystitis, Acute* ; Diagnosis ; Drainage* ; Empyema ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Laparotomy ; Postoperative Complications

Gallbladder paraganglioma is a very rare tumor and so far only a few cases have been reported. Most of these were asymptomatic and were found incidentally during operation. Recently, we experienced a gallbladder paraganglioma that gave rise to hemorrhage, which in turn caused acute cholecystitis. Our case involved a 45 year-old female patient complaining of an intermittent right upper abdominal pain. After a preoperative evaluation, cholecystectomy and lymphadenectomy were performed under the impression of gallbladder cancer with acute cholecystitis. Postoperative pathologic examination revealed a hemorrhagic gallbladder paraganglioma accompanied by acute cholecystitis. Immunohistochemical staining of the chief cells for neuron specific enolase, chromogranin and synaptophysin were positive. Sustentacular cells also stained positively for S100 protein.
Acute Disease ; Case Report ; Cholecystitis/*etiology ; Female ; Gallbladder Neoplasms/*complications/pathology ; Hemorrhage/*complications ; Human ; Immunohistochemistry ; Middle Age ; Paraganglioma/*complications/pathology

BACKGROUND: A pancreaticoduodenectomy is the procedure of choice in patients with periampullary cancer. Because of the improvement in the postoperative mortality and morbidity over the past several decades, the indications for pancreaticoduodenectomy are becoming more extended. The aim of this study was to determine the incidence, the origin, and the present management strategy for early and late complications following this operation. METHODS: In one hundred twenty-two patients who had undergone a pancreaticoduodenectomy for periampullary cancer, mid bile-duct cancer, and other benign or malignant diseases during the period from Oct. 1994 to Dec. 1997 postoperative complications and operative mortality were analyzed retrospectively. RESULTS: Thirty-nine patients were treated for common bile-duct cancer, 37 patients for cancer, 22 patients for ampulla of Vater cancer, 5 patients for duodenal cancer, 4 patients for advanced gastric cancer, 2 patients for gall bladder cancer, and 13 patients for benign diseases or traumatic injury of the pancreas. A standard pancreaticoduodenectomy was performed in 92 patients, a pylorus-preserving pancreaticoduodenectomy in 12 patients, a total pancreatectomy in 11 patients, and a hepatopancreaticoduodenectomy in 7 patients. Of all the patients, 6 patients were treated with a pancreticoduodenectomy with combined portal vein resection. There was one hospital death. Postoperative complications occurred in 66 patients, and 24 patients had more than one. In 10 patients with complications, reoperative treatment was performed. The remaining 56 patients underwent the conservative treatments. CONCLUSIONS: The pancreaticoduodenectomy remains a formidable procedure despite the low mortality rate reported recently. Postoperative complications following a pancreaticoduodenectomy are common and their prompt recognition and appropriate management are of great importance in contributing to a successful outcome for the majority of patients.
Ampulla of Vater ; Duodenal Neoplasms ; Gallbladder Neoplasms ; Humans ; Incidence ; Mortality ; Pancreas ; Pancreatectomy ; Pancreaticoduodenectomy* ; Portal Vein ; Postoperative Complications* ; Retrospective Studies ; Stomach Neoplasms

PURPOSE: It is increasingly being recognized that the lymph node ratio (LNR) is an important prognostic factor for gallbladder carcinoma patients. The present study evaluated predictors of tumor recurrence and survival in a large, mono-institutional cohort of patients who underwent surgical resection for gallbladder carcinoma, focusing specifically on the prognostic value of lymph node (LN) status and of LNR in stage IIIB patients. METHODS: Between 2004 and 2011, 123 patients who underwent R0 radical resection for gallbladder carcinoma at the Chonnam National University Hwasun Hospital were reviewed retrospectively. Patients were staged according to the American Joint Committee on Cancer 7th edition, and prognostic factors affecting disease free survival, such as age, sex, comorbidity, body mass index, presence of preoperative symptoms, perioperative blood transfusion, postoperative complications, LN dissection, tumor size, differentiation, lymph-vascular invasion, perineural invasion, T stage, presence of LN involvement, N stage, numbers of positive LNs, LNR and implementation of adjuvant chemotherapy, were statistically analyzed. RESULTS: LN status was an important prognostic factor in patients undergoing curative resection for gallbladder carcinoma. The total number of LNs examined was implicated with prognosis, especially in N0 patients. LNR was a powerful predictor of disease free survival even after controlling for competing risk factors, in curative resected gallbladder cancer patients, and especially in stage IIIB patients. CONCLUSION: LNR is confirmed as an independent prognostic factor in curative resected gallbladder cancer patients, especially in stage IIIB gallbladder carcinoma.
Blood Transfusion ; Body Mass Index ; Chemotherapy, Adjuvant ; Cohort Studies ; Comorbidity ; Disease-Free Survival ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Joints ; Lymph Nodes ; Postoperative Complications ; Prognosis ; Recurrence ; Retrospective Studies ; Risk Factors

OBJECTIVETo summarize and compare the short-term and long-term clinical efficacy of percutaneous transhepatic biliary drainage (PTBD) and percutaneous transhepatic biliary stent (PTBS) in the treatment of malignant obstructive jaundice.

METHODS210 cases of malignant obstructive jaundice underwent interventional therapy, of which 161 cases of drainage catheters placement and 49 cases of metallic stent implantation. Follow-up information was obtained through telephone review or check-up records.

RESULTSThe technical success rate of technique was 100%. At 3 - 5 days after treatment, the serum total bilirubin in 15 metallic stent-treated patients was decreased by (178.04 +/- 42.32) micromol/L, and direct bilirubin by (83.97 +/- 23.63) micromol/L. Compared with those of 28 cases treated with drainage catheters: (95.67 +/- 34.28) micromol/L and (49.84 +/- 28.21) micromol/L, there were statistically significant differences between the two groups (P = 0.017 and P = 0.035). At 6 - 9 days after treatment, the serum total bilirubin in 28 cases of metallic stent group was decreased by (188.22 +/- 79.90) micromol/L, and that in 126 cases of drainage catheter group decreased by (141.39 +/- 65.32) micromol/L. The difference was statistically significant (P = 0.014). But the decline value of direct bilirubin had no significant difference. The median patency period and the median survival time of the drainage catheter group were 60 and 148 days, respectively, those of metallic stent group were 197 days and 245 days. There were statistically significant differences between the two groups (P < 0.05).

CONCLUSIONThe results of this study indicate that the short-term and long-term efficacies of metallic stent implantation are better than those of catheter drainage technique.

Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms ; complications ; Bilirubin ; blood ; Drainage ; instrumentation ; methods ; Female ; Gallbladder Neoplasms ; complications ; Humans ; Jaundice, Obstructive ; blood ; etiology ; therapy ; Liver Neoplasms ; complications ; Male ; Middle Aged ; Pancreatic Neoplasms ; complications ; Stents ; Survival Rate

Although acute acalculous cholecystitis (AAC) accounts for less than 10% of acute cholecystitis in the adult population, gangrene and perforation are much more frequent compared to the usual cases of acute cholecystitis (calculus cholecystitis). However, spontaneous biliary-enteric fistula is well recognized in AAC, 90% of which are cholecystoduodenal fistula (CDF) though it is an uncommon disorder. The majority of the CDF are caused by cholelithiasis. As patients are usually associated with complicated clinical illness, the diagnosis is often difficult to make and required surgery is often delayed. We have studied a rare complication of acute acalculous cholecystitis which was presented as intermittent upper gastrointestinal bleeding. Ulceration of the superficial branch of the cystic artery has been observed due to acalculous cholecystitis associated with a cholecystoduodenal fistula. We have performed a transfixing ligation of the bleeding vessel, cholecystectomy and simple closure of the CDF. We have finally made a diagnosis of early gallbladder cancer through a frozen section. There was no serious complication after the operation and the patient has achieved an uneventful recovery.
Acute Disease ; Cholecystectomy ; Cholecystitis/*diagnosis ; Duodenal Diseases/*complications ; Gallbladder Neoplasms/diagnosis ; Gastrointestinal Hemorrhage/*etiology ; Human ; Intestinal Fistula/*complications ; Male ; Middle Aged

BACKGROUND/AIMS: CyberKnife(TM) stereotactic body radiotherapy (SBRT) has been thought as a promising treatment modality for inoperable or recurred pancreaticobiliary malignancies. But, clinical course of CyberKnife(TM) treatment have not been established yet, so we report the experience of CyberKnife(TM) treatment in 19 patients with recurred or advanced pancreaticobilliary malignancies. METHODS: Between July 2008 and May 2009, 19 patients (gallbladder cancer 4, common bile duct cancer 5, and pancreatic cancer 10) with recurred (12) and advanced pancreaticobiliary cancer (7) underwent CyberKnife(TM) treatment in Soonchunhyang University Hospital. Tumor size was evaluated at 1, 3, 6, 8 and every 3 months after SBRT. RESULTS: The mean age was 60.2 years, and the mean size of target lesions was 28.1+/-1.30 mm. After CyberKnife(TM) treatment, the average size of target lesions was decreased; 2.53+/-4.18 mm from months 0-1 in 19 patients, 2.47+/-4.7 mm from months 1-3 in 15 patients, 0.08+/-5.11 mm from months 3-6 in 12 patients. However, the average size of target lesions was increased 3.67+/-8.98 mm from months 6-8 in 6 patients. There were 2 cases of massive duodenal ulcer bleeding after CyberKnife(TM) treatment, one of them expired due to ulcer bleeding. Also, other minor complications appeared such as 1 case of abdominal pain and 1 case of diarrhea. CONCLUSIONS: CyberKnife(TM) treatment seems to be effective in local control of pancreaticobiliary cancer, but we experienced serious complications. Further prospective studies will be needed for the proper evaluation of role of Cyberknife(TM) treatment in patients with advanced pancreaticobiliary malignancies.
Adult ; Aged ; CA-19-9 Antigen/analysis ; Common Bile Duct Neoplasms/complications/pathology/*surgery ; Female ; Gallbladder Neoplasms/complications/pathology/*surgery ; Gastrointestinal Hemorrhage/etiology ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms/complications/pathology/*surgery ; Radiosurgery ; Retrospective Studies ; Tomography, X-Ray Computed

Obesity is an important health problem in the world and related to many critical diseases, such as diabetes, cardiovascular disease, and metabolic syndrome. Obesity leads to fat infiltration of multiple organs and infiltrated adipose tissue produces many cytokines resulting in the dysfunction of organs such as the gallbladder. In the biliary diseases, obesity and overweight have been known as a major risk factor for gallstones. According to current studies, obesity, insulin resistance, hyperinsulinemia, and metabolic syndrome are related to various gallbladder diseases including gallbladder stones, cholecystitis, gallbladder polyps, and gallbladder cancers. We reviewed further literature on the obesity and gallbladder diseases, in aspects of epidemiology, mechanism, pathology and prevention.
Body Mass Index ; Cholecystitis/etiology ; Exercise ; Gallbladder Diseases/drug therapy/epidemiology/*etiology/prevention & control ; Gallbladder Neoplasms/epidemiology/etiology ; Gallstones/epidemiology/etiology ; Humans ; Hyperinsulinism ; Hypolipidemic Agents/therapeutic use ; Insulin Resistance ; Obesity/*complications ; Ursodeoxycholic Acid/therapeutic use ; Weight Loss

OBJECTIVE: To evaluate the feasibility, safety and the effectiveness of the complex assembly of open cell nitinol stents for biliary hilar malignancy. MATERIALS AND METHODS: During the 10 month period between January and October 2007, 26 consecutive patients with malignant biliary hilar obstruction underwent percutaneous insertion of open cell design nitinol stents. Four types of stent placement methods were used according to the patients' ductal anatomy of the hilum. We evaluated the technical feasibility of stent placement, complications, patient survival, and the duration of stent patency. RESULTS: Bilobar biliary stent placement was conducted in 26 patients with malignant biliary obstruction-T (n = 9), Y (n = 7), crisscross (n = 6) and multiple intersecting types (n = 4). Primary technical success was obtained in 24 of 26 (93%) patients. The crushing of the 1st stent during insertion of the 2nd stent occurred in two cases. Major complications occurred in 2 of 26 patients (7.7%). One case of active bleeding from hepatic segmental artery and one case of sepsis after procedure occurred. Clinical success was achieved in 21 of 24 (87.5%) patients, who were followed for a mean of 141.5 days (range 25-354 days). The mean primary stent patency period was 191.8 days and the mean patient survival period was 299 days. CONCLUSION: Applying an open cell stent in the biliary system is feasible, and can be effective, especially in multiple intersecting stent insertions in the hepatic hilum.
Adult ; Aged ; Aged, 80 and over ; *Alloys ; Bile Duct Neoplasms/*complications ; Cholangiocarcinoma/*complications ; Cholestasis, Intrahepatic/etiology/*therapy ; Drainage/*instrumentation ; Female ; Gallbladder Neoplasms/complications ; Humans ; Male ; Middle Aged ; *Palliative Care ; *Stents