PURPOSE: To evaluate the surgical results of endonasal dacrocystorhinostomy with two silicone intubation in common canalicular obstruction. METHODS: Forty patients (57 eyes) who complained of tearing due to common canalicular obstruction underwent endonasal dacryocystorhinostomy. In this study, We randomly divided patients into two groups. One group underwent one-silicone tube intubation (29 eyes, group A) and the other group underwent two-silicone tube intubation (28 eyes, group B). After surgery, we compared the success rates and the causes of surgical failure between the two groups. RESULTS: There were no significant differences between the two groups with regard to age, sex, duration of silicone intubation, or follow-up time. The primary success rates of the group A and the group B were 65.5% (19/29) and 85.7% (24/28) [(P=0.078)], respectively. the final success rates after the revisional surgery were 76.4% (21/29) and 92.8% (26/28) [(P=0.043)] respectively. Primary causes of surgical failure in the group A were: membranous obstruction of the internal ostium (6), common canalicular re-obstruction (2), sump syndrome (1), and functional obstruction (1). The main causes of surgical failure in the group B were: membranous obstruction of the internal ostium (2), and granuloma formation (2). CONCLUSIONS: We believe that endonasal dacryocystorhinostomy with two-silicone tube intubation might be an excellent alternative treatment modality in order to improve success rates in common canalicular obstruction.
Dacryocystorhinostomy ; Follow-Up Studies ; Granuloma ; Humans ; Intubation ; Postcholecystectomy Syndrome ; Silicones*

Laparoscopic cholecystectomy has been widely performed as a gold standard in patients with symptomatic gallstone disease. To avoid bile duct injury during operation, it is recommended that dissection should be kept close to the gallbladder despite the potential risk of long cystic duct stump. Post-cholecystectomy syndrome refers to a wide spectrum of conditions that often pose a diagnostic and therapeutic dilemma for surgeon. Cystic duct remnant may cause postcholecystectomy syndrome in the presence of stones. A case is presented in which a symptomatic gallbladder remnant with gallstone was removed successfully by laparoscopic technique. In the era of laparoscopic surgery, which favors a long cystic duct remnant, we should be aware of cystic duct remnant stones as a possible cause of post-cholecystectomy syndrome.
Bile Ducts ; Calculi* ; Cholecystectomy, Laparoscopic ; Cystic Duct* ; Gallbladder* ; Gallstones ; Humans ; Laparoscopy ; Postcholecystectomy Syndrome

Sump syndrome is a rare late complication of choledochoenteric anastomosis, and this caused by the accumulation of food debris, choledocholithiasis, bile sludge and cholesterol crystals in the distal common bile duct. This syndrome is characterized by symptoms such as abdominal pain and fever. The treatment modality for this syndrome has been surgery in the past. However, endoscopic treatment such as endoscopic sphinterotomy is currently regarded as the primary therapeutic approach for this condition. We experienced a patient with a history of choledochoduodenostomy and who developed sump syndrome as a complication of the surgery. Endoscopic sphinterotomy was performed for treatment, but this only produced the recurrence of the disease. The recurrent sump syndrome was eventually successfully controlled by performing endoscopic papillary balloon dilatation.
Abdominal Pain ; Bile ; Choledocholithiasis ; Choledochostomy ; Cholesterol ; Common Bile Duct ; Dilatation ; Fever ; Humans ; Postcholecystectomy Syndrome ; Recurrence ; Sewage

PURPOSE: Postcholecystectomy syndrome (PCS) is characterized by abdominal symptoms following gallbladder removal. However, there is no consensus for the definition or treatment for PCS. The purpose of this study was to define PCS among various symptoms after laparoscopic cholecystectomy, and to identify risk factors affecting PCS. METHODS: This study was conducted at Dongguk University Ilsan Hospital and Chung-Ang University Hospital (2012–2013). Outcomes were assessed using European Organization for Research and Treatment of Cancer QLQ–C30 questionnaire. Symptom cluster for determining PCS was made by factor analysis. Cluster analysis evaluating risk factors of PCS was made by Ward methods and Dentogram. RESULTS: Factor analysis revealed three distinct symptom clusters, those are ‘insomnia and financial difficulties (eigenvalue, 1.707; Cronbach α, 0.190),’‘appetite loss and constipation (eigenvalue, 1.413; Cronbach α, 0.480),’ and ‘right upper quadrant (RUQ) pain and diarrhea (eigenvalue, 1.245; Cronbach α, 0.315).’ Among these symptom clusters, the cluster of ‘RUQ pain and diarrhea’ was determined as PCS. However, we could not find any risk factors between high symptomatic group and low symptomatic group. CONCLUSION: PCS could consist of RUQ pain and diarrhea. Well-designed prospective trials are needed to determine risk factors of PCS.
Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Consensus ; Constipation ; Diarrhea ; Gallbladder ; Postcholecystectomy Syndrome* ; Prospective Studies ; Quality of Life ; Risk Factors

Postcholecystectomy syndrome is the persistence or recurrence of symytom complex following cholecystectomy, The majority of the patients have mild symptoms. However, the cause of recurrent symptoms is often obscure and as a consequence, a plan of management is difficult to formulate. Recently ERCP has proved to be increasingly helpful in the investigation of postcholecystectomy patients. The purpose of this study was to test the effectiveness of the ERCP in the evaluation of patients with postcbiolecystectomy syndrorae. The results are as follows 1) 102 postcholecystectomy patients were studied by endoscopic retrograde cholangiopancreatography and successful cannulation with demonstration of at least one duct was achieved in 49 of 50 jaundiced patients and in 49 of 52 non-jaundiced patients. The overall success rate was 96. 1%. 2) The results of ERCP were normal in 26 patients(26.5%) and abnormal in 72 patients (73.5%), Only 3 of 50 jaundiced patients were normal, but 23 of 52 non-jaundiced patients showed no abnormal findings. 3) The most common abnormality was biliary stone in common bile duct and intrahepatic duct which were present in 51 patients(50%). Cholangitis without stone was next common finding which was in 13 patients(13%). Of the remaining patients have air biligram, 2 CBD stricture, 1 CBD aseariasis & 1 chronic pancreatitis. 4) Time lapse between onset of symptoms and cholecystectomy was variable. 31 patients were studied less than 2 years after cholecystectomy. 18 of these patients had jaundice and 13 had no jaundice. Within 2 years afte chklecystectomy, the biliary stone was most common finding which were present in 14 out of 31 patients.
Catheterization ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholangitis ; Cholecystectomy ; Common Bile Duct ; Constriction, Pathologic ; Humans ; Jaundice ; Pancreatitis, Chronic ; Postcholecystectomy Syndrome ; Recurrence

PURPOSE: To evaluate the usefulness of laser cystectomy for the treatment of patients with dacryocystitis and sump syndrome. METHODS: Thirteen patients (13 eyes) diagnosed with acute or chronic dacryocystitis, and nine patients (9 eyes) who developed sump syndrome after dacryocystorhinostomy from 2005 to 2006 underwent laser cystectomy and endonasal dacryocystorhinostomy. RESULTS: Pain and swelling around the orbit improved immediately after the operation in patients with acute dacryocystitis, and all symptoms of sump syndrome disappeared by 1 month postoperatively. Epiphora reduced in all patients. During the follow-up period, functional nasolacrimal duct obstruction occurred in one eye and membranous obstruction developed in two eyes. In these two eyes with membranous obstruction, revisional surgery was performed successfully. No recurrence of dacryocystitis was noticed. CONCLUSIONS: Laser cystectomy with endonasal dacryocystorhinostomy is a simple and effective treatment modality for patients with dacryocystitis and sump syndrome that minimizes the risk of recurrence.
Cystectomy ; Dacryocystitis ; Dacryocystorhinostomy ; Eye ; Follow-Up Studies ; Humans ; Lacrimal Apparatus Diseases ; Nasolacrimal Duct ; Orbit ; Postcholecystectomy Syndrome ; Recurrence

Sump syndrome is one of the late complications of a side to side choledochoduodenostomy, but it is a rare malady. The anastomosis of the bile duct and small bowel results in exclusion of the distal limb of the common bile duct from drainage of bile with the potential formation of a sump. Food material and bile sludge may accumulate in distal segment of common bile duct and so this cause recurrent bile duct stones. Bezoars frequently result from disturbed passage of the gastrointestinal tract, especially after surgery, and it may develop various symptoms by irritating or obstructing the gastrointestinal tract. The bezoar accompanied with sump syndrome after choledochoenterostomy has not yet been reported in the literature. We report here on a case of small intestinal obstruction due to bezoars accompanied with sump syndrome.
Bezoars ; Bile ; Bile Ducts ; Choledochostomy ; Common Bile Duct ; Drainage ; Extremities ; Gallstones ; Gastrointestinal Tract ; Intestinal Obstruction ; Postcholecystectomy Syndrome ; Sewage

BACKGROUND/AIMS: Gallbladder diseases can give rise to dyspeptic or colonic symptoms in addition to biliary pain. Although most biliary pain shows improvement after cholecystectomy, the fates of dyspeptic or colonic symptoms still remain controversial. This study assessed whether nonspecific gastrointestinal symptoms improved after laparoscopic cholecystectomy (LC) and identified the characteristics of patients who experienced continuing or exacerbated symptoms following surgery. METHODS: Sixty-five patients who underwent LC for uncomplicated gallbladder stones or gallbladder polyps were enrolled. The patients were surveyed on their dyspeptic or colonic symptoms before surgery and again at 3 and 6 months after surgery. Patients' mental sanity was also assessed using a psychological symptom score with the Symptom Checklist-90-Revised questionnaire. RESULTS: Forty-four (67.7%) patients showed one or more dyspeptic or colonic symptoms before surgery. Among these, 31 (47.7%) and 36 (55.4%) patients showed improvement at 3 and 6 months after surgery, respectively. However, 18.5% of patients showed continuing or exacerbated symptoms at 6 months after surgery. These patients did not differ with respect to gallstone or gallbladder polyps, but differed in frequency of gastritis. These patients reported lower postoperative satisfaction. Patients with abdominal symptoms showed higher psychological symptom scores than others. However, poor mental sanity was not related to the symptom exacerbation. CONCLUSIONS: Elective LC improves dyspeptic or colonic symptoms. Approximately 19% of patients reported continuing or exacerbated symptoms following LC. Detailed history-taking regarding gastritis before surgery can be helpful in predicting patients' outcome after LC.
Brief Psychiatric Rating Scale ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Colon* ; Gallbladder ; Gallbladder Diseases ; Gallstones ; Gastritis ; Humans ; Polyps ; Postcholecystectomy Syndrome ; Surveys and Questionnaires

During laparoscopic cholecystectomy, the cystic duct is frequently divided closer to the gallbladder to avoid iatrogenic injury to the common bile duct. Postcholecystectomy syndrome can be considered if the patient complains of right upper abdominal discomfort after cholecystectomy. We report a case of a laparoscopic resection for the treatment of a symptomatic remnant huge cystic duct with stones after a previous laparoscopic cholecystectomy. A 46-year-old male was admitted to our hospital due to right upper quadrant abdominal pain. Five years earlier, the patient had undergone a laparoscopic cholecystectomy under the diagnosis of acute calculous cholecystitis but he subsequently suffered from intermittent right upper abdominal pain and fever. An abdominal computed tomography scan revealed a stone in a dilated remnant cystic duct. A laparoscopic remnant cystic duct resection was performed and apathologic diagnosis was made with chronic calculus cystic duct inflammation. The patient was discharged without complications and has been doing well without recurrent symptoms.
Abdominal Pain ; Calculi ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Common Bile Duct ; Cystic Duct ; Fever ; Gallbladder ; Humans ; Inflammation ; Laparoscopy ; Male ; Middle Aged ; Postcholecystectomy Syndrome

BACKGROUND/AIMS: After cholecystectomy, patients have reported postcholecystectomic syndromes such as abdominal symptoms, dyspepsia, and diarrhea, which suggest a relationship between cholecystectomic symptoms and diet, although the details of this association remain unclear. The present study investigated the hypothesis that dietary intake of nutrients and foods was significantly associated with postcholecystectomic syndromes. METHODS: Gallstone patients (n = 59) who underwent laparoscopic cholecystectomy were enrolled, and dietary intake and clinical parameters were assessed immediately postcholecystectomy and 3 months later. RESULTS: There were no significant differences in biochemical measurements or characteristics between symptomatic and asymptomatic patients. Immediately postcholecystectomy, there were no significant differences in consumption of nutrients or foods between symptomatic and asymptomatic patients. However, 3 months after cholecystectomy, symptomatic patients consumed more animal protein, cholesterol, and eggs, and fewer vegetables than did asymptomatic patients. Multivariable-adjusted regression analyses also indicated that the risk for symptoms was positively associated with intake of animal protein, cholesterol, and eggs, but negatively associated with intake of vegetables after adjusting for confounders. In addition, symptomatic patients consumed more bread-based breakfast foods, while asymptomatic patients consumed more rice. CONCLUSIONS: Postcholecystectomic syndromes were positively associated with intake of cholesterol, animal protein, and eggs, and negatively associated with intake of vegetables, suggesting that diet was plays a role in postcholecystectomic syndromes.
Animals ; Breakfast ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholesterol ; Diarrhea ; Diet ; Dyspepsia ; Eggs ; Follow-Up Studies ; Gallbladder Diseases* ; Gallbladder* ; Gallstones ; Humans ; Ovum ; Postcholecystectomy Syndrome ; Vegetables