Authors' experience in the treatment of common bile duct stones (LVBP), including 592, operated patients, is presented. During the years 1969-1983, the most used technique was transduodenal sphincterotomy, while after 1983 choledocotomy, mostly with associated external temporary biliary drainage, was the preferred one. Since 1985 endoscopic sphincterotomy (SE) has been used, firstly for high-risk patients, and then with increasing indications; at present the first choice in treatment of LVBP consists in sequential SE and laparoscopic cholecystectomy. Postoperative results of these techniques showed a specific mortality rate of 1.1% for ST, of 0% for CT and SE, and a specific morbidity rate of 4.6% for ST, of 6.9% for CT and of 5.6% for SE. At follow-up patients in I and II Visick group were 87% for ST, 91% for CT and 100% for SE. Even if a statistical analysis of such results is not proposable, the only existence of a specific mortality for ST made us to change our choice. At present the treatment of choice for LVBP is in our opinion the sequential SE and laparoscopic cholecystectomy, waiting for a complete evaluation of all laparoscopic procedure. Traditional surgery is now indicated for failures of sequential approach and, as a first choice, for treatment of "empierrement" of common bile duct, for intrahepatic lithiasis and for atonic megacholedocus.

Choledochostomy↗

PubMedDate not supplied

[Latero-lateral portocaval anastomosis in the surgical treatment of portal hypertension: evaluation of a mean follow up of 14 years].

After the enthusiasm given by the new treatment techniques of complicated portal hypertension (sclerotherapy, TIPS and liver transplantation), various authors in the literature are considering the role of derivative surgery in the treatment of this affection, due to their consolidated experiences and with a long term follow-up. The authors analyse their own long experience, regarding 104 side-to-side porto-caval shunt. It has been done a complete follow-up, of 71 patients, for a period lasting from 4 to 20 years from the operation. Intraoperative mortality was 5,7%, global morbidity was 28%. Haemorrhagic recurrence from rupture of oesophageal varices was found in 2 cases (1 soon after and the other 3 months from the operation). 5 years survival was depending from Child score (96% Child A, 66,4 Child B, 25% Child C) and from the ethology of cirrhosis (70% for alcoholic cirrhosis and 80% for post-hepatitis cirrhosis). The survival was anyhow mainly connected with the persistence of alcohol abuse. The EPS appeared or became worse after the operation in 12 patients out of 71 checked (16.7%). It has never made a patient enable to lead an ordinary life. Due to the results of their own experience, the authors underline the efficacy of side-to-side porto-caval shunt in the prevention of the haemorrhagic recurrence from oesophageal rupture. In selected patients, Child A and B, not responding to the endoscopic treatment and in elective operations, the mortality was very well contained with a good prevention even after many years and a very small occurrence of EPS. For all those reasons, the side-to-side porto-caval shunt still keeps its validity also towards the selective shunts that are much more difficult technically and that can't be done on ascitic patients.

Esophageal and Gastric Varices↗

PubMedDate not supplied

[The "mixed" hospital department for clinical and rehabilitation purposes].

Explore the source record for details and available documents.

Community Health Services↗