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C N Tang

Publications and source records attributed to C N Tang.

At least 19 recordsLinked to original sources
PubMed2006

Laparoscopic exploration of the common bile duct: 10-year experience of 174 patients from a single centre.

OBJECTIVES: To evaluate the role of laparoscopic exploration of the common bile duct in the management of common bile duct stones. DESIGN: Retrospective study. SETTING: Regional minimal access surgery training centre in Hong Kong. PATIENTS: Patients undergoing laparoscopic exploration of the common bile duct from 1995 to 2005. MAIN OUTCOME MEASURES: Demographic information, reasons for failed endoscopic retrograde cholangiopancreatography and open conversions, and operative morbidity and mortality. RESULTS: A total of 174 laparoscopic explorations of the common bile duct were performed. Indications for surgery (some overlapping) included: concomitant gallstones and common bile duct stones (n=68, 39%) in young persons (<60 years), previously failed endoscopic extraction (n=59, 34%), large (>2 cm) or multiple common bile duct stones (n=40, 23%), and need for laparoscopic bypass to improve bile drainage (n=34, 20%). Mean patient age was 63 (standard deviation, 16) years and 103 were female. Altogether 156 choledochotomies and 18 transcystic duct explorations were performed, with 12 (7%) open conversions. The mean operating time was 129 (standard deviation, 57) minutes. Additional procedures included: 54 laparoscopic operative cholangiographies, 34 laparoscopic biliary bypasses, and 31 instances of adhesiolysis in patients with a history of open upper gastro-intestinal surgery. Complete stone clearance was achieved in 160 (92%) patients. Non-lethal complications occurred in 34 (20%) patients and one died of sepsis after a major bile leak. The mean postoperative stay was 9 (standard deviation, 9) days. Stone recurrence ensued in seven (4%) patients after a mean follow-up of 37 (standard deviation, 29) months. CONCLUSIONS: Laparoscopic exploration of the common bile duct is highly successful and can achieve satisfactory ductal clearance even after unsuccessful endoscopic extraction and previous upper gastro-intestinal surgery. In skilled hands, for selected patients laparoscopic bypass can also achieve improved bile drainage.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2006

A single-centre experience of 40 laparoscopic liver resections.

OBJECTIVE: To review results of laparoscopic liver resections, particularly in those patients with hepatic malignancy and recurrent pyogenic cholangitis. DESIGN: Retrospective analysis. SETTING: Minimal access surgery training centre, Hong Kong. PATIENTS: Patients with pathologies located at anterio-inferio-lateral segments (Couinaud segments 2, 3, 4b, 5, 6) for laparoscopic resection were recruited during the period 1998 to 2005. Patients were excluded from review if they had: pathologies at central locations and the superior and posterior segments (4a, 7, 8), large tumours (>5 cm in diameter), and those close to major vasculature or the liver hilum. RESULTS: During the study period, we attempted 40 such laparoscopic liver resections, excluding marsupialisations and resections for simple liver cysts. There were 20 female and 20 male patients, with a mean age of 57 (standard deviation, 13; range, 29-81) years. All but one underwent a successful laparoscopic operation. Pathology included hepatocellular carcinoma (n=17), recurrent pyogenic cholangitis (n=14), colorectal liver metastasis (n=4), benign liver tumour (n=4), and intrahepatic cholangiocarcinoma (n=1). All except four were hand-assisted laparoscopic liver resections. The mean operating time was 169 (range, 60-290) minutes and mean blood loss amounted to 270 mL (range, 0-1000 mL). Complications occurred in eight (20%) patients, which included six wound infections, one postoperative bile leak, and two incisional hernias. There was no operative or hospital mortality. For hepatocellular carcinoma, clear resection (>10 mm) was achieved in all except five patients, and the 1-year and 2-year survival rates were 86% and 59% respectively. Favourable results were also obtained for resections in patients with recurrent pyogenic cholangitis; after a mean (standard deviation) follow-up of 29 (23) months, only one was readmitted (for cholangitis). CONCLUSION: In appropriately selected patients, laparoscopic liver resection is feasible and safe, and achieves acceptable survival among individuals with hepatic malignancy and very favourable long-term outcomes in those with recurrent pyogenic cholangitis undergoing hand-assisted laparoscopic segmentectomy.

Adult↗
PubMed2005

An alternative gallbladder extraction technique in laparoscopic cholecystectomy.

In this era of minimally invasive surgery, the challenge remains in finding techniques to reduce access trauma in terms of fewer and smaller size trocar ports. Our new described technique will allow a smaller subxiphoid port to be used to achieve extraction of the gallbladder without the need to change to a 5 mm laparoscope. We believe this method is easy to learn, safe and with no observable complications from our experience.

Cholecystectomy, Laparoscopic↗
PubMed2005

Laparoscopy versus open left lateral segmentectomy for recurrent pyogenic cholangitis.

BACKGROUND: Recurrent pyogenic cholangitis (RPC) is a common disease in Southeast Asia. Its classical presentation is repeated attacks of cholangitis with multiple recurrences of bile duct stones. The stones are commonly located in the left lateral segments (2 and 3) and therefore complete clearance is difficult to achieve by either endoscopic retrograde cholangiopancreatography or surgical exploration of the common bile duct. The definitive treatment usually involves resection of the stone-harboring segments. The recent advent in laparoscopic surgery has shown that hand-assisted laparoscopic segmentectomy is a safe and feasible, alternative. This study aimed to compare hand-assisted laparoscopic segmentectomy with open segmentectomy in patients with recurrent, RPC. METHODS: This study retrospectively reviewed a prospectively maintained database of both open and laparoscopic treatments for RPC in a single center between 1994 and 2004. During this period, patients with RPC and left intrahepatic (segments 2 and 3) ductal stones not amendable to endoscopic treatment were recruited for analysis. Patients with concomitant gallbladder stones and common bile duct stones were offered left lateral segmentectomy with cholecystectomy and exploration of the common bile duct. Selected patients would have choledochoduodenostomy drainage during the same operation. The operations were performed via either the hand-assisted laparoscopic approach or the open approach using an ultrasonic surgical aspirator. The two cohorts were compared with respect to perioperative parameters to determine whether there would be any advantage in attempting hand-assisted laparoscopic segmentectomy. RESULTS: During the study period from 1994 to 2004, 17 patients underwent left lateral segmentectomy for RPC. Of the 17 patients, 10 had hand-assisted laparoscopic resections, and 7 underwent open resections. All open resections were performed before 1999. Despite the small number of patients and potential type 2 error, there were no differences in age, sex distribution, number of cholangitic attacks, sessions of endoscopic retrograde cholangiopancreatography before surgery, or number of previous operation between the two groups. The median operating time was shorter in the open group (232.5 vs 150 min; p = 0.007), whereas the median blood loss was similar (350 vs 400 ml; p = 0.551). The median postoperative stay was 8 days for hand-assisted laparoscopic group versus 14 days for the open group. This difference was statistically significant (p = 0.019). There was one open conversion in the hand-assisted laparoscopic group because of intraoperative bleeding from the left hepatic vein. Postoperative complication rates were lower in hand-assisted laparoscopic group, but the difference was not statistically significant (20% vs 57%; p = 126). The intramuscular pethidine requirement again was less in hand-assisted laparoscopic group (0 vs 600 mg; p = 0.002). There was no operative mortality in either group of patients. No recurrent cholangitis was noted in either groups during the median follow-up period of more than 3 years. CONCLUSION: This study not only confirmed the feasibility of hand-assisted laparoscopic segmentectomy for recurrent pyogenic cholangitis, but also showed that this treatment approach is associated with less pain and shorter hospital stay. However, hand-assisted laparoscopic segmentectomy is a lengthier operation and technically more challenging. Nevertheless, the authors believe that with more experience and further improvement of ancillary technology, this procedure can become a standard treatment for recurrent pyogenic cholangitis in selected cases.

Adult↗
PubMed2004

Laparoscopic exploration of common bile duct in difficult choledocholithiasis.

BACKGROUND: This review investigated the role played by laparoscopic exploration of the common bile duct (LECBD) in the management of difficult choledocholithiasis. METHODS: This retrospective study reviewed a prospective database of LECBD for difficult choledocholithiasis during the period 1995 to 2003. RESULTS: Of the 97 LECBDs performed in the authors' center from 1995 to 2003, 25 were performed for difficult choledocholithiasis. Difficult choledocholithiasis was defined as failure of endoscopic stone retrieval for the following reasons: access and cannulation difficulty, the difficult nature of common bile duct (CBD) stones, and the presence of endoscopic retrograde cholangiopancreatography (ERCP)-related complications. There were seven unsuccessful cannulations because of previous gastrectomy (n = 5) and periampullary diverticulum (n = 2). Among the 18 patients with failed endoscopic extraction, there were 10 impacted stones, 2 incomplete stone clearances after multiple attempts, 2 type 2 Mirizzi syndromes, 1 proximal stent migration, 1 repeated post-ERCP pancreatitis, 1 situs inversus, and 1 stricture at the distal common bile duct. There were 14 male and 11 female patients with a mean age of 67.8 +/- 15 years. Initial presentations included cholangitis (n = 14, 56%), biliary colic (n = 3, 12%), jaundice/deranged liver function ( n = 5, 20%), cholecystitis (n = 2, 8%), and pancreatitis (n = 1, 4%). Regarding the approach for LECBD, there were 2 transcystic duct explorations and 23 choledochotomies. The mean operative time was 149.4 +/- 49.3 min, and there were three conversions (12%). The stone clearance rate was 100%, and no recurrence was detected during a mean follow-up period of 16.8 months. Five complications were encountered, which included bile leak (3 patients) and wound infection (2 patients). When the results were compared with the remaining 72 LECBDs for nondifficult stones during the same period, the complication rate, conversion rate, and rate of residual stones were similar despite a longer operation time (149.4 +/- 49.4 min vs 121.6 +/- 50.5 min). CONCLUSION: When ERCP is impossible or stone retrieval is incomplete, LECBD is the solution to difficult CBD stones.

Adult↗
PubMed2004

Routine use of laparoscopic repair for perforated peptic ulcer.

BACKGROUND: Laparoscopic repair of perforated peptic ulcer was reported in 1990 but has not gained wide acceptance. The aim of this study was to evaluate the safety and efficacy of laparoscopic repair for perforated peptic ulcer in routine clinical practice. METHODS: This was a prospective analysis of 172 patients who underwent laparoscopic repair of a perforated peptic ulcer between July 1997 and June 2003. RESULTS: One hundred and seventy-two patients of mean age 54 (range 14-93) years had perforated peptic ulcer diagnosed by laparoscopy. There were 172 duodenal ulcers, 22 prepyloric and 13 non-juxtapyloric gastric ulcers. One hundred and sixty-five patients underwent omental patch closure of perforations; there were six Pólya gastrectomies and one ulcerectomy. Thirty-seven patients (21.5 per cent) required conversion to laparotomy. The mean operating time was 64.8 (range 14-180) min. The median postoperative requirement for intramuscular pethidine was one dose. The median postoperative hospital stay was 6 days. Complications occurred in 28 patients (16.3 per cent) resulting in three reoperations. Six patients with intra-abdominal collections were managed by percutaneous drainage. Two patients who underwent conversion developed a wound infection. Fourteen patients (8.1 per cent) died, 11 of whom were American Society of Anesthesiologists grade III and IV. CONCLUSION: Laparoscopic repair of perforated peptic ulcer is a safe emergency procedure in routine clinical practice for patients with perforated pyloroduodenal ulcer.

Adolescent↗
PubMed2003

Laparoscopic choledochoduodenostomy: an effective drainage procedure for recurrent pyogenic cholangitis.

BACKGROUND: This article reports the technical aspects of laparoscopic choledochoduodenostomy (LCD) in patients with recurrent pyogenic cholangitis (RPC) and the perioperative results are also evaluated. This is a retrospective review of a prospectively maintained database. METHODS: Twelve patients diagnosed to have RPC with the absence of intrahepatic stricture were selected for LCD during the period from 1995 to 2002. The majority of our patients had repeated attacks of cholangitis and had already undergone multiple sessions of endoscopic and operative lithotripsy. The LCD was performed using a five-port approach with the patient lying in the supine position. The stones were first cleared through the longitudinal supraduodenal choledochotomy followed by construction of a side-to-side diamond-shaped anastomosis of at least 15 mm between the bile duct and the first part of the duodenum using 2/0 monocryl in the single-layer method. RESULTS: During the period from 1995 to 2002, 12 patients with RPC underwent LCD. There were 3 male and 9 female patients with a mean age of 62 (40-77). The median operation time was 137.5 min (90-270) and the median postoperative stay was 7.5 days (5-20). All cases were successful using the laparoscopic approach. Average analgesic requirement post operation was 126 mg (50-200 mg) intramuscular pethidine. There was one postoperative bile leak, and this complication was settled by conservative measures. Upon a mean follow-up of 37.6 months (6-91), there was no recurrent attack of cholangitis or any evidence of sump syndrome in this group of patients. CONCLUSION: LCD is a safe and effective drainage procedure for patients with RPC. Complications are uncommon and postoperative results are promising.

Adult↗
PubMed2002

Hand-assisted laparoscopic segmentectomy in recurrent pyogenic cholangitis.

Recurrent pyogenic cholangitis (RPC) is a prevalent disease in Southeast Asia and presents a unique challenge to both gastroenterologist and hepatobiliary surgeon. Despite rapid development in endoscopic instrumentation and skill maturation, it is still difficult to clear those pigmented stones lodged in the intrahepatic ducts. The alternative approach to stones through the percutaneous transhepatic route can offer access for repeated ductal dilatation and lithotripsy. However, recurrence is still commonly seen. Resection of the atrophic stone-harboring segment has proven to be an effective treatment option associated with the lowest recurrence rate. Compared to the other technique, it is the only treatment that can potentially offer a cure. The complication rate is higher because of existing bacterial colonization and access trauma. With the accumulation of laparoscopic experience and improved instrumentation, laparoscopic liver resection is demonstrated to be safe and feasible for either benign or malignant conditions. This article reviews a single-center experience of hand-assisted laparoscopic segmentectomy (HALS) in patients with RPC.

Adult↗
PubMed2002

Laparoscopic cholecystectomy versus open cholecystectomy in elderly patients with acute cholecystitis: retrospective study.

OBJECTIVE: To study the safety and efficacy of laparoscopic cholecystectomy for acute cholecystitis in elderly patients by comparing the results with open cholecystectomy. DESIGN: Retrospective study. SETTING: Regional hospital, Hong Kong. SUBJECTS AND METHODS: Patients aged 75 years or older undergoing laparoscopic cholecystectomy for acute cholecystitis between January 1994 and December 1999 were selected from the database. The comparison group comprised patients from the same age-group who underwent open cholecystectomy for acute cholecystitis during the same period. MAIN OUTCOME MEASURES: Operating time, hospital stay, morbidity, and mortality. RESULTS. Thirty-one patients underwent laparoscopic surgery and 42 had open surgery. The demographic data and co-morbidities were comparable between the two groups. The postoperative hospital stay was significantly shorter for patients undergoing laparoscopy (P=0.03). The overall morbidity rate was significantly lower for patients undergoing laparoscopy (P<0.05). There was, however, no statistical significant difference in the mortality rate. There was no major bile duct injury for patients in either group. CONCLUSION: Laparoscopic cholecystectomy is a safe procedure for acute cholecystitis in elderly patients, resulting in fewer complications and shorter hospital stay than open cholecystectomy.

Acute Disease↗
PubMed2002

A retrospective review of transcatheter hepatic arterial embolisation for ruptured hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is a disease with a high prevalence in South East Asia. It is not uncommon to encounter rupture of the tumour in an emergency situation. Operative measures in this situation are often associated with high mortality rates. Transcatheter arterial embolisation (TAE) appears to be an effective alternative to surgery and is increasingly used by many centres. In this study, we have reviewed the outcome of our patients after receiving TAE and tried to identify prognostic indicator(s). PATIENTS AND METHODS: From 1996 to 2000, we had retrospectively reviewed the outcome of 31 patients who had undergone TAE for rupture of HCC and compared their survival with respect to different prognostic indicators. RESULTS: The were 31 patients with a mean age of 53 years. At the time of rupture, 19 patients had Child's A, 5 Child's B and 7 of Child's C disease. The most common presentation was abdominal pain (14 patients). Bleeding was successfully arrested in all 31 patients. The most common complication was fever (13 patients). The overall mean survival was 126 days. Eight patients died within 30 days of admission, the major cause of death was liver failure, which occurred in 6 patients. In addition, we had also postulated several prognostic indicators for patients' survival. The results showed that only those with a bilirubin level below 50 umol/L and who presented with shock had a poor outcome. CONCLUSION: TAE should be considered in the initial management of patients with ruptured HCC. It is effective in arresting tumour bleeding and allows the patient to have subsequent definitive management.

Carcinoma, Hepatocellular↗
PubMed2000

Laparoscopic pancreas-preserving total gastrectomy for proximal gastric cancer. A case and technical report.

Although total gastrectomy with distal pancreatectomy has been the standard surgical treatment for advanced gastric cancer, this procedure is frequently complicated by leakage of pancreatic juice and postoperative diabetes mellitus. We present the case of a 74-year-old woman with proximal gastric cancer who underwent a laparoscopic modification of an open pancreas-preserving procedure first described by Maruyama et al. in 1995. With this novel technique, there is no pancreatic leakage, and at 12-month follow-up our patient remains free of diabetes. Herein we give the details of our new method and offer some caveats for its performance.

Aged↗
PubMed1998

Pancreatic tuberculosis: case reports and review of the literature.

Tuberculosis affecting the pancreas is rare. Its occurrence may pose a diagnostic problem in differentiating it from carcinoma of the pancreas. Two cases of tuberculosis affecting the pancreas are reported, illustrating the value of fine needle aspiration in such a situation. The response of the disease to antituberculous drugs was slow, but sure.

Adult↗
PubMedDate not supplied

Primary closure versus T-tube drainage after laparoscopic choledochotomy for common bile duct stones.

BACKGROUND/AIMS: To demonstrate the safety and feasibility of primary closure of the common bile duct (CBD) after laparoscopic choledochotomy in patients with CBD stones. Traditionally, the CBD is closed with T-tube drainage after choledochotomy and removal of CBD stones. However, the insertion of a T-tube is not without complication and the patients have to carry it for several weeks before removal. In the laparoscopic era, surgery is performed with minimally invasive techniques in order to reduce the trauma inflicted on patients, hasten their recovery and hence reduce the hospital stay. T-tube insertion seems to negate these benefits and we believe that primary closure can be as safe as closure with T-tube drainage. METHODOLOGY: This is a retrospective analysis of patients who underwent primary closure of the CBD after successful laparoscopic choledochotomy for ductal stones between January 2000 and December 2003. A concurrent control group of patients who underwent T-tube drainage was used for comparison. RESULTS: Of the 64 patients that underwent laparoscopic exploration of the CBD, 24 (37%) underwent transcystic duct approach and 40 (63%) underwent choledochotomy. There were three open conversions (5%). Stone clearance was achieved in all patients with successful laparoscopic choledochotomy (100%). Of the 38 successful laparoscopic choledochotomies, 12 had primary closure of the CBD and 26 had closure with T-tube drainage. There was no mortality in both groups. One patient in the primary closure group suffered from paralytic ileus and small subhepatic collection which was treated conservatively. The median operative time (90 vs. 120 minutes, p=0.002) and postoperative stay (5 vs. 8.5 days, p=0.003) were shorter in the primary closure group when compared with the T-tube group. CONCLUSIONS: Primary closure of the CBD is feasible and as safe as T-tube insertion after laparoscopic choledochotomy for stone disease.

Adult↗
PubMedDate not supplied

Endo-laparoscopic approach in the management of obstructive jaundice and malignant gastric outflow obstruction.

BACKGROUND/AIMS: Only a minority of patients with tumor at the pancreaticoduodenal junction is suitable for resection, palliation is however often required relieving the obstructive jaundice and gastric outflow obstruction (GOO). This study evaluates endo-laparoscopic approach as a palliative treatment of obstructive jaundice and malignant gastric outflow obstruction. METHODOLOGY: A retrospective review of a prospectively maintained database. During the period from 1992-2002, patients with diagnosis of unresectable tumor at the pancreaticoduodenal junction were evaluated. If the tumor was confirmed to be unresectable, patients would be offered either open double bypass or laparoscopic gastrojejunostomy (LGJ) +/- endoscopic or percutaneous transhepatic stenting for any obstructive jaundice, the choice of approach would depend on whether the endoscopic access was still maintained. RESULTS: Out of 942 patients with tumors around the pancreaticoduodenal junction during the study period from 1992-2002, there were 34 patients (13 male & 21 female) with median age 69 years (range, 48-87) selected for LGJ. Of these 34 patients, 3 of them underwent endoscopic biliary stenting whereas 16 jaundice patients were palliated by transhepatic biliary drainage. When the results were compared to the 35 open double bypass (roux-en-Y choledochojejunostomy and gastrojejunostomy) during the same study period, the median operation time was significantly shorter (80 vs. 135 minutes; P=0.0001) and median intraoperative bleeding was significantly less in the endo-laparoscopic group (0 vs. 100mL; P=0.0001). Two patients in the endo-laparoscopic group were converted to open because of tumor infiltration of the small bowel mesentery causing difficulty in construction of gastrojejunostomy. Although the overall complication rate (13 vs. 17; P=0.387) and incidence of delayed gastric emptying (7 vs. 7, P=0.952) were similar in both groups, the incidence of wound infection was remarkably less common in the endo-laparoscopic group (0 vs. 6, P=0.012). The 15 postoperative complications (13 patients) in the endo-laparoscopic group (38.2%) included prolonged gastric stasis (7), biliary sepsis (2), chest infection (2), myocardial ischemia (2), gastrointestinal bleeding (1) and extensive ischemic stroke (1). Median time to resume diet was statistically shorter in endo-laparoscopic group (5 vs. 7 days, P=0.009) however the hospital stay was similar in both groups (11.5 vs. 14 days, P=0.238). The hospital mortality rate was again comparable between the two groups (6 vs. 5, P=0.703). The short median survival in the endolaparoscopic group (3 vs. 7 months; P=0.0001) might just be a reflection of selection bias. CONCLUSIONS: With the advent of laparoscopic and endoscopic surgery, palliation of both gastric outflow obstruction and obstructive jaundice can also be accomplished using the endo-laparoscopic approach. In comparing to the open double bypass, operation time, intraoperative blood loss and incidence of wound infection are significantly less and patients can have early resumption of diet. However, the results can be improved further with a better patient selection and perioperative optimization.

Aged↗