Biomedical subjects

J L Overby

Publications and source records attributed to J L Overby.

3 recordsLinked to original sources

PubMed1987

Choledochoscopy in prevention of retained common bile duct stones.

More than 150,000 patients undergo exploration of the common bile duct each year in the United States, and approximately 10 per cent of these patients are later found to have retained common bile duct stones. The usual recommended procedure to decrease the incidence of retained calculi is a more complete exploration of the common duct at time of initial operation. It is thought that the incidence of retained common bile duct stones can be decreased and almost eliminated with proper use of the flexible choledochoscope following intraoperative cystic duct cholangiogram. The technical aspects of choledochoscopy are reviewed and experience with its use in 102 cases between July 1978 and October 1985 is reported. There were no residual stones in the span of the study using the flexible choledochoscope as a routine procedure in common bile duct exploration.

Endoscopes↗

PubMed1986

Routine intraoperative cholangiogram.

The value of a routine intraoperative cholangiogram is controversial. We reviewed 352 consecutive instances of cholecystectomy for nonmalignant disease during a period of three years to assess the diagnostic accuracy and additional cost of the roentgenographic technique. Intraoperative cholangiogram was done in all except 11 patients. Forty-nine of 341 patients underwent exploration of the common bile duct. The diagnosis was determined by the cholangiogram and was correct in 46 patients with three false-positive results. The other 292 patients did well without exploration of the common bile duct. The cholangiocatheter and a special cholangioclamp made the procedure easy and minimized additional operation time (five minutes with no mortality and negligible morbidity). Clinical indications for exploration of the common bile duct correlated poorly with abnormal findings in the bile duct. Unsuspected common duct stones were detected by cholangiogram in 17 (5 per cent) patients. Possible iatrogenic trauma to the common duct was prevented when significant abnormal findings were demonstrated by cholangiogram. The results of this study indicate that routine intraoperative cholangiogram is: accurate for diagnosis of common bile duct stones; useful in identification of bile duct anomalies and, thus, aids in preventing injury to the common bile duct; safe with negligible risk, and neither expensive nor time consuming if done correctly as a routine procedure.

Adult↗

PubMed1982

The extrahepatic biliary tract injury: perspective in diagnosis and treatment.

Nonsurgical trauma to the extrahepatic biliary tract is being reported with increasing frequency. There has been no recent review of the management of these injuries. Forty patients over the past twelve years at Charity Hospital, New Orleans, were studied. The 10% mortality rate was due to associated injuries. Tangential injuries were best managed by suture closure and T-tube drainage. Biliary-enteric anastomoses were most successful in the treatment of complete transections. Delayed diagnosis is not uncommon, and new methods of diagnosis are discussed. Injuries of this nature are responsible for high morbidity rates due to fistula or stricture formation. Successful management of these injuries is vital, even in those patients with more severe associated injuries.

Adolescent↗