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At least 37 records · Page 2Linked to original sources
PubMed1991

[Laparoscopic cholecystectomy: new evaluation of a surgical method in the light of endoscopic techniques].

The laparoscopic cholecystotomy was developed to remove calculi while preserving a functioning gallbladder. 120 phantom tests on pig's gallbladders were performed. No major complications were observed in 20 animal experiments with pigs. Compared with competing conservative and interventional methods the laparoscopic cholecystotomy provides immediate removal of stones and a definite closure of the gallbladder by a clip. Calcified stones are no contraindication for the procedure. After introduction into the clinical routine, an outpatient treatment in local anaesthesia seems to be possible. Patients with a high operative risk should be treated by this method. The laparoscopic cholecystotomy represents an alternative to the percutaneous transhepatic litholysis and the ESWL.

Anesthesia, Local↗
PubMed1990

Biliary elimination of low-dose methotrexate in humans.

We studied the pharmacokinetics of methotrexate (MTX) in a 64-year-old man with rheumatoid arthritis. After 6 months of treatment, acute clinical complications arose, requiring emergency laparotomy and cholecystotomy. A biliary tube was inserted, and this allowed for direct analysis of the bile. The pharmacokinetics of 2 separate doses of MTX (orally and intravenously) were assessed (dosage 10 mg/m2). No substantive differences in the pharmacokinetics were found between pre- and post-cholecystotomy MTX treatment, including clearance rates, volumes of distribution, and terminal half-lives. The results, however, demonstrated a change in the bioavailability of the drug (decreasing from 84.7% to 38.9%). Based on extrapolations of the data, with assumed rates of bile flow, the findings also suggest that there is substantial biliary elimination of MTX (8.7-26.0%) and its principal 7-hydroxy metabolite (1.5-4.6%).

Arthritis, Rheumatoid↗
PubMed1988

Acute acalculous cholecystitis in acute renal failure.

Acute acalculous cholecystitis developed in 16 of 92 patients with acute renal failure who had no prior or coincidental biliary tract disease. The cause of this complication is considered to be multifactorial. Risk factors include sepsis, previous surgery, trauma, total parential nutrition, intermittent positive pressure ventilation, opiate sedation, multiple transfusions and hypotension. One patient had 5 risk factors, 15 had 6 or more. Diagnosis was based on clinical suspicion, serial ultrasound scanning and serial estimations of white cell count, liver function and C-reactive protein. Four patients were treated conservatively with antibiotics and ultrasound observation, 10 underwent cholecystotomy and 2 patients had cholecystectomy. Eleven patients survived (69% survival). No patient treated by cholecystotomy required further surgery to the biliary tract. Acute acalculous cholecystitis has become a significant complication in our "high risk" acute renal failure population as intensive care has advanced and patients are surviving longer. Prompt and appropriate treatment will prevent it contributing significantly to the already high mortality of acute renal failure. Anticipation is the watchword.

Acute Disease↗
PubMed2006

[Percutaneous cholecystostomy in acute cholecystitis--a solution for risk patient groups?].

In treating acute cholecystitis in patients with a high operative risk, the general rule is to treat conservatively, with surgery indicated in those patients where this therapy is insufficient. Cholecystotomy is one alternative method of treatment. Due to its disadvantages, it belongs to one of the most seldomly used surgical procedures. These drawbacks, however, may be curtailed by using a percutaneous cholecystotomy (PC) done under CT or US navigation. The authors here recount their experiences of treating acute cholecystitis with PC in two case studies, relating difficulties in indication, technical performance, and complications of the procedure. In accordance with scientific literature, we consider PC an effective treatment method with minimal complications.

Aged, 80 and over↗
PubMed1993

Cholelithiasis in dogs: 29 cases (1980-1990).

Medical records of 29 dogs with cholelithiasis were reviewed. Aged female small-breed dogs were overrepresented. Mean age was 9.5 years, and mean weight was 12 kg. Vomiting, anorexia, weakness, polyuria/polydipsia, weight loss, icterus, fever, and signs of abdominal pain were the most common clinical signs. Leukocytosis, neutrophilia with left shift, monocytosis, high activity of serum hepatic enzymes, hypoalbuminemia, and high concentrations of serum total bilirubin were common. Radiopaque choleliths were evident on abdominal radiography of 13 of 27 dogs. Microbial culturing of bile isolated organisms in 15 of 20 dogs. Gram-negative bacteria were most common. Surgery was performed in 22 dogs. Four dogs were treated medically, and 3 dogs were euthanatized without treatment. Surgical treatment consisted of cholecystectomy in 11 dogs, choledochotomy in 5 dogs, cholecystotomy in 4 dogs, and cholecystojejunostomy in 1 dog. Sphincter of Oddiotomy was performed in 1 dog. Five dogs had concurrent generalized peritonitis attributable to bile. Multiple choleliths were detected in most of the dogs. Choleliths were located in the gallbladder in 20 dogs and in the bile ducts in 14 dogs. The most common abnormalities of the gallbladder, identified histologically, were chronic cholecystitis, mucosal hyperplasia, and pericholecystic inflammation. The most common abnormalities of the liver were cholestasis, hepatocellular degeneration, and periportal fibrosis. Survival rate of dogs that underwent cholecystectomy tended to be higher (86%) than that of dogs treated via cholecystotomy (50%) or cholecystectomy in combination with choledochotomy (33%). Dogs that underwent medical treatment, abdominal exploratory, cholecystojenunostomy, choledochotomy, and sphincter of Oddiotomy died or were euthanatized because of redevelopment of clinical signs associated with cholelithiasis.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

A safe new procedure for high-risk patients with symptomatic gallstones.

Cholecystectomy is associated with an appreciable mortality rate in elderly high-risk patients. Patients aged over 60 years with symptomatic gallstones, at high operative risk, underwent cholecystotomy under local anaesthesia through a 3-cm incision. Stones were removed and clearance was demonstrated endoscopically and by tube cholecystography. Catheter drainage was continued for 7 days until a further cholecystogram confirmed clearance. The procedure was attempted in 26 patients with concomitant cardiovascular, respiratory or malignant disease. Successful removal of all gallbladder stones was possible in 24 patients. Four patients had common bile duct stones demonstrated on cholecystography, all of which were successfully treated by endoscopic sphincterotomy. All patients are symptom-free at a mean follow-up of 36 weeks with no recurrent stones on ultrasonography.

Aged↗
PubMedDate not supplied

Immediate cystic duct occlusion using an endoluminal absorbable polyglycolic acid screw.

Endoscopic in situ occlusion of the cystic duct and ablation of the gallbladder could constitute a useful alternative to cholecystectomy in certain patients. The purpose of this study was to examine the feasibility of endoluminal occlusion of the cystic duct using a biodegradable polyglycolic acid screw and simultaneous gallbladder mucosal ablation with a Sotradecol-ethanol mixture. Eight pigs had operative cholecystotomy. A polyglycolic acid screw was twisted into the cystic duct after the proximal cystic duct mucosa was thermally ablated using electrocautery. Cholecystography confirmed occlusion of the cystic duct. Synchronous ablation of the gallbladder mucosa was then done by instilling absolute alcohol and 2% Sotradecol. The gallbladder was drained. Animals were sacrificed on days 14, 28, and 42. All animals survived operation and showed no untoward effects. Postmortem gross inspection showed gallbladders were shrunken and surrounded with adhesions from adjacent tissue. Cholangiography and cholecystography confirmed occlusion of the cystic duct in 6 of 8 pigs (75%). Histopathologic examination showed extensive areas of mucosal necrosis mixed with small areas of epithelial regeneration. Immediate occlusion of the cystic duct is possible using an endoluminal polyglycolic acid screw.

Animals↗
PubMed1986

Percutaneous removal of large gallstones.

Two patients are described in whom large gallstones, up to 4 cm in diameter, were removed percutaneously. The technique has some relevance to high risk patients with surgical cholecystotomies in whom elective cholecystectomy may be deferred if all the calculi can be removed. It may also be relevant if "percutaneous cholecystectomy" is ever developed clinically.

Aged↗
PubMed1976

Carl Langenbuch and the first cholecystectomy.

Cholecystectomy is the second most common operation performed today, but its founder, Carl Langenbuch, has received little recognition. The evolution of biliary surgery to the first cholecystectomy is traced. Contributions of von der Wiel, Petit, and Thudicum are reviewed. The cases of the first cholecystotomy by John Stough Bobbs, the first cholecystostomy by Marion Sims, and the first cholecystectomy of Carl Langenbuch are described.

Berlin↗
PubMed1986

The effects of prosthetic gallstones on gallbladder function and bile composition.

Diminished gallbladder emptying has been implicated in the pathogenesis of gallstone formation. This study assessed the effect of the physical presence of inert, prosthetic gallstones on gallbladder contractility, histopathology, and bile composition. Three glass beads, each 3 mm in diameter, were implanted in the guinea pig gallbladder. Six weeks later the in vitro contractility was assessed in response to cholecystokinin. Sham-operated animals underwent cholecystotomy without bead implantation. The gross and microscopic appearance of gallbladders from sham-operated and implanted animals was the same. The presence of stones moderately inhibited gallbladder contraction reaching 20.5% (P less than 0.05) at the maximally effective dose of cholecystokinin compared to sham-operated animals. Sham-operated and control (unoperated) animals had similar gallbladder contractility. Thus surgery itself did not alter gallbladder motility. The presence of stones had no effect on biliary lipid composition. It thus appears that gallstones, in the unobstructed gallbladder, cause only a moderate inhibition of gallbladder contractility and have little effect on biliary physiology.

Animals↗
PubMed1988

Extracorporeal shock-wave lithotripsy (ESWL). II. In vivo canine results of blast path treatment of human gallstones.

To evaluate the role of ESWL in vivo for the treatment of human gallstones positioned on the blast path, a canine model was developed to determine the efficacy of stone fragmentation and the subsequent histopathological injury that occurs as a result of this therapeutic technique. Twenty-four 16- to 20-kg mongrel dogs were divided into five groups: I: ESWL without stone, autopsy at 48 hr (N = 6); II: ESWL with stone (mean diameter 16.8 mm, range = 14-19 mm), autopsy at 48 hr (N = 10); III: ESWL without stone, autopsy at 41-46 days (N = 6); IV: ESWL without stone, autopsy immediately after ESWL (N = 1); V: No ESWL or stone, autopsy 2 hr after anesthesia induction (N = 1). A human gallstone (96% cholesterol) was inserted by cholecystotomy (N = 10) in Group II only. All groups (N = 24) had operative placement of a 6.5 Fr accordion catheter into the gallbladder for radiographic visualization. For each blast path treatment, 2000 discharges were delivered at 18-24 kV. Histopathologically, the Group V gallbladder served as a control. Groups I, II, and IV revealed mild subacute injury; dog gallbladders in Group III showed regression of these changes. Total surface area (TSA) of Group II stones increased from a pre-ESWL mean of 6.60 +/- 0.0.84 cm2 to 53.84 +/- 26.8 cm2 post-ESWL (P less than 0.001). Cumulative post-ESWL fragment sizes for particles in less than or equal to 2-, less than or equal to 3-, less than or equal to 5-, less than 10- and greater than or equal to 10-mm categories represented 32.9, 41.6, 49.4, 74.3, and 100% of pretreatment stone weight, respectively. These data indicate that human gallstones can be fractured to a variable degree when treated on the ESWL blast path and that TSA increased significantly. Gallbladder histopathologic changes appear to be reversible by 41-46 days post-ESWL.

Animals↗
PubMedDate not supplied

Interventional computed tomography.

Due to the development and refinement of computed tomography (CT), sonography, and interventional techniques, the field of interventional radiology has seen tremendous growth in recent years. In particular, the precise anatomic detail provided by CT and sonography has allowed percutaneous biopsies and abscess drainages to be performed safely and effectively. Percutaneous biopsies are now becoming the most common interventional radiographic procedures in many institutions. The usual indications for a biopsy are to determine the etiology of a mass, neoplasm, or inflammation, and to determine whether masses in known oncologic patients represent scarring or residual viable tumor. Accuracy rates for most percutaneous CT-directed biopsies are well over 90%, and the complication rate is very low. CT-directed percutaneous abscess drainages are also safe and effective and, in most cases, will be preferable to surgical drainage. The initial indications for percutaneous drainage (single, unilocular fluid collections) have been greatly expanded to include multiloculated collections, interloop abscesses, periappendiceal abscesses, and even percutaneous cholecystotomies. Biopsy and drainage procedures, together with their accuracy rates, indications and complications, are reviewed in this monograph.

Abscess↗
PubMed2001

A comparison of common bile duct pressures after botulinum toxin injection into the sphincter of Oddi versus biliary stenting in a canine model.

BACKGROUND: Botulinum toxin A (Botox) functionally paralyzes the sphincter of Oddi in both animals and humans, resulting in reduced pressures. No study, however, has specifically addressed common bile duct (CBD) pressures after Botox injection into the sphincter of Oddi with regard to treating biliary leaks and fistulae. The goals of this present study are to compare, versus biliary stenting, the change in CBD pressures after Botox injection into the sphincter of Oddi, as well as to evaluate the timing of onset and duration of these effects on sphincteric relaxation. METHODS: After midline laparotomy in 20 mongrel dogs, a pediatric umbilical catheter was inserted into the CBD via a small cholecystotomy and attached to a water-perfused pressure transducer. After baseline CBD pressure readings, a lateral duodenotomy was performed. A total of 100 units of Botox was injected with an endoscopic sclerotherapy needle into all four quadrants of the ampulla. The dogs were randomly divided into four groups to undergo repeat laparotomy at either postoperative day 1 (group I), postoperative day 3 (group II), postoperative day 7 (group III), or postoperative day 14 (group IV). At the time of second laparotomy, a pressure-sensing catheter was reinserted into the CBD and pressures recorded. Each dog then underwent transpapillary biliary stenting with a 7 Fr. x 5 cm Cotton-Leung biliary stent and CBD pressures were again recorded. RESULTS: CBD pressures were significantly lower as compared with baseline for all groups after Botox injection and after biliary stenting (P <0.001) In addition, no significant differences in the degree of CBD pressure reduction were identified between groups I through IV after Botox injection. The measured decrease in CBD pressure from baseline after Botox injection as compared with biliary stenting was significantly different for groups I and II (P <0.05) but not for groups III and IV. CONCLUSION: Botox injection into the sphincter of Oddi results in significant CBD pressure reduction within 24 hours and continues for 14 days. Also, after postoperative day 3, there is no significant difference in the reduction of CBD pressure from baseline between Botox injection and biliary stenting. Based on these findings, Botox injection into the sphincter of Oddi may be a beneficial alternative to biliary stenting for the treatment of biliary leaks and fistulae.

Animals↗