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At least 55 records · Page 3Linked to original sources
PubMed1993

Laparoscopic stenting for protection of common bile duct sutures.

Laparoscopic common bile duct exploration is comparable with the open operation and it is usually finished with the insertion of external bile drainage such as a T-tube. We performed an antegrade placement of a biliary stent with primary suture of the common bile duct following common bile duct exploration. We thereby avoided the acquisition of the additional expensive equipment required for the transcystic approach and the placement of a T-tube, which in our eyes contradicts the idea of minimized discomfort in minimally invasive surgery.

Adult↗
PubMed1989

Histological analysis of liver parenchyma and choledochal wall, and external diameter and intraluminal pressure of the common bile duct in controls and patients with common bile duct stones with and without acute suppurative cholangitis.

The purpose of this prospective controlled study was to determine the changes in intraluminal pressure and diameter of the common bile duct in a total of 121 bile patients with choledocholithiasis, and the consequences of these alterations for choledochal mucosa and liver histology. In fact, the reflux of bacteria from the obstructed biliary tract into the bloodstream is responsible for producing the clinical syndrome of acute suppurative cholangitis. Group I (26 patients) served as controls, Group II (50) had choledocholithiasis with clear green bile, and Group III (45) were patients with acute suppurative cholangitis with pus in the biliary tract. Ultrasonography revealed gallstones in all the patients. The external diameter of the common bile duct in patients with choledocholithiasis and acute suppurative cholangitis was significantly greater than in those of the other groups. Patients with acute suppurative cholangitis also had a higher intraluminal pressure than those of Groups I or II.

Acute Disease↗
PubMed1999

Recurrent common bile duct stones containing metallic clips following laparoscopic common bile duct exploration.

A case of recurrent common bile duct stones 2 years following laparoscopic cholecystectomy and laparoscopic common bile duct exploration in a 52-year-old man is reported. Surgical material as a nidus for recurrent stone formation has been reported and occurred in the present case. Factors influencing metallic clip migration after biliary surgery are discussed, with recommendations for decreasing recurrent stones caused by foreign material.

Cholangiography↗
PubMedDate not supplied

Tumor-associated focal chronic pancreatitis from invasion of the pancreatic duct by common bile duct carcinoma: radiologic-pathologic correlation.

We report a case of tumor-associated focal chronic pancreatitis of the uncinate process of the pancreas. The chronic pancreatitis was secondary to stenosis of the main pancreatic duct from invasion by a common bile duct carcinoma. A feature distinguishing the chronic pancreatitis from pancreatic carcinoma was the localized dilatation of pancreatic duct branches evident in the focal lesion of the uncinate process.

Cholangiocarcinoma↗
PubMed1996

Simultaneous bacteriologic assessment of bile from gallbladder and common bile duct in control subjects and patients with gallstones and common duct stones.

OBJECTIVES: To determine the simultaneous prevalence of bacteria in bile from the gallbladder and common bile duct and to determine the influence of the number of stones present on bacteriologic findings. METHODS: A prospective study was performed in 467 subjects divided into seven groups: 42 control subjects with normal biliary tracts, 221 patients with symptomatic gallstone disease, 12 patients with hydropic gallbladder, 52 patients with acute cholecystitis, 67 patients with common bile duct stones without cholangitis, 49 patients with common bile duct stones and acute cholangitis, and 24 patients with previous cholecystectomy and common bile duct stones. In all except controls, bile samples from the gallbladder and common bile duct were taken simultaneously for aerobic and anaerobic cultures. RESULTS: Control subjects had no bacteria in gallbladder bile. Patients with gallstones, acute cholecystitis, and hydropic gallbladder had similar rates of positive cultures in the gallbladder and common bile duct, ranging from 22% to 46%, but the rate was significantly higher in patients with common bile duct stones without cholangitis (58.2%). Patients with cholangitis or previous cholecystectomy had a high rate of positive cultures of common duct bile (93% to 100%). Age greater than 60 years had a significant influence on the rate of positive bile cultures. There was no relationship between the number of stones in the gallbladder or common bile duct and the percentage of positive cultures. In 98% of the patients, the same bacteria were isolated from gallbladder and common duct bile. CONCLUSIONS: In normal subjects, no bacteria were present in the biliary tract. Among patients with common bile duct stones, there was an increasing percentage of positive cultures according to the severity of the disease. Age had an important influence, but sex and the number of common bile duct stones had no influence on positive cultures.

Acute Disease↗
PubMed1995

A new method for early diagnosis of carcinoma in bile duct-sonography of common bile duct before and after injection of ceosunin.

42 cases of dilatation (7-15 mm) of extrahepatic bile duct after ceosunin injection (cholagogic method) were observed ultrasonographically. Among the 18 cases of testified obstructive lesions of the bile duct, 13 (72%) showed widening of the bile duct with an increase of calibre from 9.8 mm to 11.7 mm, 3 (16%) had no obvious change, and 2 (12%) shrank. Among the 24 cases of non-obstruction 22 (92%) shrank with a decrease calibre from 9.6 mm to 6.3 mm, and 2 (8%) showed no obvious change. After receiving cholagogue, 9 cases of periampullary carcinoma in the obstructive group were confronted with widening of the bile duct calibre. After longitudinal and transverse rotation scanning method was used, 8 of the 9 cases had their tumor mass visualized. Combined cholagogic and rotation scanning methods raised the lesion manifestation rate of lower bile duct from 41% to 88%. A dilated bile duct unable to show shrinkage of calibre after cholagogue injection is believed to be a criterion for judging the presence of a suspicious case of bile duct obstruction. This criterion has a sensitivity of 89%, specificity of 92%, and accuracy of 90%.

Adenocarcinoma↗
PubMed1986

Chemical composition of common bile duct stones.

The common bile duct stones obtained from 148 patients were analysed chemically for cholesterol, calcium and bilirubin. When stones were present in both the common bile duct and gallbladder at the time of surgery, the common duct stones were similar in chemical composition to gallbladder stones in the majority of cases and were predominantly cholesterol-type stones. However, common bile duct stones from patients whose gallbladders had been removed at least one year before the detection of common duct stones contained less cholesterol and more bilirubin than common bile duct stones which were associated with gallbladder stones. Thirty per cent of these stones contained suture material in the centre of the stone. Overall, the results indicate that common bile duct stones are more likely to be pigment type than gallbladder stones, especially if the common duct stones are large, have formed in the duct and become symptomatic less than 12 years after cholecystectomy. Non-absorbable suture material should be avoided in surgery involving the common bile duct.

Adolescent↗
PubMed2002

Laparoscopic transcystic bile duct stenting in the management of common bile duct stones.

BACKGROUND: The management of patients with common bile duct stones associated with stones in the gall bladder remains controversial. METHODS: Over the three-year period from 1996 to 1999, patients with cholelithiasis and known choledocholithiasis, or choledocholithiasis found at laparoscopic cholecystectomy, were initially treated by placing a stent across the sphincter of Oddi. The stent was pushed along a guide wire through the cystic duct and then down the common bile duct, before the cystic duct was closed. Subsequently, the stent was used to facilitate performance of a needle knife endoscopic sphincterotomy. The stent was then removed, a cholangiography was performed and the common bile duct was cleared. Patients with persistent jaundice usually had a preoperative endoscopic retrograde cholangio-pancreatography. RESULTS: Transcystic stenting was the 'intention-to-treat' basis of therapy for 56 of the patients. The placement of the stent only failed once when the stent became trapped in the cystic duct. Complications of the operation included: pain and jaundice (n = 2), cholangitis (n = 1), and pulmonary embolus (n = 1). The median postoperative hospitalization was 2 days (range: 1-15). Five further patients had common bile duct stones removed via a choledochotomy; a stent was placed through the choledochotomy before its closure. The selective common bile duct cannulation rate at the first endoscopic retrograde cholangio-pancreatography, was 98%. A second endoscopic retrograde cholangio-pancreatography was required in 15% of patients. The only complication of all the endoscopic procedures was a single case of mild cholangitis; there were no cases of pancreatitis. CONCLUSION: A treatment option open to all surgeons for non-jaundiced patients with known choledocholithiasis or choledocholithiasis found at operative cholangiogram, is the transcystic stenting of the sphincter of Oddi at the time of laparoscopic cholecystectomy. At a subsequent sitting, the common bile duct can be safely cleared endoscopically using a sphincterotomy facilitated by the stent.

Adolescent↗
PubMed1995

[Criteria for suspected lithiasis of the common bile duct].

Although the common bile duct is now accessed using a coelioscopic approach by an increasing number of surgical equipes, the problems related to the diagnostic iter of lithiasis of the common bile duct and the need to obtain a correct preoperative diagnosis, in order to select the most appropriate form of therapy, are of growing topical importance. Following a revision of the literature, the authors focus their attention on those studies which seem to be most interesting and important in relation to the criteria for suspected lithiasis of the common bile duct, studied in single, multivariable and preoperative analyses, namely without taking account of perioperative analyses, namely without taking account of perioperative criteria. These studies reveal the most statistically significant criteria for predicting lithiasis of the common bile duct. Although the application of these studies is not practicable, they undoubtedly arouse considerable interest. The authors have selected the simple criteria whose rigorous application may result in the selection of patients with 0 criteria, with a 1% risk of non-suspected lithiasis of the common bile duct. Perioperative cholangiography (POC) and echoendoscopy are closely correlated to these criteria. The authors outline their diagnostic iter within the framework of a prospective study they carrying out.

Gallstones↗
PubMed1979

Common bile duct pressure and Oddi sphincter pressure in patients with common bile duct stones with and without juxta-ampullar diverticula of the duodenum.

Resting common bile duct pressure and Oddi sphincter pressure were measured in 16 patients with common bile duct stones, 8 having in addition a juxta-ampullar diverticulum. Pressure measurements were performed with an infused catheter introduced through an endoscope under direct vision. No significant differences in fasting common bile duct pressures were observed between the two groups. The Oddi sphincter had a phasic activity, and the peak pressure was similar in both groups.

Aged↗
PubMed1991

Laparoscopic common bile duct exploration.

Operative common bile duct exploration, performed in conjunction with cholecystectomy, has been considered the treatment of choice for choledocholithiasis in the presence of an intact gallbladder. With the advent of laparoscopic cholecystectomy, the management of common bile duct stones has been affected. More emphasis is being placed on endoscopic sphincterotomy and options other than operative common duct exploration. Because of this increasing demand, we have developed a new technique for laparoscopic common bile duct exploration performed in the same operative setting as laparoscopic cholecystectomy. A series of five patients who successfully underwent common bile duct exploration, flexible choledochoscopy with stone extraction, and T-tube drainage, all using laparoscopic technique, is reported. Mean postoperative length of hospital stay was 4.6 days. Outpatient T-tube cholangiography was performed in all cases and revealed normal ductal anatomy with no retained stones. Follow-up ranged from 6 weeks to 4 months, and all patients were asymptomatic and had normal liver function tests.

Adolescent↗