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At least 19 recordsLinked to original sources
PubMed1977

[Hemobilia, a rare and dangerous postoperative complication].

3 cases of severe postoperative hemobilia are reported, one patient with an echinococcus cysticus of the liver, two others after surgical procedures on biliary tract. Diagnostic means as cholangiography, coeliacography, scanning of the liver and endoscopic retrograde cholangiography were not possible because of the massive bleeding. In those cases, if no other sources of bleeding are found, only esophago-gastro-duodenoscopy can leed to the correct diagnosis. In gastrointestinal bleeding after surgical manipulation on the biliary tract, the duodenum and the pancreas, hemobilia is a possible cause.

Adult↗
PubMed1992

[Biliary tract surgery in patients of 70 and older: an assessment of our experience with 100 consecutive cases].

A series of 100 consecutive patients aged 70 years and older having biliary tract lithiasis observed over a 19-year period (1970-1989) at the 1st Surgical Department of the University of Rome was analyzed in an effort to define morbidity and mortality. Eighty-eight patients underwent surgical treatment. Three patients died postoperatively (3.4%); 12 patients had local and 13 general complications. The highest incidence of complications occurred in patients with associated diseases and bacteriobilia. A long-lasting symptomatology involved a more frequent exploration of the common bile duct. Morbidity and mortality were not significantly related to the type of surgical procedure performed. Elective biliary tract surgery is a safe procedure even in aged patients.

Age Factors↗
PubMed1975

[Use of a mechanical suture in operations on the liver and the biliary tract].

Based on 93 observations on application of a mechanic suture for vesico-digestive anastomoses and anastomoses between the hepatocholedochus and duodenum, it has been found that these operations have a number of advantages over routinely used procedures and could be employed in everyday surgical practice, thus facilitating technical accomplishment of surgical procedures on bile passages.

Biliary Tract Surgical Procedures↗
PubMed1976

Congenital biliary atresia. Analysis of 97 cases with reference to prognosis after hepatic portoenterostomy.

The prognosis of 97 patients with congenital biliary atresia treated by hepatic portoenterostomy was studied. In 37 of 97 patients (38%), good bile excretion was observed after surgery, and jaundice cleared. Sixteen of the 37 patients developed ascending cholangitis; 11, esophageal varices; and nine died. Seven died of ascending cholangitis and two of hepatic failure. Fourteen patients had an uneventful course. In the remaining 60 patients, bile excretion was scanty, and the disease progressed to biliary cirrhosis; 52 died. Causes of death were hepatic failure (53%), intracranial hemorrhage (16%), rupture of esophageal varices (12%), severe dehydration (9%), and postoperative complications (9%). The age at death ranged from 2 to 52 months, with an average at 16 months.

Bile Ducts↗
PubMed1978

New perspectives on biliary atresia.

An investigation into the aetiology, diagnosis, and treatment of biliary atresia was carried out because the prognosis remains so poor.In an electron microscopical study no viral particles or viral inclusion bodies were seen, nor were any specific ultrastructural features observed. An animal experiment suggested that obstruction within the biliary tract of newborn rabbits could be produced by maternal intravenous injection of the bile acid lithocholic acid.A simple and atraumatic method of diagnosis was developed using(99) (m)Tc-labelled compounds which are excreted into bile. Two compounds, (99m)Tc-pyridoxylidene glutamate ((99m)Tc-PG) and (99m)Tc-dihydrothioctic acid ((99m)Tc-DHT) were first assessed in normal piglets and piglets with complete biliary obstruction. Intestinal imaging correlated with biliary tract patency, and the same correlation was found in jaundiced human adults, in whom the (99m)Tc-PG scan correctly determined biliary patency in 21 out of 24 cases. The (99m)Tc-PG scan compared well with liver biopsy and (131)I-Rose Bengal in the diagnosis of 11 infants with prolonged jaundice.A model of extrahepatic biliary atresia was developed in the newborn piglet so that different methods of bile drainage could be assessed. Priorities in biliary atresia lie in a better understanding of the aetiology and early diagnosis rather than in devising new bile drainage procedures.

Adult↗
PubMed1978

Modern operative fluorocholangiography: utopia or overlooked entity?

A system of image amplification with television fluoroscopy and 100 X 100 mm cut film technique is presented for use in the operating room. Biliary surgery has benefited from this equipment as operative cholangiography has been improved and unnecessary extension of operating time avoided. Applications of the equipment for other procedures are discussed.

Biliary Tract Surgical Procedures↗
PubMed1977

[Diagnostic exploration of biliodigestive anastomoses with isotopes (author's transl)].

Using the radiopharmaceutical Solcoscint-Hepatobida (99mTc) and a high definition camera, sequential hepato-biliary scans were performed. Twenty-five patients were used to demonstrate the value of the method for the evaluation of biliodigestive anastomoses and for the recognition of post-operative complications. The method can be recommended in combination with radiological procedures or in situations where radiology cannot be used.

Bile Ducts, Intrahepatic↗
PubMed1978

Biliary obstruction after gastrectomy for carcinoma of the stomach.

Extrahepatic biliary obstruction occurred in 34 patients after 1,300 gastrectomies performed for carcinoma of the stomach. Metastasis to the portal nodes caused mainly by distal gastric neoplasms is the most common cause of extrahepatic biliary obstruction. The syndrome of severe unrelenting bilirubinemia with abdominal aches and a palpable liver signifies extrahepatic biliary obstruction until proved otherwise and calls for early exploration. Palliative operation can prolong survival if properly performed. Selection of the proper procedure requires operative cholangiograms. Pancreatoduodenectomy is the most successful palliative procedure. Prevention of extrahepatic biliary obstruction requires a meticulous dissection of the portal pedicle during radical gastrectomy.

Biliary Tract Surgical Procedures↗
PubMed1978

Percutaneous transhepatic drainage of the biliary tract: technique and results in 104 cases.

A two-step procedure for percutaneous transhepatic drainage (PTD) of the biliary tract is described. This technique was applied on a total of 105 cases of obstructive jaundice, 84 with malignant and 21 with benign lesions, and was successful in 104. Decompression effect was adequate and reduction in serum bilirubin level was quick. Operative mortality, which used to be high in jaundiced patients with serum bilirubin levels above 10 mg per dl, has been significantly reduced with this procedure employed as the first step in a two-stage operation for malignant biliary obstruction. PTD proved to be very useful in the management of acute obstructive suppurative cholangitis and ensuing liver abscesses. Continuous drainage was also achieved by PTD in inoperable cases, and 1 patient with a hilar carcinoma was kept alive for 2 years and 1 month by PTD alone. With the improvement in the diagnosis of biliary tract disease this procedure will assume an important position in the management of obstructive jaundice.

Aged↗
PubMed1979

Evaluation of the results of external choledochoduodenostomy for retained, recurrent, or primary common duct stones.

Twenty-five patients were treated for retained, recurrent, or primary common duct stones by permanent drainage of the biliary tract with external choledochoduodenostomy. Twenty-one patients had common duct stones which became evident two to fifty years after the initial biliary tract procedure and which may represent stones formed in the common duct. Three recent patients had a clinical history of primary common duct stones, had stones which were soluble in chloroform-methanol solution, and had hepatic bile which was lithogenic as determined by evaluating the molar percentage of cholesterol, phospholipid, and bile salt in bile samples obtained at the time of choledochoduodenostomy. These data suggest that further stone formation is possible and that permanent bypass of the sphincter of Oddi is indicated to prevent recurrent bile duct obstruction. Long-term evaluation of the results of external choledochoduodenostomy indicates that the procedure is safe and effective in the prevention of recurrent biliary tract calculi.

Adult↗
PubMed1977

[Acute pancreatitis--the current state of surgical treatment].

In the beginning of this century the "early operation" in acute pancreatitis was widely used. The irreversibility of the local necrosis and the failure of conservative treatment again lead to the application of this procedure. Early operation is indicated when the pancreatitis shows a more severe degree and when there is no success on conservative therapy or even deterioration in the patient's condition. Early operation means digital removal of the necrosis and/or resection of the pancreas, procedures on the biliary tract, methods for suppression of the secretory activity and installation of jejunal fistulas for external feeding. The mortality rate of partial necrotizing pancreatitis was lowered by this means. In case of total necrosis the mortality was still about 100%. In the postacute stage complications such as sequestration, abscess formation, sepsis, hemorrhage, fistulas can arise. In some of these complications only a "delayed operation" is successful. If a biliary acute pancreatitis was not early and definitively treated, the causative diseases of the biliary tract have to be cured in the postacute stage.

Acute Disease↗
PubMed1977

A safe method of intrahepatic biliary drainage in obstructive jaundice.

In malignant disease with severe obstructive jaundice, survival after operative intervention is extremely low. Simple external biliary drainage is desirable for these patients, as a preliminary procedure for radical operation or long-term palliation. Intrahepatic biliary drainage at the anterior edge of the liver can be performed easily and safely under local anesthesia in case of obstruction of the proximal bile ducts, just as cholecystostomy is indicated for obstruction of the common bile duct.

Bile Duct Neoplasms↗
PubMed1978

Relief of malignant obstructive jaundice by percutaneous insertion of a permanent prosthesis in the biliary tree.

Twelve patients with malignant obstruction of the biliary tree were treated by dilating the lesion percutaneously and inserting an internal large-bore teflon prosthesis in place bridging the the stricture. All 12 patients had unresectable neoplasms. The procedure was devised because existing modes of palliation using surgical techniques are associated with significant mortality or mobidity. There are also many problems with nonsurgical catheter drainage. Decompression was achieved in all 12 patients as shown radiographically by passage of contrast into the duodenum. Disappearance of pruitus was achieved in seven of seven patients, and in 10 of 12 disappearance of jaundice (bilirubin, before prosthesis, 18.4 +/- 4.5 mg/dl [mean +/- 1 SD], bilirubin 1 month after prosthesis, 1.8 +/- 0.6 mg/dl [mean +/- 1 SD], P less than 0.001) with improvement of general clinical status was achieved. Percutaneous placement of a permanent biliary tract prosthesis is safe and effective for the palliative decompression of malignant biliary tract obstruction.

Adenoma, Bile Duct↗
PubMed1976

[Technic for performing biliodigestive anastomoses in cancer of the pancreas and periampullar region].

Palliative treatment was employed in 183 patients with cancer of the pancreas and periampullary zone. In most of them the decompression of bile passages was accomplished by means of cholecystogastroanastomosis. The authors have modified the routinely used technic of cholecystogastrostomy. The latter procedure was supplemented by external draining of bile passages by means of a controlled transnasal drainage tube. The technic concerned seems to be recommended for constructing biliodigestive anastomoses in cancer of this region due to relative satisfactory indices of the postoperative mortality (15+/-6%).

Ampulla of Vater↗
PubMed1979

Liver transplantation--1978.

The development of liver transplantation has been made difficult because of the enormous technical difficulties of the procedure and because the postoperative management in early cases was defective in many instances. With surgical and medical improvements, the prospects for success have markedly increased recently. The wider use of thoracic duct fistula as an adjuvant measure during the first 1 or 2 postoperative months is being explored.

Age Factors↗
PubMed1992

Prospective, randomized study comparing amoxycillin-clavulanic acid and cefamandole for the prevention of wound infection in high-risk patients undergoing elective biliary surgery.

The efficacy of amoxycillin-clavulanic acid for prevention of postoperative wound infection was compared with that of cefamandole in 150 patients at risk for infected bile while undergoing elective biliary surgery in a prospective, randomized study. The two groups were comparable for age, sex, risk factors, operative procedures and positive bile cultures. Similar numbers of patients had an uncomplicated postoperative course (amoxycillin-clavulanic acid 70%; cefamandole 73%). Four patients in each group developed wound infection. The incidence of postoperative pneumonia, urinary tract infection and number of days (+/- SD) in hospital (amoxycillin-clavulanic acid 10.1 +/- 4.7; cefamandole 9.7 +/- 5.6) were similar. The efficacy of amoxycillin-clavulanic acid and cefamandole in preventing wound sepsis in high-risk patients undergoing biliary surgery was similar. Economic considerations may favour the use of amoxycillin-clavulanic acid.

Adolescent↗
PubMed1979

Technical aspects of hepatic portal dissection in biliary atresia.

During the past 8 yr, 37 patients with a noncorrectable type of biliary atresia have undergone hepatic portoenterostomy or portocholecystostomy at the Kobe Children's Hospital. The hepatic portal dissections employed in this series were classified as "supraportal" (9 procedures), "portal" (25 procedures), and "infra-portal" (3 procedures) based on the level at which the fibrous mass at the porta hepatis was transsected as determined by the operative record and the pathologic findings. Successful biliary drainage was achieved in 19 out of 25 patients (76%) with a "portal" type of dissection, while 1 out of 9 with "supra-portal" and none out of 3 with "infra-portal" type dissections were successful in this respect. Of the 19 patients who achieved significant biliary flow, 8 have lived for 2--7 yr without jaundice and 3 others are jaundice-free for shorter intervals.

Bile↗