Evaluation of mangnetic resonance cholangiography in the management of bile duct stones

Forty patients with suspected common bile duct stones [CBDSs] were scheduled to undergo an elective cholecystectomy. Confirmation or exclusion of CBDSs by magnetic resonance cholangiography [MRC] was assessed. The results of ERC were analyzed. The study concluded that MRC-based diagnosis has the potential to reduce the number of invasive preoperative diagnostic procedures and their associated risks and overall health care costs

Combined endoscopic - laparoscopic treatment of cholecystocholedocholithiasis

The aim of this study was to evaluate prospectively the results of the combined endoscopic-laparoscopic management in patients with gallstones and suspected common bile duct [CBD] stones. From November 1994 to May 1999, 600 consecutive patients were evaluated for laparoscopic cholecystectomy [LC]. The preoperative workup included clinical history and physical examination, serum levels of bilirubin, alkaline phosphatase and amylase and ultrasonography. Preoperative ERCP was indicated in cases with previous or present jaundice or acute pancreatitis, altered liver or pancreatic blood tests, dilated CBD [>8 mm] and CBD stones at ultrasonography. If CBD pathology was confirmed, endoscopic sphincterotomy [ES] was performed and treatment was attempted. All patients were assigned to undergo LC within 48 hours. Morbidity, mortality, hospital stay and disabilities were recorded

Colonic decompression without on - table irrigation for patients with an obstructed left colon

This study presented a series of patients managed prospectively by primary anastomosis without intra-operative colonic lavage. Emergency resection of acutely obstructed left-sided colonic carcinoma was performed, followed by primary anastomosis without on-table lavage after bowel decompression. Twenty-seven consecutive, unselected patients underwent bowel decompression, resection and primary colocolic anastomosis. Only one patient developed a leak at the anastomotic site requiring pelvic abscess drainage and defunctioning transverse colostomy. The mean hospital stay was 10.8 days. Emergency surgery on the obstructed left colon can be carried out safely after decompression alone without intra-operative colonic lavage

Short-term drainage seton versus two-stage seton fistulotomy in the surgical management of high anal fistula

In the present study, the clinical results obtained by both seton techniques in the surgical management of high anal fistula are compared. The study included 31 patients with high anal fistulae treated surgically by either short-term drainage seton [STDS] [n = 12] or two-stage seton fistulotomy [TSSF] [n = 19]. Complete primary healing occurred in nine patients who underwent STDS and 17 of the patients who underwent TSSF. Two of the three patients treated by STDS in whom the fistula persisted or recurred were treated successfully with subsequent division of the external sphincter and healing occurred to these patients. Following surgery using STDS, partial incontinence occurred in two patients only who reported problems controlling flatus. In conclusion, the present study confirmed that STDS can be utilizing with success and allowing preservation of the sphincter muscle and it can be used as the initial procedure for the high and difficult anal fistulae

Selective versus routine intra-operative cholangiography during cholecystectomy

This study aimed to examine the selective criteria for intraoperative cholangiography by measuring their sensitivity, specificity, positive predictive value and negative predictive value. The ability of these indicators to predict CBD stones at cholecystectomy was measured, so the role of selective intraoperative cholangiography can be evaluated. The study included 70 patients with gall bladder stones with no prove of concomitant CBD stones by clinical and ultrasonographic examination. Patients were subjected to cholecystectomy with routine intraoperative cholangiography. Out of them, eight had positive cholangiograms and common bile duct [CBD] stones. So, many unnecessary cholangiograms were performed with loss of money and time with associated morbidity. The clinical, laboratory, radiological and operative data of all cases were reviewed compared with cholangiograms. Certain parameters or criteria were common in patients with positive cholangiograms. The study also tried to determine certain criteria to select patients at high risk to perform selective intraoperative cholangiography