ABSTRACT
PURPOSE: The purpose for this study is to compare the clinical differences of the two groups (ie. colonic obstruction and non-obstruction) in colonic surgery. METHODS: A retrospective clinical analysis was done in 149 patients with colorectal disease who had been surgically treated from January 1995 to December 1997 at our institution. RESULTS: 1) The peak age of incidence was in the 7th. and 8th. decades (53.3%)in the obstruction group and 6th. and 7th. decades (54.3%) in the non-obstruction group, the sex ratio of male to female was higher in the obstruction group (2.00:1) than in the non-obstruction group (1.04:1). 2) The most common cause of colonic obstruction was malignant disease in both groups (75.4% in the obstruction group and 78.3% in the non-obstruction group). 3) The most frequent symptom and sign of the two groups were abdominal pain (36.8% and 2.6% respectively). 4) The most common location was cecum (24.6%) followed by sigmoid colon (22.8%) and rectum (15.8%) in the obstruction group, and rectum (40.2%) followed by ascending colon (15.2%), cecum (13.0%), and transverse colon (13.1 %) in the non obstruction group. 5) The right hemicolectomy was the most common procedure in the obstruction group (29.8%) while abdominoperineal resection was most frequently performed in the non-obstruction group (23.9 %). The surgical resection rate was 77.4% and 100% in obstruction group and non-obstruction group, respectively. 6) In the case of colon cancer, the stage of cancer (according to Modified Astler-Coller classification) was much higher in the obstruction group. An average 6.5 metastatic lymph nodes were found from 18.5 dissected lymph nodes in the obstruction group whereas 2.7 out of 13.9 lymph nodes in the non-obstruction group. 7) The postoperative complication rate of obstruction group were 21.4% whereas that of non-obstruction group were 15.0% respectively. The postoperative mortality rate was 14% in the obstruction group and 3.3% in the non-obstruction group. The complication rate and postoperative mortality of the obstruction group was higher than those of the non-obstruction group, especially in the malignant disesae group. CONCLUSIONS: The results of our study indicate that the obstruction group has a different clinical course from the non- obstruction group and associated higher postoperative complication and mortality rate.
Subject(s)
Female , Humans , Male , Abdominal Pain , Cecum , Colon , Colon, Ascending , Colon, Sigmoid , Colon, Transverse , Colonic Neoplasms , Colorectal Neoplasms , Incidence , Lymph Nodes , Mortality , Postoperative Complications , Rectum , Retrospective Studies , Sex RatioABSTRACT
"Hemobilia" upper gastrointestinal bleeding that originates from within the biliary tract, is a rare complication of the laparoscopic cholecystectomy. Only a few cases have been reported in the literature. It is more common in accidential or iatrogenic injury of the liver and bile ducts, even occurring spontaneously in cholelithiasis, several inflamatory processes, and vascular and neoplastic changes. The laparoscopic cholecystectomy is a recently developed and advanced surgical procedure that has rapidly gained acceptance. Its complications remain to be clinically analyzed. The authors experienced a case of massive hemobilia after a laparoscopic cholecystectomy. A 54-years-old man with hemobila resulting from right hepatic artery pseudoaneurysm communicating with the intra-hepatic bile duct was treated with angiographic tanscatheter embolization on the of 24th postoperative day. We report this case with a brief review of the literature.
Subject(s)
Aneurysm, False , Bile Ducts , Biliary Tract , Cholecystectomy, Laparoscopic , Cholelithiasis , Hemobilia , Hemorrhage , Hepatic Artery , LiverABSTRACT
BACKGROUND: Residual stones after biliary tract surgery are a formidable task for the surgeon. Choledocholithiasis and hepatolithiasis are more common in East Asia, including Korea, compared with the West, and retained and recurrent stones remain a major problem after the surgical treatment of biliary tract stones; thus, various attempts to reduce the rate of retained and recurrent stones are important in the treatment of biliary tract stones. METHODS: A retrospective analysis was done on 815 cases of patients with biliary tract stones who had undergone an operation at the Department of Surgery, Chung-ng University Hospital, during the 13 years from January 1984 to December 1996. RESULTS: The male-to-female sex ratio was 1 : 2, and the most common age group was the 7th decade. The most common symptoms and physical findings were right upper quadrant pain in 620 cases (76.1%), and right upper quadrant tenderness in 511 cases (62.1%). The most common laboratory findings were elevated alkaline phosphatase (88.3%), followed by elevated sGPT and elevated sGOT. Bile cultures and sensitivity tests were done in 815 cases and were positive in 682 cases (83.7%). The most common bacteria were E.coli in 252 cases (37.0%). The locations of the stones were gallbladder (GB) and common bile duct (CBD) in 420 cases (51.5%), the CBD in 160 cases (19.6%), the CBD and intrahepatic duct (IHD) in 108 cases (13.3%). The most common operative procedure was a cholecystectomy with T-ube insertion, 525 cases (64.4%). Postoperative complications developed in 208 cases (25.6%), and the most common postoperative complication was wound infection, 72 cases (8.8%). The operative mortality was 2.9%, and most common cause of death was sepsis (10 cases). CONCLUSIONS: The authors conclude that interventional therapy, as an initial treatment for residual stones, is a satisfactory treatment where possible. If there are residual stones in spite of the interventional therapy, a reoperation or hepatectomy is required.
Subject(s)
Humans , Alanine Transaminase , Alkaline Phosphatase , Aspartate Aminotransferases , Bacteria , Bile , Biliary Tract , Cause of Death , Cholecystectomy , Choledocholithiasis , Common Bile Duct , Asia, Eastern , Gallbladder , Hepatectomy , Korea , Mortality , Postoperative Complications , Reoperation , Retrospective Studies , Sepsis , Sex Ratio , Surgical Procedures, Operative , Wound InfectionABSTRACT
BACKGROUND: The surgical treatment of gall stone disease consists of a conventional open cholecy stectomy (OC) and a laparoscopic cholecystectomy (LC), both of which are accepted standard methods. METHODS: The goal of this study was to compare the two operations which are used at present in the treatment of gall stone disease. During the period from September 1990 to April 1997, 2504 laparoscopic cholecystectomies and from August 1984 to April 1997, 2672 open cholecystectomies were performed at the Department of Surgery, Yong San Hospital, Chung-Ang University. We did a retrospective study of these cases and addressed the age and the sex distributions, the chief complaints, the previous operation history, associated diseases, radiologic findings, operation time, pathology, postoperative admission period, perioperative changes of bilirubin, AST (aspartate aminotransferase) & ALT (alanine aminotransferase), complications, and reasons for conversion to an open cholecystectomy. RESULTS: 1) The most common age was fifty, and female patients were in the majority. 2) The most common chief complaint was right upper-quadrant pain. 3) If ultrasonography showed wall thickening, an open cholecystectomy was more acceptable. 4) A LC had advantages in operation time and period of hospitalization. 5) The most common pathology of the gallbladder was chronic cholecystitis; others were polyps, metaplasia, and adenocarcinomas. 6) Elevation of the liver function was more prominant in LC cases than in OC cases. 7) The complication rate was 10.9% for LC cases and 12.5% for OC cases, but major complications were higher among LC paitents than among OC patients. 8) The conversion rate was 1.4%, and reasons for conversion were bile duct injury, bleeding, adhesion, and bowel injury. CONCLUSIONS: A LC has many advantages, but its problems are elevation of the liver function after the operation and a high major-complication rate. If ultrasonography shows no empyema or wall thickening, LC is more acceptable and good results are expected.
Subject(s)
Female , Humans , Adenocarcinoma , Bile Ducts , Bilirubin , Cholecystectomy , Cholecystectomy, Laparoscopic , Cholecystitis , Empyema , Gallbladder , Gallstones , Hemorrhage , Hospitalization , Liver , Metaplasia , Pathology , Perioperative Period , Polyps , Retrospective Studies , Sex Distribution , UltrasonographyABSTRACT
To clarify the mechanisms of stone formation in gallbladder and in common bile duct, the bile composition, such as cholesterol, total bile acid, major bile acids, phospholipid, protein and calcium, from patients with gallbladder stones, common bile duct stones and control groups were analyzed for comparison. The control group consisted of patients who had neither biliary stone nor biliary tract disease. The results obtained are as follows; 1. In the mean concentrations of bile cholesterol and protein from each disease group, no statistically significant difference of these compositions was observed according to sorts of stone(p > 0.05). 2. In the cholesterol stone group the mean concentration of total bile acid of bile from gallbladder stone group was higher than that of common bile duct stone group (p < 0.05). In the pigment stone group, T/D ratio of bile from gallbladder stone group tended to be higher than that of CBD stone group. But these differences were not statistically significant (p = 0.09). 3. In the pigment stone groups, the mean concentration of bile phospholipid from gallbladder stone group was significantly higher than that of CBD stone group (p < 0.05). 4. The mean concentration of bile protein from gallbladder stone group was higher than that of CBD stone group in the pigment stone group (p < 0.05). 5. The mean concentration of bile calcium was significantly higher in gallbladder stone group than that in CBD stone group (p < 0.05). In conclusion, supersaturation of cholesterol in bile may not be sufficient to explain cholesterol gallstone formation. The increase in total bile acid especially LCA, DCA, CDCA may be involved in cholesterol gallbladder stone formation, whereas pigment gallbladder stone formation is thought to be related to decreased T/D ratio of bile which means high dihydroxycholanic acid of bile. Additionally, the results suggest that phospholipid, protein and calcium contribute to pigment gallbladder stone formation by playing great roles in forming matrix as nucleus in pigment stone, but further investigation may be needed to detect calcium ion critical for calcium crystal formation.
Subject(s)
Humans , Bile Acids and Salts , Bile , Biliary Tract Diseases , Calcium , Cholesterol , Common Bile Duct , Gallbladder , GallstonesABSTRACT
Elevated levels of aspartate aminotrasferase(AST), alanine aminotransferase(ALT) and bilirubin were noted incidentally after laparoscopic cholecystectomy(LC). This study was attempted to investigate the elevation of AST, ALT and bilirubin after laparoscopic cholecystectomy without bile duct injury and it,s clinical significance. Bile duct injury is most feared complication of laparoscopic cholecystectomy. Increased liver enzymes and bilirubin levels may be indicative of this complication. But, these parameters have not been investigated in patients who had laparoscopic cholecystectomy and in whom no damage to the bile duct was noted. 906 patients with normal results of preoperative liver function test were entered into the study. Blood was collected at 24 hours, 48-72 hours and 6-8 days after laparoscopic cholecystectomy, and AST, ALT, Alkaline phosphatase(AlkP) and bilirubin levels were observed. In AST, a mean 2.33-fold increase was observed. In ALT, a mean 2.10-fold increase was observed. A mean 1.42-fold and a mean 1.73-fold increase were observed in total and direct bilirubun levels. But, AlkP was not increased. In many patients a significant increase in AST, ALT and bilirubin levels occured after laparoscopic cholecystectomy. But they returned to normal values within several days without any specific treatments. These elevations of AST & ALT without increasing of AlkP, and slight elevation of bilirubin without increasing of AlkP appear to have no obvious clinical significance, the exact cause of these elevations is unclear, and need further investigation.
Subject(s)
Humans , Alanine , Aspartic Acid , Bile Ducts , Bilirubin , Cholecystectomy, Laparoscopic , Liver Function Tests , Liver , Reference ValuesABSTRACT
To identify the efficacy of laparoscopic cholecystectomy, we retrospectively analyzed 600 cases of laparoscopic cholecystectomy who were treated at the Department of Surgery, Chung Ang University from September 1990 to December l992. We intentionally divided periods into 3 groups to observe the frequency of morbidity and mortality, early and late complications, duration of operation and postoperative hospitalization with accumulaton of surgical experiences and techniques. The most prevalent age group was 6th decades, male to female ratio was 1: 1.47 and associated diseases were hypertension, obesity, pulmonary tuberculosis in order of frequency and previous abdominal operations were appendectomy, TAH, C-section in order of frequency. The duration of operation was 38.6 minutes and postoperative hospitalization was 6.2 days. The most frequent pathologic diagnosis was chronic cholecystitis. The postoperative complications were noted in 15 cases(2.5%) including 5 cases of bleeding 4 cases of bile leakage. The number of patients who needed parenteral narcotics was decreased in later peiod. According to oral cholecystogram, opacification correlated with duration of operation of laparoscopic cholecystectomy.
Subject(s)
Female , Humans , Male , Appendectomy , Bile , Cholecystectomy, Laparoscopic , Cholecystitis , Diagnosis , Hemorrhage , Hospitalization , Hypertension , Intention , Mortality , Narcotics , Obesity , Postoperative Complications , Retrospective Studies , Tuberculosis, PulmonaryABSTRACT
With advancement of endoscopical instruments and technique, gallstone diseases can be managed with laparoscopic cholecystectomy which has rapidly and radically changed the surgical treatment of gallstone diseases. The ideas of laparoscopic surgery was introduced by Germany gynecologist Semm, in 1967 and was first performed by French surgeon Mouret, Dubois in 1987. Although many reports of early laparoscopic cholecystectomy were excellent, many surgeons want to know the surgical results of laparoscopic cholecystectomy are enough good to perform comparing with the conventional cholecystectomy, especially in early complications and late complications. (continue...)