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Objective To investigate the application value of ligamentum teres hepatis approach in laparoscopic biliary reoperation.Methods The retrospective cohort study was conducted.The clinical data of 58 patients with recurrent hepatolithiasis who underwent laparoscopic biliary reoperation in the Chengdu Second People's Hospital were collected.There were 33 males and 25 females,aged from 31 to 85 years,with an average age of 54 years.Thirty-one of 58 patients who underwent laparoscopic biliary reoperation using ligamentum teres hepatis approach were divided into the ligamentum teres hepatis group,and 27 patients who underwent laparoscopic biliary reoperation using regular anatomy and positioning were divided into the regular operation group.Observation indicators:(1) intraoperative situations;(2) postoperative recovery;(3) follow-up.Follow-up using telephone interview and outpatient examination was performed to detect the recurrence of bile duct stone up to August 2018.Doppler ultrasonography of biliary tract was performed once at 3,6 and 12 months postoperatively and once at every 12 months after 1 year.Measurement data with normal distribution were represented as Mean±SD and comparison between groups was analyzed by the t test.Measurement data with skewed distribution were described as M (range) and comparison between groups was analyzed by rank sum test.Count data were analyzed using the four-grid table chi-square test or Fisher exact probability.Results (1) Intraoperative situations:all patients underwent successful laparoscopic biliary reoperation,without conversion to open surgery and perioperative death.During the intraoperative exploration,7,8,16 patients in the ligamentum teres hepatis group and 5,8,14 patients in the regular operation group were respectively found peritoneal omental adhesions,hilar omental adhesions and hilar intestinal adhesions.The operation time and volume of intraoperative blood loss were (125± 24) minutes,40 mL (range,15-100 mL) in the ligamentum teres hepatis group and (150 ± 36) minutes,55 mL (range,20-350 mL) in the regular operation group,respectively,with statistically significant differences between the two groups (t =-3.162,Z =-2.768,P＜0.05).The primary suture of bile duct,T-tube drainage and intraoperative stone removal were detected in 10,21,26 patients of ligamentum teres hepatis group and 9,18,23 patients of regular operation group,respectively,with no statistically significant difference between the two groups (x2 =0.008,0.019,P＞0.05).Postoperative residual biliary calculi were removed by choledochoscope through T-tube sinus in outpatient department after 8-week carrying T-tube.(2) Postoperative recovery:the time to initial anal exsufflation and duration of postoperative hospital stay were respectively (31 ± 7) hours,(7.2± 1.5) days in the ligamentum teres hepatis group and (35±10) hours,(7.1±1.3)days in the regular operation group,with no statistically significant difference between the two groups (t=-l.814,0.036,P＞0.05).(3) Follow-up:5 of 58 patients were lost to follow-up,including 3 in the ligamentum teres hepatis group and 2 in the regular operation group.Fifty-three patients were followed up for 6-40 months,with a median follow-up time of 28 months.No recurrence of bile duct stone was found in the ligamentum teres hepatis group.One patient in the regular operation group had recurrence of common bile duct stones at 36 months postoperatively and underwent endoscopic sphincterotomy stone.Conclusion Laparoscopic biliary reoperation for patients with recurrence of hepatolithiasis is a safe and effective method,and it can also quickly determine the location of common bile duct,with advantages of less blood loss and shorter operation time.
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Objective To investigate the clinical effect of laparoscopic reverse papillary intubation through cystic duct and laparoscope combined with duodenoscope in the treatment of cholecystolithiasis and thining choledocholithiasis.Methods The retrospective cohort study was adopted.The clinical data of 192 patients with cholecystolithiasis and thining choledocholithiasis who were admitted to Chengdu Second People's Hospital between May 2012 to August 2015 were collected.The 96 patients who underwent laparoscopic reverse papillary intubation through cystic duct were allocated into the case group,and the other 96 who received surgery by laparoscope combined with duodeuoscope were allocated into the control group.All the patients underwent laparoscopic cholecystectomy (LC) according to routine approaches.The 96 patients in the case group received the placement of 4 Fr ureter catheter via cystic duct and placement of common bile duct inserted through the duodenal papilla under laparoscope,and then the duodenal papilla was resected using needle knife along the ureter catheter and stones were removed by basket lithotriptor and ball lithotriptor.The 96 patients in the control group received the intubation using the bow knife with zebra guidewire,and stones were removed by basket lithotriptor and ball lithotriptor.During the operations,it was observed whether there were residual stones by nasobiliary radiograph.The comparison was made between the 2 groups concerning (1) surgical situation:intubation and operation time.(2) Postoperative alanine transaminase (ALT),postoperative aspartate transaminase (AST),postoperative total bilirubin (TBil),postoperative blood amylase,postoperative lipase,complications and extubation time.(3) Situation of follow-up:follow-up was done by outpatient examination or telephone interview up to November 2015.The stones recurrence was detected by retrograde cholangiography through nasal bile duct,magnetic resonance cholangiopancreatography (MRCP) or ultrasonic examination.Measurement data with normal distribution were represented as x ± s.Comparison between groups was done by the t test.Count data were analyzed by the chi-square test.Results (1) Surgical situation:2 groups both underwent successful LC.Ureteral catheter in the case group was successfully imbedded through cystic duct,including 8 patients with being difficult to intubate.Five patients in the control group were failed in endoscopic sphincterotomy (EST) due to periamullary diverticula or other causes,and then EST was performed again by the duodenal papilla through ureteral catheter which was intubated through cystic duct.Operation time of the case group and control group was (89 ± 17) minutes and (105 ± 26) minutes,respectively,with a statistically significant difference between the 2 groups (t =5.05,P ＜ 0.05).(2) Postoperative situation:ALT,AST,TBil of the case group and control group were (163 ±54)U/L,(87 ±38)U/L,(43 ± 18)tmol/L and (147 ±49) U/L,(101 ± 26) U/L,(37 ± 17) μmol/L,respectively,showing no statistically significant differences (t =0.97,1.21,0.84,P ＞ 0.05).Postoperative blood amylase and lipase of the case group and control group were (151 ± 41) U/L,(198 ± 72) U/L and (395 ± 142) U/L,(549 ± 217) U/L,respectively,showing statistically significant differences (t =16.18,15.05,P ＜ 0.05).No pancreatitis was found in the case group while 6 patients in the control group complicated with mild pancreatitis were improved by symptomatic treatment of fasting,somatostatin administration and acid suppression,with no severe pancreatitis.No complications such as intestinal perforation,bile duct perforation and massive hemorrhage were detected in both groups after operation.No death occurred.The nasal bile duct in the patients without pancreatitis was removed at postoperative day 3.The nasal bile duct in the patients with pancreatitis was removed after the remission of abdominal pain and diet intake.In the case group,it was difficult to remove the nasal bile duct of 1 patient.Nasal bile duct radiograph showed that the bending section of nasal bile duct was mistakenly sutured by the absorbable thread at the lower margin of incision of junction of cystic ducts,and yet there was unobstructed biliary drainage.The nasal bile duct was removed and the patient was discharged from hospital at postoperative day 19.The abdominal drainage tubes were removed at postoperative day 3 to5 in both groups.(3) Of 192 patients,151 were followed up for a median time of 10 months (range,3-12 months).Patients had good recovery without recurrence of abdominal pain,jaundice and stones.Conclusion Laparoscopic reverse papillary intubation through cystic duct for the treatment of cholecystolithiasis and thining choledocholithiasis is safe and feasible,and it can also reduce incidence of pancreatitis after nasobiliary drainage.
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Objective To evaluate the efficacy and safety of continuous suture by QuillTM SRS self-retaining suture for closing choledoch incision. Methods From January 2015 to October 2015, 66 patients with gall bladder calculi combined with common bile duct stones who received laparoscopic gallbladder excision, common bile duct explo-ration, laparoscopy choledochotomy, suture choledoch immediately were randomly divided into two groups, experi-mental group using QuillTM SRS self-retaining suture for closing choledoch incision and control group using tradi-tional absorbable suture for closing choledoch incision. Then observe the operation time, the risk of bile leakage oc-curred in the operation and the risk of bile leakage after operation. Results All patients successfully completed in laparoscopic surgery without laparotomy. Operation time, the risk of bile leakage occurred during operation in exper-imental group has statistically significant difference compared with control group ( 0.05). Conclusion Compared with interrupted suture by normal sutures, continuous suture by QuillTM SRS self-retaining suture for closing choledoch incision has the characteristics of shorter operation time and lower incidence of intraoperative and postoperative bile leakage. It is worthy of promoting.
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Objective To explore the effect of laparoscopic bile duct exploration,balloon dilation,and catheter drainage in the treatment of postoperative recurrent choledocholithiasis.Method The data of 61 patients with postoperative recurrent bile duct stones from August 1999 to August 2009 were retrospectively analyzed.The patients received laparoscopic bile duct exploration (LCDE),laparoscopic papillary balloon dilation (LPBD),and laparoscopic papillary balloon dilation endoprosthesis (LPBDE).ResultSatisfactory outcome was achieved in all the 61 patients.Among the 61 patients,20 patients received LPBD and primary suturing,36 patients received LPBDE and primary suturing,and 5 patients received LPBDE and T-tube drainage.There was no residual stone.There was no perioperative mortality or serious complications including biliary leak and hemobilia.On follow up for 1 to 9.5 years in 56 patients,there was no recurrent choledocholithiasis.ConclusionThe procedures were feasible and safe,and they prevent recurrence of choledocholithiasis.
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Objective To compare common bile duct pressure changes after laparoscopic common bile duct exploration between primary closure of the bile duct and T-tube drainage.Methods Postoperative common bile duct pressure changes were analyzed in 30 cases of laparoscopic common bile duct exploration,including 15 cases of primary suture of the bile duct and 15 cases of T-tube biliary drainage respectively,from August 2003 to January 2004 in this hospital.Results ①The hydrostatic pressure in common bile duct was 6.0~18.5 cm H_2O(0.54~1.66 kPa).②As compared with preoperative levels,the common bile duct pressure increased slightly on the first postoperative day and decreased significantly on the fifth postoperative day in primary suture cases(q=4.531,P
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Objective To evaluate the efficacy of laparoscopic management for bile duct and gastrointestinal injuries during laparoscopic cholecystectomy. Methods Laparoscopic cholecystectomy with or without laparoscopic bile duct exploration was attempted in 9 016 consecutive patients between October 1991 and December 2002. We experienced 14 cases of bile duct injuries (0.15%) and 3 cases of gastrointestinal injuries (0.03%). One patient with circumferential injury and 10 patients with partial laceration injuries of the bile duct underwent a laparoscopic simple closure. One gastric and two duodenal injuries were successfully repaired under laparoscope. Results Expect 1 patient suffered postoperative biliary leakage and bile duct stricture 1 year after the surgery, all the patients were cured and discharged from the hospital. Conclusions Partial laceration injuries of the bile duct or gastrointestinal injuries could be treated with a laparoscopic technique. Concerning laparoscopic management of circumferential bile duct injuries, further study should be taken.