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Objective:To investigate the effect of jejunal loop fixation in the reoperation for anastomotic stricture after cholangiojejunostomy.Methods:From Jan 2016 to Jan 2020, clinical data of 15 patients undergoing reoperations for anastomotic stenosis was analyzed retrospectively.Original anastomosis was removed and Roux-en-Y cholangiojejunostomy and jejunal loop fixation were performed in all cases. Two different types of jejunal loop fixation were used. One with a blind loop of 10-15 cm at the proximal side of the anastomosis, which is fixed with a mark of the abdominal wall under the xiphoid process. The second is to mark and fix the jejunal side wall and the right abdominal wall about 10 cm from the distal side of the anastomosis. A T tube is placed in the intestine through the central part of the fixed intestinal wall.Results:Five cases underwent blind loop fixation, 10 cases underwent lateral wall fixation. There were 3 complications after operation, including 1 case of bile fistula, 1 case of incision infection, 1 case of abdominal hemorrhage, all were cured by conservative treatment, and there was no perioperative death. One case had postoperative anastomotic stenosis in the follow-up. The patient underwent jejunal puncture under local anesthesia, and was cured by percutaneous choledochoscopy.Conclusions:The possibility of restenosis should be considered in the reoperation of anastomotic stenosis. The jejunal loop should be fixed and marked during the operation in high risk patients. Once the anastomotic stricture recurred, choledochoscopy could be performed by puncture and dilation of fixed loop of intestine to avoid reopen surgery.
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Objective:To study the impact of repeat hepatectomy for patients with post-hepatectomy recurrent hepatocellular carcinoma (HCC).Methods:The data of patients who developed post-hepatecotmy recurrent HCC and underwent repeat hepatectomy at the General Surgery Department of Beijing Tongren Hospital from May 2013 to May 2016 (the Recurrence Group), were retrospectively compared with the data from patients who underwent initial hepatectomy for HCC during the same study period (the Primary Group). The general data, perioperative data, postoperative complications and survival of the two groups were compared.Results:The primary group included 179 patients, consisting of 133 males and 46 females, aged (57.3±11.7) years, with a range from 14.0 to 84.0 years. The recurrence group included 36 patients, consisting of 30 males and 6 females, aged (55.9±11.4) years, with a range from 40.0 to 77.0 years. There were no statistically significant differences between the two groups in gender, age, hepatitis virus infection status, preoperative alpha fetoprotein, Child-Pugh score and indocyanine green retention rate at 15 min ( P>0.05). However, there were statistically significant differences ( P<0.05) between the two groups in operative time [(244.2±84.3)min vs. (283.4±66.8)min], intraoperative blood loss[(428.5±151.6)ml vs. (756.2±187.4)ml], anatomic or nonanatomic hepatectomy, single tumor or multiple tumors, and maximum tumor diameter[(5.81±2.24)cm vs. (3.69±1.55)cm]. There were no statistically significant differences between the two groups in incidences of tumor capsular invasion, tumor thrombus and degrees of tumor differentiation ( P>0.05). There were no statistically significant differences in surgical complication rates ( P>0.05), and in 1-year and 3-year overall and disease free survival rates between the two groups ( P>0.05). Conclusions:Repeat hepatectomy for recurrent HCC after hepatectomy was safe and effective. Its long-term survival outcomes were similar to first hepatectomy for HCC.
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Objective To summarize the experience of the laparoscopic common bile duct exploration for choledocholithiasis and cholecystolithiasis.Methods From Jan 2014 to May 2018,laparoscopic common bile duct exploration were successfully completed in 112 cases of choledocholithiasis and cholecystolithiasis.Results Laparoscopic common bile duct exploration was performed successfully in 14 cases through cystic duct,while in 78 cases through the mini-incision at insertion of cystic duct,and in 20 cases through direct incision of common bile duct.In 3 cases T-tube was placed.9 cases developed bile leakage postoperatively and recovered after 3-7 days of conservative treatment.Conclusion Laparoscopic common bile duct exploration through cystic duct is the first choice of common bile duct exploration followed by mini-incision at insertion of cystic duct.Laparoscopic exploration of common bile duct via choledochotomy was performed when there was abnormal anatomy of cystic duct.
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Objective To analyze our experience in laparoscopic common bile duct ( CBD) explo-ration using a 5 mm choledochoscope through a micro-incision at the junction between the cystic duct and the CBD for patients with choledocholithiasis and cholecystolithiasis. Methods From January 2014 to May 2018, laparoscopic common bile duct exploration through a micro-incision at the cystic duct-CBD junction was performed in 77 patients with choledocholithiasis and cholecystolithiasis at Beijing Tongren Hospital, Capital Medical University. Results Laparoscopic common bile duct exploration was performed successfully through a micro-incision in 77 patients with primary suturing of the micro-incision. The range of operation time, blood loss, and hospital stay were 65～150 min, 10～50 ml, and 4～9 d respectively. Seven patients developed minor bile leakage postoperatively and were treated successfully after 3 ～7 days of conservative treatment. Conclusion Common bile duct laparoscopic exploration using a choledochoscope for choledocho-lithiasis and cholecystolithiasis through a micro-incision at the junction of cystic duct and CBD was a safe and effective method.
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Objective To study preventive measures against conversions to open surgery during laparoscopic cholecystectomy(LC).Methods The study was based on 25 cases of conversions to laparotomy out of 852 cases of LC(2.93%)from December 1999 to October 2005 in this hospital.The clinical data revealed a bile duct injury in 3 cases,bleeding in 1 case,severe adhesion in abdominal cavity or between the gallbladder and neighboring tissues in 9 cases,disturbed anatomy and adhesion in the region of the Calot's triangle in 5 cases,cholecystoduodenal fistula in 2 cases,and Mirizzi syndrome(type Ⅱ)in 5 cases.Results The conversion to open surgery was successfully completed in all the 25 cases.No complication was encountered.Follow-up examinations for 1～2 years showed no bile duct stenosis.Conclusions Proper preoperative patient selection and use of intraoperative preventive measures are helpful to minimize the possibility of conversion to open surgery.