Comparison between early gall bladdercancer and advanced gall bladdercancer in terms of clinicopathologic factors: large volume tertiary center experience

Background:Early diagnosis of gallbladder cancer (GBC) which enables to surgical resection is key for improve prognosis. Aim of this study was to investigate clinical features of early GBC patients compare to advanced ones.Methods:We retrospectively reviewed medical records of all pathologically confirmed primary GBC patients between in single tertiary referral center.Results:250 patients (57.3%) were early GBC (stage IandII) and 186 (42.7%) were advanced GBC (stage IIIandIV). Less patients with early GBC had symptom at initial diagnosis (69.2% versus90.8%, p<0.001). Large number of patients with early GBC were diagnosed GBC incidentally after surgical resection which initially suspected benign gallbladder polyp or symptomatic gallbladder stones (71/250, 28.4% versus7/186, 3.8%) (p<0.001). Patients who initially diagnosed gallbladder stone or cholecystitis tended to more advanced than gallbladder polyp.Conclusions:There were no definitive symptoms which can detect early GBCs. Large number of early GBCs were diagnosed incidentally and many of these initially diagnosed with or accompany with benign cholecystic disease. Careful examination should be performed before diagnosis and after treatment, even in patient with vague symptom or benign cholecystic disease without elevated tumor markers.

Asymptomatic Cholecystocolic Fistula Diagnosed Accurately before Surgery / 대한췌담도학회지

Cholecystocolic fistula (CCF) is a rare and late complication of gallbladder disease. The cause of CCF is known to be peptic ulcer, gallbladder disease, malignant tumor, trauma, and postoperative complications. The proper treatment method is to perform cholecystectomy and to identify and alleviate the CCF. However, cholecystectomy is not always possible owing to technical difficulties and disease severity. CCF is difficult to diagnose preoperatively, and CCF operation without an accurate preoperative diagnosis can lead to a more complicated surgery and cause surgeons to face more difficult situations or to endanger patients' lives. We report a case of asymptomatic CCF successfully treated with laparoscopic surgery after accurate diagnosis before surgery.

Application of continuous two-layer suture of gallbladder incision with a single absorbable suture on laparoscopic gallbladder-preserving cholecystolithotomy / 中国内镜杂志

Objective To evaluate the clinical application of continuous two-layer suture of gallbladder incision with a single absorbable suture on laparoscopic minimally invasive gallbladder-preserving cholecystolithotomy. Methods The clinical data of 74 cases underwent laparoscopic minimally invasive gallbladder-preserving cholecystolithotomy were retrospectively analyzed. Main surgical procedures included the longitudinal incision of gallbladder wall, choledochoscopy and the removal of all stones and the closure of the gallbladder incision. The mucous incision was first closed using a 4-0 absorbable suture with continuous everting suture. Using the same suture, the seromuscular incision was then closed with continuous invering suture. The operation time, suturing time, complications and postoperative hospitalization time were also documented. Results Laparoscopic gallbladder-preserving cholecystolithotomy was successfully performed in all cases using the suturing technique introduced in Methods. The operation time was 33~78 min (average 45.11 ± 14.96 min). Suturing time for gallbladder incision was 9 ~ 22 min (average 14.86 ± 3.88 min). No severe complications occurred, such as bile leakage, peritonitis, residual gallstone, hemorrhage or infection. The postoperative hospitalization time was 2~4 d (average 3.21 ± 0.69 d). A postoperative follow-up of 3 ~ 62 months (average 35.50 ± 18.94 months) indicated gallbladder stone recurrence of 2 cases, with a recurrence rate of 2.7%. Continuous two-layer suture of gallbladder incision with a single absorbable suture is a safe, practical and reliable technique for the closure of the gallbladder incision in laparoscopic gallbladder-preserving cholecystolithotomy.

Diagnostic value of serum liver function indexes for gallbladder stones combined with asymptomatic secondary common bile duct stones / 中华消化外科杂志

Objective To investigate the diagnostic value of serum liver function indexes for gallbladder stones combined with asymptomatic secondary common bile duct stones.Methods The retrospective cohort study was conducted.The clinical data of 460 patients with gallbladder stones who were admitted to the Affiliated Hospital of Zunyi Medical College from June 2012 to June 2016 were collected.Of 460 patients,106 combined with asymptomatic secondary common bile duct stones and 354 with gallbladder stones were allocated into the common bile duct stone group and gallbladder stone group,respectively.The serum liver function test was applied to the 2 groups,including alanine transaminase (ALT),aspartate transaminase (AST),total bilirubin (TBil),direct bilirubin (DBil),glutamyltransferase (GGT) and alkaline phosphatase (ALP).The receiver operating characteristic (ROC) curve was built using significant statistical indicators,and correspondent cut-off value,sensitivity and specificity were calculated according to ROC curve.Observation indicators:(1) comparison of serum liver function indicators (ALT,AST,TBil,DBil,GGT,ALP) between the 2 groups;(2) analysis result of ROC curve.Measurement data with normal distribution was represented as x±s.The comparison between groups was evaluated with the independent-sample t test.The comparison of count data were analyzed using the chi-square test.The ROC curve analysis was done for significant statistical indicators.Results (1) Comparison of serum liver function indicators between the 2 groups,the levels of ALT,AST,TBil and DBil were (32±8)U/L,(35±8)U/L,(12.8±2.5)μmol/L,(2.6±0.4)μmol/L in the common bile duct stone group and (30±7)U/L,(32±7)U/L,(12.2± 2.4)μmol/L,(2.5 ±0.4)μmol/L in the gallbladder stone group,respectively,with no statistically significant difference (t=0.891,0.786,0.924,1.026,P＞0.05).The levels of GGT and ALP were (162±43) U/L and (145±37) U/L in the common bile duct stone group and (36± 10)U/L and (128±23) U/L in the gallbladder stone group,respectively,with significantly statistical differences (t =20.859,2.483,P＜0.05).(2) Result of ROC curve showed that areas under the curve of GGT and ALP were respectively 0.963 [95％ confidence interval (CI):0.938-0.988] and 0.621 (95％CI:0.561-0.684).The correspondent cut-off value of diagnostic accuracy,sensitivity and specificity of GGT and ALP were 92.5 U/L and 139.5 U/L,91.6％ and 50.7％,95.7％ and 76.5％,respectively.Conclusion The abnormally elevated levels of serum GGT have major diagnostic value for patients with gallbladder stones combined with asymptomatic secondary common bile duct stones,with an advantage of convenient and fast operation,and it is worth to be applied and popularized.

Timing of laparoscopic cholecystectomy in acute pancreatitis with gallbladder stones / 中华肝胆外科杂志

Objective To evaluate the timing,feasibility and necessity of early laparoscopic cholecystectomy (LC) in management of patients with mild to moderate acute pancreatitis with gallbladder stones.Methods The clinical data of 75 patients with mild to moderate acute pancreatitis and gallbladder stones treated from September 2010 to August 2014 in our hospital were analyzed retrospectively.32 patients underwent LC within 48 hours of the pancreatic attack.The results were compared with those from 43 patients with delayed LC.Results All the patients were operated by experienced surgeons.There were no significant differences between the two groups in operation time,postoperative complications,intraoperative blood loss,conversion rates,white blood cell count,percentage of neutrophils and blood amylase before and after the operation (P ＞0.05).Patients who received delayed LC had longer hospital stay [(10.6 ± 1.3) vs (17.1 ± 1.8),P ＜ 0.05].The readmission rate in patients with delayed LC was 30.2％ (13/43),and most admissions occurred within 2 ～4 weeks of hospital discharge.In patients with early LC,one patient developed necrotic pancreatitis and died of septic shock.All the remaining patients were cured.Conclusions It is safe,feasible and necessary to perform LC within 48 h in patients with mild to moderate acute pancreatitis and gallbladder stones.Such patients have a high readmission rate and the best timing of delayed LC is within 2 ～ 4 weeks after discharge from hospital.

Clinical experience of laparoscopic treatment on cholecystitis complicated with gallstones report of clinical analysis of 94 cases / 中国综合临床

Objective To summary clinical experience of laparoscopic treatment of cholecystitis with cholecystolithiasis complicated,in order to provide reference for clinical difficult laparosco-pic resection of gallbladder.Methods Reviewing the operation treatment of laparoscopic cholecystectomy on 94 complex cases of resection during January 2008 to December 2014.Results The 94 patients included 17 cases with severe adhesion around gallbladder,9 cases with gallbladder atrophy,39 cases with gallbladder ampulla and cystic duct stone incarceration,11 cases with acute gangrenous cholecystitis with gallbladder stones,14 cases with gallbladder triangle anatomy is not clearing and 19 cases with gallbladder stones with schistosomial cirrhosis or liver volume variation.Some cases were with the two or more kinds gallbladder stone.There were 91 cases with successful implementation of the laparoscopic cholecystectomy,4 of 91 cases were treated with subtotal cholecystectomy,and 3 cases were converted to open cholecystectomy.There were no cases with serious complications or even deaths.Conclusion Regarding of the complex gallbladder stones appear different situation in operation,we can complete the operation by using different operation method and treatment method in laparoscopic.

Association between Clonorchis sinensis infestation and different types of gallbladder stones / 中华肝胆外科杂志

Objective To study the relationship between Clonorchis sinensis infestation and different types of gallbladder stones.Methods From May 2011 to September 2014, 1 052 cases of gallbladder stones were collected from the Department of General Surgery at The Sixth People's Hospital of Nansha, Guangzhou.These stones were first grinded for microscopic examination and divided into two groups based on the results of detection of Clonorchis sinensis eggs.They were then analyzed by FTIR spectroscopy to identify the type of gallbladder stones.Some stones were also chosen randomly for observation under scanning electron microscope (SEM).Results Clonorchis sinensis eggs were found in 300 stones and among these, the number and proportion of cholesterol, bile pigment, calcium carbonate, mixed and other types of stones were 28 (9.3％), 102 (34.0％), 102 (34.0％), 50 (16.7％), and 18 (6.0％), respectively.In the 752 egg-negative stones, the number and proportion of the above five types of stones were 414 (55.1％), 132 (17.6％), 66 (8.8％), 94 (12.5％), and 46 (6.1％), respectively.Observation under SEM showed a lot of tiny particles were absorbed on the mesh of the superficial texture of the Clonorchis sinensis eggs, which were also adherent to the bilirubin particles, calcium stearate crystals, phosphate, calcium stearate and protein particles.Conclusions The main types of egg-positive stones were bile pigment and calcium carbonate stones, while cholesterol stone was the main type of egg-negative stones.Clonorchis sinensis infestation was associated mainly with bile pigment and calcium carbonate stones.

Laparoscopic surgical treatment for schistosomiasis liver fibrosis portal hy-pertension combined with calculous cholecystitis / 中国血吸虫病防治杂志

Objective To evaluate the curative effect of laparoscopic cholecystectomy(LC)in the treatment of schistosomia-sis liver fibrosis portal hypertension combined with calculous cholecystitis. Methods The clinical data of 196 cases of schistoso-miasis liver fibrosis portal hypertension combined with calculous cholecystitis(Child A 160 cases,Child B 36 cases)treated with LC were collected and analyzed from June 2006 to June 2013. Results Among the 196 cases,there were 154 cases of schistoso-miasis liver fibrosis portal hypertension combined with chronic calculous cholecystitis,and 42 cases of schistosomiasis liver fibro-sis portal hypertension combined with acute calculous cholecystitis. Totally 189 patients underwent LC successfully,but 7 were transited to the general operation because of LC failure,including 3 cases of adhesion around gallbladder and ambiguous dissec-tion of gallbladder triangle,and 4 cases of intraoperative bleeding and the bleeding was difficult to stop under the laparoscopy. All the 196 patients were cured. Conclusion LC is effective and safe in the treatment of schistosomiasis liver fibrosis portal hyperten-sion combined with calculous cholecystitis.

Gallbladder disease in type-2 Diabetes mellitus patients.

Background: Diabetes mellitus is a modern epidemic which leads to various complications over a period of time. Autonomic neuropathy is one such complication which may lead on to gallbladder dysmotility and gallbladder stones. Objectives: To determine the incidence of gallbladder disorders in patients of type 2 diabetes mellitus and to find out the incidence of autonomic dysfunction in type 2 diabetes mellitus and correlate it with presence of gall bladder disorders. Material and Methods: The present study was conducted in 50 cases of type 2 diabetes mellitus and 25 healthy age and sex matched normal individuals were taken as controls. The cases as well as the controls underwent ultrasonographic examination for gall bladder volume, wall thickness, intraluminal mass and contraction in response to fatty meal. Data thus collected was compared and analysed statistically by using students ‘t’ test and chi- square test. Results: Mean postprandial gallbladder volume was 20.56±8.87 cm3 in diabetics with ANP with gallstones, 26.16±1.24 cm3 in diabetics with ANP with dysmotility 13.0±6.26 cm3 in diabetics with gallstones without ANP, 12.14±4.88 cm3 in normal diabetics and 13.60±5.95 cm3 in controls. The percentage contraction post fatty meal was calculated from these values and found to be 24.73±14.64% in diabetics with ANP with dysmotility, 26.38±17 .04% in diabetics with ANP with dysmotility, 43.48±8.45% in diabetics with gallstones without ANP, 56.84±9.02% in normal diabetics and 57 .64±9.92% in controls. Conclusion: Incidence of gallbladder disease is much higher in type 2 diabetics (40%) as compared to normal healthy adults (4%). It was concluded that diabetics with ANP had significantly impaired gallbladder emptying. Poor control of diabetes, hypercholesterolemia and diabetic autonomic neuropathy are important risk factors for the development of gallbladder disease.

Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

OBJECTIVE: To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis. MATERIALS AND METHODS: Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique. RESULTS: Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days). CONCLUSION: Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis.

Relationship between Metabolic Syndrome and Gallbladder Stone / 가정의학회지

BACKGROUND: The prevalence of metabolic syndrome is increasing in Korea. The aim of this study was to establish if there is an association between the presence of metabolic syndrome and the development of gallbladder stones in Koreans. METHODS: Among the subjects who visited a health promotion center of a general hospital from January 2001 to December 2005, a total of 34,574 adults was examined. Among them, the final 34,470 adults (males 20,277, females 14,193) were included. Metabolic syndrome was defined if they fell under the three conditions of BMI > or = 25 kg/m2, blood pressure > or = 130/85 mmHg, fasting glucose 110 mg/dL, triglyceride > or = 150 mmHg and low HDL-cholesterol (< 40 mg/dL in men, < 50 mg/dL in women). After adjusting for age and sex, logistic regression analysis was done to evaluate the relationship between metabolic syndrome and gallstones. RESULTS: This study showed that the prevalence of metabolic syndrome was 17.6% (males 21.1%, females 12.4%). Gallbladder stone risk was increased according to BMI, high blood pressure, high fasting blood glucose and low HDL. Gallbladder stone risk was increased according to clustering of components of metabolic syndrome after adjustment for age and sex (1 criterion: OR = 1.42, 95% CI, 1.20-1.69, P = 0.000; 2 criterion: OR = 1.86, 95% CI, 1.57-2.21, P = 0.000; 3 criterion: OR = 2.02, 95% CI, 1.66-2.45, P = 0.000; 4 criterion: OR = 2.17, 95% CI, 1.66-2.85, P = 0.000; 5 criterion: OR = 2.17, 95% CI, 1.17-4.02, P < 0.014). CONCLUSION: Gallbladder stone risk was increased according to BMI, and increased with people who had combination of more metabolic syndrome components.

Inhibitory Effect of Piperine on Gallstone Formation in the Gallbladder of C57BL/6 Mice / 中国中医药信息杂志

Objective To observe the effect of piperine (PA) on experimental gallstone formation in the gallbladder of C57BL/6 mice. Methods 3 dietary groups of C57BL/6 with 10 mice each group were allocated as control (normal mice chow),lithogenic (1% cholesterol diet) and PA (1% cholesterol diet + PA 30 mg/kg body weight) group respectively for 4 weeks. The expression of Scp2 gene in liver tissue was measured by RT-PCR and the bile lipid contents was measured chemically,the cholesterol saturation index (CSI) was calculated by Carey’s method. Results Cholesterol crystals and stones were found in 10/10 and 9/10 gallbladders respectively in lithogenic group,but not found in control and PA groups. Comparing with the lithogenic group,the expression of Scp2 gene in liver tissue and CSI in the gallbladder bile were significantly decreased in PA group. Conclusions PA inhibit the experimental gallstone formation induced by high cholesterol feeding in C57BL/6 mice,with simultaneous decreasing of both the Scp2 gene expression in the liver tissue and the CSI value in the gallbladder bile. The further study of the preventive effect of gallstong formation of PA,whether or not related to the above results,is strongly suggested.

A case of limy bile accompanied with gallbladder stones and common bile duct stone / 대한내과학회지

Limy bile is a rare condition characterized by excessive precipitation of calcium carbonate in the gallbladder. It has been known a cause of cholecystitis. Churchman firtst reported a case of curious deposition of calcium salts within the gallbladder in 1911. The etiology of limy bile is unclear. Recently we experienced a 32-year-old woman who had a limy bile in the gallbladder, right hepatic duct, common hepatic duct with multiple gallbladder stones and common bile duct stone. We report this case with a review of literature.

Safety evaluation of laparoscopic cholecystectomy in patients with end-stage renal diseases / 中国微创外科杂志

Objective To evaluate the perioperative safety of laparoscopic cholecystectomy(LC) in patients with gallstones complicated with end-stage renal disease(ESRD). Methods Clinical data of 41 patients with gallstones accompanying ESRD treated with LC(ESRD Group) between May 1994 and May 2005 were analyzed retrospectively.Another 200 patients without ESRD(non-ESRD Group) receiving LC during the same period were randomly selected for comparison.Results The patients in the ESRD Group were older than those in the non-ESRD Group(49.8?11.9 years vs 44.2?12.3 years;t=2.655,P=0.008).There were significant differences between the ESRD Group and the non-ESRD Group in hemoglobin levels(76.3?11.7 g/L vs 120.1?8.4(g/L)) and platelet count [(141?36)?10~9/L vs(183?51)?10~9/L)] (t=22.905 and 6.226;P

Incidence of Gallbladder Stones in Renal Transplant Recipients / 대한소화기학회지

BACKGROUND/AIMS: Gallbladder stone is one of the major cause of morbidity in adults. Renal transplantation has been found to increase the risk of gallbladder stone formation. The real incidence of gallbladder stones in renal transplant recipients is not exactly known. We performed this study to identify the risk factors for cholecystolithiasis. METHODS: We compared the prevalence of gallbladder stone in 222 renal transplantation patients with that in 222 age and sex matched controls. Patients who had chronic liver disease, renal disease, and diabetes were excluded from the control group. RESULTS: In our study, the incidence of gallbladder stones is 8.6% (19/222 patients) in renal transplantation patients, which was significantly higher than 3.60% (8/222 control) in the control group (p=0.029). In the most of our renal transplantation patients, cholecystolithiasis was asymptomatic. We did not find a difference in age, sex, duration after transplantation, causes of renal failure, resistance index between patients with and without gallbladder stones in renal transplantation patients. CONCLUSIONS: Our results suggest that the incidence of gallbladder stones is higher in renal transplant recipients than non-transplant population in Korea. Further studies will be needed to focus the factors contributing to the gallbladder stone formation after renal transplantation, especially in regard to immunosuppressive drugs.

Analysis of gallstones which cause biliary symptoms or complication / 대한내과학회지

BACKGROUND: Gallstone is one of the most common cause of acute abdominal pain and is increasingly managed by laparoscopic cholecystectomy. Silent gallstones are usually managed expectantly and are considered for surgery only if the characteristic biliary pain occurs. If predictors of stone-related complications such as acute cholecystitis, pancreatitis, and cholangitis can be identified, patients at high risk can be selectively referred for treatment regardless of symptoms development, while those at lower risk may be safely observed. The purpose of this study was to find out the predictors of stone-related complication or biliary pain in patients with gallbladder stones. METHODS: We collected clinical data retrospectively on patients who were diagnosed with gallstone at Asan Medical Center. Total gallstone number was classified into 1, 2~4, over 5. Diameter of the gallstones were subdivided into 20 mm. Statistical analysis was performed using SAS program (Ver 6.11). RESULTS: 918 patients (432 men and 486 women) were included in the analysis. The mean age was 54.3 years; that of men was 55 years and women was 53.8 years. Stone-related complications developed in 201 patients of acute cholecystitis, 78 patients of acute gallstone pancreatitis and 80 patients of acute cholangitis. Biliary pain was occurred in 568 patients. 658 patients were experienced cholecystectomy (158 patients open cholecystectomy and 500 patiens LLC). 377 patients were experiened ERCP, and 289 persons of that were experienced EST. Acute gallstone pancreatitis and acute cholangitis were significantly more frequent in older age and patients experiencing biliary pain. Their gallstone size was significantly smaller and the number was significantly more numerous in the univariate analysis. But, in the multiple logistic regression analysis, only age and the smallest stone size were independent risk factors. Patients who experiencing biliary pain were older and had significantly smaller and multiple gallstones in the univariate analysis. However in the multiple logistic regression analysis only age and stone number were independent variables. Acute cholecystitis was significantly more frequent in the old age group and patients with biliary pain. CONCLUSION: In the multiple logistic regression analysis, old age and small gallstones were predictors of acute gallstone pancreatitis and acute cholangitis. Old age and multiple gallstones were associated with biliary pain. Old age and biliary pain were predictors of acute cholecystitis, but the gallstone size and number were not associated in this study. We suggest that a well-designed prospective study is necessary in the future.

Study on application of ultrasound in the diagnosis of gallbladder stone comparing with surgery

The ultrasound for early, right local diagnosis helps convenient operation, improves the treatment quality and reduces the mortality rate. Study on 97 patients with operation for the gallbladder stone in the central army hospital No 108 from Jan. 1993 to June 1994 received an operation by Kontrol. The corrects of ultrasound before operation for the gallbladder stone, OMC stone, inner hepatic stone and biliary ascariasis are 95%; 97.94%; 87.63%-93.84%; 92.78%-94.85%, respectively. The ultrasound only has determined dilation of bile-duct. The diagnosis of narrow of bile-duct, especially inner hepatic bile-duct remainly are limited by ultrasound.

Comparison of postoperative immune function of patients undergoing Zeus robot-assisted laparoscopic cholecystectomy and laparoscopic cholecystectomy / 中国普通外科杂志

Objective To compare the postoperative changes in immune function of patients undergoing robot-assisted laparoscopic cholecystectomy(RLC) and conventional laparoscopic cholecystectomy(CLC).Methods The clinical data of 52 cases of gallbladder stones and gallbladder polyps treated with RLC(23 cases),and with LC(29 cases) was compared.Blood samples from both groups were taken to measure immune markers(T cells,IgA,IgM,IgG,C3,C4) before operation and in the first postoperative morning.Results The postoperative levels of CD4/CD8 and IgM decreased from 1.56?0.67,1.42 ?0.58 to 1.30?0.53,1.26?0.46 respectively after RLC(all P0.05).Conclusions RLC and CLC showed no significant postoperative effect on cellular immune function,but both had some effect on humoral immune function.

Value of ultrasound in the diagnosis of gallbladder stone in ViÖt §øc hospital

Retrospective study on 194 dossiers of the patients with common bile duct stones, including 90 patients with calculi in the lower choledochus (posterior pancreas), 68 patients are examined in urgent situation and 126 patients non-urgent, 73 patients with history of abdominal surgery, 121 patients without history of abdominal surgery. All patients were diagnosed by sonography and have been operated at Viet Duc Hospital in 2 years of 1998-1999. The result shown that the sensitivity of sonography in diagnosing common bile duct stones is 95% and in diagnosing lower choledochus stones is 87.8%. Urgent or non-urgent ultrasonic examination have unconsidered influence to the sonographic value in diagnosing common bile duct stones with the sensitivity 92.6% and 97.6% respectively. The situation of abdominal surgery influences the sonographic value in diagnosing common bile ducts stones: The sensitivity is 91.8% to patients with abdominal surgery and is 91.8% to patients with abdominal surgery and is 98.3% to patients without abdominal surgery.

Laparoscopic Cholecystectomy after an Endoscopic Sphincterotomy for Patients with Choledocholithiasis

BACKGROUND: Laparoscopic cholecystectomy (LC) has become the treatment of choice for patients with symptomatic gallbladder (GB) stones. About 10% of patients with symptomatic GB stones may have common duct (CD) stones at the same time. For patients with symptomatic GB stones and suspected CD stones, an endoscopic retrograde cholangiopancreaticography (ERCP) should be performed. The preferred approach to these patients is an ERCP, an endoscopic sphincterotomy (EST), and removal of the CD stones, followed by a LC. The aims of this study were to test the safety and to evaluate the efficacy of the endoscopic and laparoscopic procedure in patients with symptomatic GB stones associated with CD stones. MATERIAL AND METHODS: A retrospective review was conducted on 522 patients who had been treated surgically for GB stones with or without CD stones between Jul. 1994 and Jun 1997. Among them, an ERCP followed by a LC was performed in 57 (67.1%) of the 85 patients who had CD stones, a LC in 377, an open cholecystectomy in 60, and an open cholecystectomy and CD exploration in 28. RESULTS: There were significant differences in operation times, hospital stays, and postoperative complications between the group with an EST followed by a LC and the group with an open cholecystectomy and CD exploration, but no significant differences between the LC group and the group with an EST followed by a LC. CONCLUSIONS: An EST followed by a LC is a good and safe treatment mordality for patients with symptomatic GB stones associated with CD stones.