Comparison between primary suture and T tube drainage in 124 cases of laparoscopic choledocholithotomy / 中国医师进修杂志

Objective:To investigate the clinical difference between primary suture and T tube drainage in laparoscopic choledocholithotomy.Methods:The clinical data of 124 patients treated by laparoscopic choledocholithotomy in Suzhou Municipal Hospital from December 2018 to February 2020 were retrospectively studied. The patients were divided into the primary suture group (71 cases) and the T tube drainage group (53 cases) according to the different surgical methods, and the differences in the relevant treatment indicators were compared between the two groups.Results:There were no statistically significant differences between the two groups in gender, hypertension, diabetes mellitus, preoperative aspartate aminotransferase, preoperative alanine aminotransferase, preoperative total bilirubin, preoperative common bile duct diameter, postoperative length of stay, total cost of hospitalization, postoperative exhaust time, or postoperative biliary leakage, et al. Compared with the T tube drainage group, the primary suture group had more single choledocholithiasis before operation (33 cases vs. 15 cases), shorter operation time: (100.14 ± 38.90) h vs. (140.45 ± 54.17) h, less intraoperative bleeding: (35.70 ± 30.17) ml vs. (49.53 ± 34.58) ml, and later extraction time of Winslow hole drainage tube after operation: (7.15 ± 2.61) d vs. (5.45 ± 3.35) d, and the differences were statistically significant ( P<0.05). Conclusions:Under the condition of strictly controlling the indications of primary suture and being operated by general surgeons who can skillfully operate laparoscope and choledochoscope, laparoscopic choledocholithotomy for primary suture has better curative effect than T tube drainage, and has higher clinical application value.

Clinical effect of laparoscopic common bile duct exploration through micro-incision of cystic duct and its junction in for choledocholithiasis / 国际外科学杂志

Objective:To investigate the clinical effect of laparoscopic common bile duct exploration through Micro-incision of cystic duct and its junction in for choledocholithiasis.Methods:The clinical data of 62 patients with cholecystolithiasis complicated with choledocholithiasis treated in the Department of hepatobiliary and pancreatic surgery of Huangshi Central Hospital, Edong Healthcare Group from January 2017 to December 2021 were analyzed retrospectively, and were divided into two groups according to different treatment schemes. Among them, 32 cases underwent laparoscopic cholecystectomy, common bile duct exploration and lithotomy (primary suture group), Laparoscopic choledocholithotomy and exploration + T-tube drainage (T-tube Drainage Group) 30 cases. The general data, operation time, intraoperative bleeding, postoperative exhaust time, first time out of bed, postoperative hospital stay, 24-hour postoperative pain score and the incidence of total complications were compared between the two groups.Results:The operation was successfully performed in both groups, there was no perioperative death.There was no significant difference in general data, operation time, intraoperative bleeding and the incidence of total complications between the two groups ( P> 0.05), the postoperative anal exhaust time, the first time out of bed and the postoperative hospital stay in the primary suture group were (20.3±5.8) h, (15.5±4.3) h and (4.5±1.7) d, respectively, which were significantly shorter than those in the T-tube drainage group (28.3±7.9) h, (22.8±6.7) h and (7.0±2.8) d( P<0.05); The hospitalization cost in the primary suture group was (18 725.9±855.8) yuan, which was significantly lower than that in the T-tube drainage group (23 450.7±975.4) yuan ( P< 0.05). The 24-hour pain score (2.7±0.9) scores in the primary suture group was significantly lower than that in the T-tube drainage group (3.8±1.2) scores ( P< 0.05). Conclusion:Laparoscopic common bile duct exploration through micro-incision of cystic duct and its junction is safe and effective, which can accelerate the rehabilitation of patients and reduce the cost of hospitalization, which is more in line with the concept of ERAS.

Valor pronóstico de los índices de severidad en las lesiones traumáticas de colon y recto / Prognostic value of severity indices in traumatic colon and rectal injuries

RESUMEN Introducción: Los índices de severidad en trauma son una serie de escalas que permiten describir la gravedad de un individuo traumatizado y se asocian con su pronóstico y probabilidad de sobrevida. Objetivo: Determinar el valor pronóstico de los índices de severidad anatómicos en la evolución de pacientes con lesiones traumáticas de colon y recto. Métodos: Se realizó un estudio observacional descriptivo y de corte transversal. Se incluyeron los pacientes con lesiones traumáticas de colon o recto intervenidos quirúrgicamente en cuatro hospitales de La Habana en el periodo 2008-2015. Los datos fueron recolectados de la historia clínica. Se utilizó análisis de distribución de frecuencias y las curvas de operación característica del receptor (curvas ROC). Resultados: La edad promedio de los pacientes 37,4 años (desviación estándar 13,6 años). Predominó el sexo masculino (76, 7 por ciento). De los 6 scores estudiados, solamente CIS Flint y COIS resultaron ser útiles para predecir sepsis de la herida quirúrgica. En la predicción de defunción, el área mayor bajo la curva correspondió a COIS (0,92), posteriormente le siguió NISS (0,86) y luego CIS Flint (0,81). Los puntos de corte óptimos calculados fueron: ( 3 para COIS, ( 24 para NISS y ( 2 para CIS Flint. Conclusiones: Se demuestra el valor de los índices COIS y Flint, para pronosticar la ocurrencia de complicaciones en los pacientes con lesiones traumáticas de colon y recto, y la utilidad de los diferentes índices, en el pronóstico de defunción(AU)

ABSTRACT Introduction: Trauma severity indices are a series of scales that describe the severity of a traumatized individual and are associated with their prognosis and probability of survival. Objective: To determine the prognostic value of anatomical severity indices in the evolution of patients with traumatic lesions of the colon and rectum. Methods: A descriptive observational and cross-sectional study was carried out. Patients with traumatic lesions of the colon or rectum who underwent surgery in four Havana hospitals in the period 2008-2015 were included. The data was collected from the medical history. Frequency distribution analysis and receiver characteristic operation curves (ROC curves) were used. Results: The average age of the patients 37.4 years (standard deviation 13.6 years). Male sex predominated (76.7 percent). Of the 6 scores studied, only CIS Flint and COIS were found to be useful in predicting sepsis of the surgical wound. In the prediction of death, the largest area under the curve corresponded to COIS (0.92), followed by NISS (0.86) and then CIS Flint (0.81). The calculated optimal cut-off points were: ( 3 for COIS, ( 24 for NISS and ( 2 for CIS Flint. Conclusions: The value of the COIS and Flint indices is demonstrated to predict the occurrence of complications in patients with traumatic lesions of the colon and rectum, and the usefulness of the different indices in the prognosis of death(AU)

Resultados terapéuticos en pacientes con traumas de colon y recto tratados con sutura primaria o colostomía / Therapeutic Results in patients with Colon and Rectal Traumas Treated with Primary Suture or Colostomy

RESUMEN Introducción: El trauma de abdomen tiene alta incidencia y con frecuencia afecta el colon y el recto, se aboga por el tratamiento mediante sutura primaria. Objetivo: Identificar diferencias en las características clínico-quirúrgicas y resultados terapéuticos de pacientes con lesiones traumáticas de colon y recto, tratados con sutura primaria y técnicas derivativas. Método: Se realizó un estudio multicéntrico descriptivo ambispectivo para determinar características clínico-quirúrgicas y resultados terapéuticos en pacientes con lesiones traumáticas de colon y recto en los hospitales Carlos J. Finlay, Joaquín Albarrán, Calixto García y Enrique Cabrera de La Habana, en el periodo 2010-2015. El universo estuvo conformado por todos los pacientes intervenidos quirúrgicamente por trauma de colon y/o recto. Resultados: La colostomía fue el proceder más frecuente (53,1 por ciento). Los pacientes en edades medias de la vida (promedio: 43,5 años), sexo masculino (71,4 por ciento), evolución hasta el tratamiento quirúrgico menor de 12 horas (73,4 por ciento); causadas por empalamientos y otros (49 por ciento) y heridas con arma blanca (38,8 por ciento). La magnitud del daño de colon y recto fue baja, con mayor afectación de colon izquierdo. La frecuencia de complicaciones graves y mortalidad fue alta en la colostomía. Conclusiones: La sutura primaria muestra mejores resultados terapéuticos y debe ser la técnica de elección en las lesiones traumáticas de colon y recto intraperitoneal(AU)

ABSTRACT Introduction: Abdominal trauma presents high incidence and often affects the colon and rectum; primary suture is the preferred treatment. Objective: To identify differences between the clinical-surgical characteristics and the therapeutic outcomes in patients with traumatic lesions of the colon and rectum, treated with primary suture and derivative techniques. Method: A multicentric, descriptive and ambispective study was carried out to determine the clinical-surgical characteristics and the therapeutic outcomes in patients with traumatic colon and rectal lesions in Carlos J. Finlay, Joaquín Albarrán, Calixto García and Enrique Cabrera Hospitals in Havana, in the period from 2010 to 2015. The study population was made up of all patients surgically intervened for colon and/or rectal trauma. Results: The colostomy was the most frequent procedure (53.1 percent). Patients in middle ages of life (average: 43.5 years), male sex (71.4 percent), evolution to surgical treatment under 12 hours (73.4 percent); caused by impalement and others (49 percent) and cutting wounds (38.8 percent). The magnitude of colon and rectum damage was low, with greater involvement of the left colon. The frequency of serious complications and mortality was high in the colostomy. Conclusions: Primary suture shows better therapeutic results and should be the technique of choice in traumatic lesions of the intraperitoneal colon and rectum(AU)

Clinical research of laparoscopic common bile duct exploration with primary suture and T tube drainage in the management of choledocholithiasis / 国际外科学杂志

Objective@#To investigate the short-term clinical efficacy of laparoscopic common bile duct exploration(LCBDE) with primary suture or T tube drainage in the management of choledocholithiasis.@*Methods@#The retrospective cohort study was conducted from January 2014 to December 2018 with the clinical data of patients with choledocholithiasis being analyzed. A total of 863 patients were enrolled in this study. There were 431 males and 432 females. The median age was 60 (range 11 to 94). These patients had received LCBDE with primary suture (n=287) and T tube drainage (n=576) in the Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University. Observation indicators: (1)Preoperative blood biochemistry, including blood serum levels of total bilirubin, direct bilirubin, ALT, AST, GGT. (2) Intraoperative conditions, including operation time, blood loss, diameter of common bile duct, number of common bile duct stone.(3)Short-term postoperative conditions, including postoperative hospital stay, postoperative complications. Measurement data with non-normal distribution were described as M (P25, P75), and comparison between groups was done using Mann-Whitney U test. Comparison of count data between groups were analyzed using the chi-square test. Univariate analysis and subsequent multivariable logistic regression were used to investigated the factors affecting the selection of surgical methods.@*Results@#(1) Blood serum levels of total bilirubin and direct bilirubin in the T tube drainage group were 17.0(12.2, 36.0) μmol/L, 7.6(4.9, 19.0) μmol/L, which were significantly higher than those of the primary suture group[15.7(11.8, 29.7) μmol/L, 6.7(4.4, 16.5) μmol/L)](Z=-2.023, -2.468, P<0.05). Preoperative blood serum levels of ALT, AST and GGT in the T tube drainage group were 56.7 (26.6, 128.8) U/L, 38.0(24.3, 75.8) U/L and 179.7(50.8, 394.4) U/L, the primary suture group were[68.2(24.8, 165.3) U/L, 35.5(22.8, 96.9) U/L and 235.2(74.9, 459.1) U/L], with no difference between the two groups (Z=-0.985, -0.437, -1.740, P>0.05). (2)The operation time of the primary suture group was 85(70, 100) min, which was significantly shorter than that of the T tube drainage group[97(75, 120) min](Z=-5.532, P<0.05). The diameter of common bile duct in the primary suture and T tube drainage group were 1.0(0.8, 1.2) cm and 1.0(0.8, 1.2) cm, respectively. Significant difference was observed between the two groups(Z=-2.071, P<0.05). The intraoperative blood loss in the primary suture and T tube drainage group were 20(10, 50) ml and 20(20, 50) ml, with no difference between the two groups (Z=-0.477, P>0.05). 61.32%(176/287) and 67.36%(388/576) of patients in the primary suture group and T tube drainage group were found with multiple stones in the common bile duct, with no difference between the two groups (χ2=3.083, P>0.05). (3)The primary suture group showed shorter postoperative hospital stay compared with the T tube drainage group[4(3, 5) d vs 6(5, 6) d, Z=-12.057, P<0.05]. The primary suture group showed more patients with bile leakage (2.09%) compared with that of the T tube drainage group (0.35%). Multivariable logistic regression showed that the number of common bile duct stone, diameter of common bile duct, time period of surgery, surgery group were significant factors affecting the selection of surgical methods(OR=1.687, 2.423, 0.587, 4.632, 95%CI: 1.152-2.470, 1.519-3.865, 0.511-0.675, 3.698-5.802, P<0.05).@*Conclusions@#Although different surgeons showed different opinions with the method of primary suture, laparoscopic common duct exploration with primary suture is safe and reliable in the management of choledocholithiasis with shorter operation time and faster postoperative recovery. T tube drainage is not absolutely necessary in the management of choledocholithiasis. Patients with multiple common bile duct stone or large diameter of common bile duct are likely to receive T tube drainage.

Clinical research of laparoscopic common bile duct exploration with primary suture and T tube drainage in the management of choledocholithiasis / 国际外科学杂志

Objective To investigate the short-term clinical efficacy of laparoscopic common bile duct exploration(LCBDE) with primary suture or T tube drainage in the management of choledocholithiasis.Methods The retrospective cohort study was conducted from January 2014 to December 2018 with the clinical data of patients with choledocholithiasis being analyzed.A total of 863 patients were enrolled in this study.There were 431 males and 432 females.The median age was 60 (range 11 to 94).These patients had received LCBDE with primary suture (n =287) and T tube drainage (n =576) in the Department of General Surgery,the First Affiliated Hospital of Nanjing Medical University.Observation indicators:(1) Preoperative blood biochemistry,including blood serum levels of total bilirubin,direct bilirubin,ALT,AST,GGT.(2) Intraoperative conditions,including operation time,blood loss,diameter of common bile duct,number of common bile duct stone.(3) Short-term postoperativeconditions,including postoperative hospital stay,postoperative complications.Measurement data with non-normal distribution were described as M (P25,P75),and comparison between groups was done using Mann-Whitney U test.Comparison of count data between groups were analyzed using the chi-square test.Univariate analysis and subsequent multivariable logistic regression were used to investigated the factors affecting the selection of surgical methods.Results (1) Blood serum levels of total bilirubin and direct bilirubin in the T tube drainage group were 17.0(12.2,36.0) μmol/L,7.6 (4.9,19.0) μmol/L,which were significantly higher than those of the primary suture group[15.7 (11.8,29.7) μmol/L,6.7 (4.4,16.5) μmol/L)] (Z =-2.023,-2.468,P ＜ 0.05).Preoperative blood serum levels of ALT,AST and GGT in the T tube drainage group were 56.7 (26.6,128.8) U/L,38.0 (24.3,75.8) U/L and 179.7 (50.8,394.4) U/L,the primary suture group were [68.2 (24.8,165.3) U/L,35.5(22.8,96.9) U/L and 235.2(74.9,459.1) U/L],with no difference between the two groups (Z =-0.985,-0.437,-1.740,P ＞ 0.05).(2) The operation time of the primary suture group was 85 (70,100) min,which was significantly shorter than that of the T tube drainage group [97 (75,120) min] (Z =-5.532,P ＜ 0.05).The diameter of common bile duct in the primary suture and T tube drainage group were 1.0(0.8,1.2) cm and 1.0 (0.8,1.2) cm,respectively.Significant difference was observed between the two groups(Z =-2.071,P ＜ 0.05).The intraoperative blood loss in the primary suture and T tube drainage group were 20(10,50) ml and 20(20,50) ml,with no difference between the two groups (Z =-0.477,P ＞0.05).61.32％ (176/287) and 67.36％ (388/576) of patients in the primary suture group and T tube drainage group were found with multiple stones in the common bile duct,with no difference between the two groups (x2 =3.083,P ＞ 0.05).(3)The primary suture group showed shorter postoperative hospital stay compared with the T tube drainage group [4 (3,5) d vs 6 (5,6) d,Z =-12.057,P ＜ 0.05].The primary suture group showed more patients with bile leakage (2.09％) compared with that of the T tube drainage group (0.35％).Multivariable logistic regression showed that the number of common bile duct stone,diameter of common bile duct,time period of surgery,surgery group were significant factors affecting the selection of surgical methods (OR =1.687,2.423,0.587,4.632,95％CI:1.152-2.470,1.519-3.865,0.511-0.675,3.698-5.802,P＜0.05).Conclusions Although different surgeons showed different opinions with the method of primary suture,laparoscopic common duct exploration with primary suture is safe and reliable in the management of choledocholithiasis with shorter operation time and faster postoperative recovery.T tube drainage is not absolutely necessary in the management of choledocholithiasis.Patients with multiple common bile duct stone or large diameter of common bile duct are likely to receive T tube drainage.

Treatment of oral and maxillofacial dog bites in children / 口腔疾病防治

Objective @#To summarize experience treating dog bites in the oral and maxillofacial regions of children and provide a reference for clinical practice.@*Methods @#Nineteen children with dog bite wounds in the maxillofacial region were treated from July 2011 to June 2018 with primary debridement and suturing. A rabies vaccine, tetanus vaccine and human immunoglobulin as a passive immune agent were given via intramuscular injection. Anti-inflammatory therapy with amoxicillin and clavulanate potassium or other antibiotics. Follow-up observation and a retrospective analysis of the treatment effect were carried out.@*Results@#After treatment, among the 19 pediatric patients, 18 cases showed primary healing and 1 case showed secondary healing. The follow-up period ranged from six months to seven and a half years. No cases of rabies occurred.@*Conclusion @#For the treatment of patients with maxillofacial dog bite wounds, the first stage debridement and suture can reduce the scar after operation and is beneficial to the recovery of face.

Laparoscopic self-releasing J tube drainage combined with primary suturing of common bile duct in the treatment of extrahepatic cholangiolithiasis / 中华肝胆外科杂志

Objective To study the feasibility and efficacy of treatment of extrahepatic cholangiolithiasis using laparoscopic self-releasing J-tube drainage combined with primary suturing of common bile duct.Methods The clinical data of 172 patients with extrahepatic cholangiolithiasis who underwent operations from March 2013 to January 2015 were retrospectively studied.The patients were divided into two groups:the J-tube drainage group (n =82) and the T-tube drainage group (n =90).Surgical duration,intraoperative bleeding,postoperative hospital stay,treatment cycles,hospital costs,incidences of postoperative bile leakage and residual extrahepatic cholangiolithiasis were compared between the two groups.Results The length of postoperative hospital stay in the J-tube drainage group was (4.9 ± 1.2) days and in the T-tube drainage group was (8.0 ± 2.0) days.The treatment cycles in the J-tube drainage group were (4.9 ± 1.2) days while in the T-tube drainage group were (24.1 ± 3.2) days.The hospital costs in the J-tube drainage group were (12 817.1 ±3 167.1) yuan and the costs in the T-tube drainage group were (15 012.5 ±2 354.8) yuan.There were significant differences in hospital stay,treatment cycles and hospital costs between the two groups (all P ＜ 0.05).The surgical duration in the J-tube drainage group was (108.2 ± 10.2) minutes and the duration in the T-tube drainage group was (110.1 ± 13.1) minutes.The amount of intraoperative bleeding in the J-tube drainage group was (35.0 ± 20.0) ml and the amount in the T-tube drainage group was (42.0 ±30.0) ml.There were no significant differences in intraoperative bleeding and surgical duration between the two groups (all P ＞ 0.05).No significant differences were observed in the incidences of post-operative bile leakage and in residual extrahepatic cholangiolithiasis between the two groups (P ＞ 0.05).Conclusions Self-releasing J-tube drainage combined with laparoscopic primary suturing of common bile duct was safe and efficacious.It was minimally invasive in treating patients with extrahepatic cholangiolithiasis.

Clinical analysis on safety of primary suture in laparoscopic choledocholithotomy / 重庆医学

Objective To explore the feasibility and safety of primary suture in laparoscopic common bile duct exploration(LCBDE) for treating choledocholithiasis.Methods The clinical data in 185 cases of choledocholithiasis underwent LCBDE in Sun Yat-sen Memorial Hospital from March 2010 to October 2015 were retrospectively analyzed.The patients were divided into 1aparoscopic common bile duct exploration and primary suture(LBEPS) group(117 cases) and T tube drainage group(68 cases) according to different processing modes of common bile duct incision.The operative time,intra-operative blood loss amount and postoperative complications were observed in the two groups.Results All operations were successfully performed in both two groups without converting to laparotomy.The operative time,intra-operative blood loss amounts and postoperative complications had no statistically significant differences between the LBEPS group and T tube drainage group(P>0.05).The postoperative hospital stay of the LBEPS group was significantly shorter than that of the T tube drainage group(P<0.01).There was no bile duct stricture or stone recurrence during the follow up period in the two groups.Conclusion Under strictly grasping the operation indication,selecting correct suture material and possessing practiced operating skills,primary suture of laparoscopic choledocholithiasis is safe and feasible,can avoid the risk of T tube placing related complications,has short postoperative hospitalization duration and increases postoperative living quality.

Can the wounds after infected meshes removal be sutured primarily: a retrospective study / 中华普通外科杂志

Objective To explore the efficacy of debridement and primary suture for mesh-related infections after tension-free inguinal hernia repair.Methods From January 2007 to December 2013,208 cases with nesh infections following inguinal hernia repairs were treated with debridement in Department of Hernia and Abdominal Wall Surgery of Beijing Chaoyang Hospital,147 cases were treated with primary suture (suture group) and 61 cases were treated with dressing change (open group).Results The mean time of mesh infection was (8.37 ± 6.89) months.The results of bacterial culture in the two groups were similar.First grade healing rate of suture group was 80.95％ (119/147),compared to zero percent in open group.Length of stay [(20.86 ± 7.90) d vs.(31.82 ± 11.50) d,t =3.47,P =0.034] and hospital cost [(3 200 ± 5 800) yuan vs.(26 500 ± 6 600) yuan,t =4.51,P =0.02] in suture group were less than in open group.No patients developed recurrent hernia in suture group compared with one recurrence in open group.Conclusions Debridement and primary suture for mesh-related infections after tension-free inguinal hernia repair could increase the rate of first grade healing,shorten average length of hospital stay and reduce total costs.

A clinical study on laparoscopic choledocholithotomy and primary suture in treatment of choledocholithiasis / 中华普通外科杂志

Objective To explore the indication,technology and clinical significance of laparoscopic choledocholithotomy and primary suture in treatment of choledocholithiasis.Methods 78 patients with choledocholithiasis were divided into two groups receiving respectively laparoscopic choledocholithotomy and T-tube drainage treatment,and laparoscopic choledocholithotomy and primary suture after common bile duct exploration.The time of operation,postoperative hospital stay and complications were analyzed and compared.Results Bile leakage occurred in 2 cases in the primary suture group and 3 cases in the T-tube drainage group;No residual stones or biliary stricture was found in either groups.The time of operation,postoperative complications were not statistically different (P ＞ 0.05).The difference in postoperative hospital stay and GI function recovery time between the two groups was statistically significant (P ＜ 0.05).Conclusion In well selected cases,the primary suture of common bile duct after laparoscopic choledocholithotomy is feasible and safe.

Sutura primaria en lesiones traumáticas de colon y recto / Primary suture in colon and rectum traumatic lesions

Introducción: en la vida civil la tendencia actual en el tratamiento de las lesiones traumáticas de colon y recto es hacia el cierre primario, pero aún no existe consenso. Objetivo: identificar características y evolución de 36 pacientes con traumatismos de colon a los que se les practicó sutura primaria. Métodos: estudio descriptivo, de cohorte retrospectiva. Se estudiaron pacientes atendidos en hospitales docentes de la provincia de La Habana, desde noviembre de 2008 hasta enero de 2012, así como los factores relacionados con la ocurrencia de complicaciones y los costos. Los datos fueron tomados de la historia clínica y del informe operatorio, en cada hospital. La información fue procesada de forma automatizada (SPSS 15.0). Se utilizó análisis de distribución de frecuencias, y el test de homogeneidad para identificar las variables relacionadas con la ocurrencia de complicaciones. Resultados: la causa más frecuente de las lesiones fue el arma blanca (86,1 por ciento). Los factores relacionados con la ocurrencia de complicaciones fueron el agente causal y la severidad de las lesiones según la escala de Flint (p= 0,02 y p= 0,04). Los costos promedio por tiempo quirúrgico y estadía resultaron ser de: $ 1091,88 y $ 1250,82. Conclusiones: las principales complicaciones por empleo de sutura primaria en los hospitales docentes de La Habana fueron: infección del sitio quirúrgico y sangramiento postoperatorio, y los factores relacionados con ellas: el agente causal y la severidad de las lesiones. El empleo de la sutura primaria es una opción terapéutica que parece razonable y menos costosa que la colostomía(AU)

Introduction: In civilian life, the current trend in the treatment of colon and rectum traumatic lesions is for the primary closure, but there is still no consensus. Objective: to identify the characteristics and outcome of 36 patients with colon trauma colonist who underwent primary suture. Methods: A descriptive study of retrospective cohort was carried out; we studied patients treated in Havana Province teaching hospitals, from November 2008 to January 2012, as well as the factors related to the occurrence of complications and costs. Data were collected from the medical records and the operative report, in each of the hospitals. The information was processed in an automated system (SPSS 15,0). Analysis of frequency distribution and homogeneity test were used to identify variables related to the occurrence of complications. Results: The most frequent cause of injury was stab (86,1 percent). The factors related to the occurrence of complications and the severity of lesions were the causative agents, as measured by the Flint scale (p= 0,02 and p= 0,04). Average costs per surgical and stay time turned out to be: $ 1091,88 and $ 1250,82. Conclusions: The main complications from the use of primary suture in teaching hospitals of Havana are: surgical site infection and postoperative bleeding, and other factors related to them: the causative agent and the severity of lesions. The use of primary suture is a therapeutic option that seems to be reasonable and less expensive than the colostomy(AU)

Comparison of unidirectional barbed suture and traditional suture for closing choledoch incision / 中国内镜杂志

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.

Prevention and treatment of bile leakage after laparoscopic common bile duct exploration and choledochoscopy followed by primary suturing of choledochal incision / 中华肝胆外科杂志

Objeetive To analyze the causes and to explore prevention and management of bile leakage after laparoscopic common bile duct exploration with choledochoscopy followed by primary suturing of choledochal incision.Methods The clinical data of 52 patients with bile leakage after laparoscopic common bile duct exploration choledochoscopy and primary suturing of choledochal incision carried out for choledocholithiasis between June 2011 to June 2013 were retrospectively studied.Results All the 52 patients successfully underwent the laparoscopic surgery and left hospital.The operation time was (101 ± 26) minutes (range 55～ 145 minutes).The intraoperative blood loss was (36±28) ml (range 10～ 100 ml).All the patients were ambulatory after the first postoperative day.The recovery time of postoperative gastrointestinal function was (49.8 ± 12.5) hours (range 37 ～ 74 h).The total hospitalization time was (10.8 ± 2.5) days (range 7 ～ 15 days).The average hospitalization days after surgery was (5.7 ± 1.7) days.The average hospitalization cost was (24 827 ± 3 776) yuan.There were two patients who developed intraoperative bile leakage which was treated with further suturing.Five patients developed postoperative bile leakage and they were cured after unobstructed drainage for 5 days through conservative treatment.After a follow-up of 1 ～ 2years,there was no recurrent lithiasis.The stone clearance rate was 100％.There was no bile duct stricture or other complications.Conclusion In expert hands and with proper selection of patients,laparoscopic common bile duct exploration,choledochoscopy and primary suturing of choledochal incision were safe,effective and feasible for choledocholithiasis.

Application of Layered Suture Technique in Laparoscopic Common Bile Duct Exploration with Primary Suture / 中国微创外科杂志

Objective To explore the application value of layered suture technique in laparoscopic common bile duct exploration with primary suture. Methods A total of 216 patients received laparoscopic common bile duct exploration with primary suture in our hospital from March 2007 to March 2013.Of these cases, layered suture technique was utilized in 89 patients and single-layer suture was used in 127 patients.The operation time, postoperative hospital stay, and postoperative complications were compared between the two groups. Results Two groups of patients were operated smoothly, with no conversions to laparotomy.Postoperative recovery was smooth.The operative time was not significantly different between the two groups of patients (t=-0.931, P=0.353). The postoperative hospital stay and incidence of postoperative bile leakage were significantly lower in layered suture group than those in single-layer suture group [(5.9 ±1.7) d vs.(7.7 ±1.8) d,t =7.400, P=0.000;3.4%(3/89) vs.20.5%(26/127), χ2 =13.167, P=0.000].In the single-layer suture group, the incidence of postoperative bile leakage was significantly higher in patients complicated with acute cholangitis [45.4%(10/22) vs.15.2%(16/105),χ2 =8.429, P=0.004], whereas in the layered suture group, the incidence of postoperative bile leakage was insignificantly different among patients with and without acute cholangitis [7.1%(1/14) vs.2.7%(2/75),χ2 =0.002, P=0.964]. Conclusion Application of layered suture technique in laparoscopic common bile duct exploration with primary suture is feasible and safe, with advantages of less bile leakage and shorter hospital stay.

Application of Nasobiliary Duct Instead of T-tube in Laparoscopic Common Bile Duct Exploration and Primary Suture / 中国微创外科杂志

Objective To explore the application value of nasobiliary duct instead of T-tube in primary suture after laparoscopic common bile duct exploration (LCBDE). Methods A total of 58 cases of choledocholithiasis without acutecholangitis were divided into experimental and control group according to the odevity of the last number of admission number .Patients in odd number belonged to experimental group , while the even number patients belonged to control group .The experimental group received endoscopic nasobiliary drainage ( ENBD ) combined with LCBDE and primary suture;the control group underwent LCBDE combined with T-tube drainage .The intraoperative and postoperative data were compared between the two groups . Results All surgeries were completed successfully under laparoscope .The experimental group had much shorter hospital stay than that of the control group [(7.5 ±2.1) d vs.(10.3 ±3.2) d,t=-3.965,P=0.000].No significant differences were found in the operative time , incidence of bile leakage and postoperative incision pain between the two groups (P>0.05).All the cases were followed up for 6-12 months (average, 9 months) and no patients were hospitalized due to complications related to the billiary surgery .MRCP showed no complications such as biliary stricture and residual stones 6 months after operation . Conclusions Nasobiliary duct can substitute for T-tube in LCBDE .It ensures the safety of the primary suture and reduces T-tube related complications .

Clinical Discussion of Laparoscopic Joint Choledochoscope Common Bile Duct Exploration and Primary Suture in Operation for Choledocholithiasis on 53 Cases / 昆明医科大学学报

Objective Discuss the clinical experience of laparoscopic common bile duct exploration and primary suture in operation for choledocholithiasis. Methods From August 2010 to December 2012, 53 patients with choledocholithiasis were treated with laparoscopic common bile duct exploration and primary suture laparoscopic common bile duct exploration and primary suture,not T tube drainage in Dept. of General Surgery First,Wenjiang branch courts of Sichuan provincial people's hospital. Their clinical data were selected and retrospectively analyzed. Results 53 cases have successfully operated (100%), the operated time was 100-180 minutes, and the postoperative hospitalization time was 6-12 days. 4 cases occured bile leakage (7.5%), but they were cured through abdominal cavity drainage. All the patients were follow-up visited in 2-14 months. There was no bile leakage, bile duct stenosis, bile duct bleeding or residual calculi. Conclusion Under the strict conditions for mastering operative indications, laparoscopic common bile duct exploration and primary suture is a safe, effective, more minimally invasive, faster recovery treatment for choledocholithiasis.

Clinical study on primary suture of common bile duct and T-tube drainage / 中国医师进修杂志

ObjectiveTo explore the clinical significance of primary suture of common bile duct and early intermittented clamping of T-tube.MethodsOne hundred and one cases underwent bile duct surgery were divided into three group by random digits table,in which 33 cases were performed with primary suture of common bile duct (group A),33 cases were applied of early intermittented clamping of T-tube (group B),the other 35 cases were clamped T-tube as in routine measures (group C).The efficacy was compared between three groups.ResultsThe postoperative intestinal function recovery time,fluid support,hospitalization time in group A and group B was (47.63 ± 12.42) h,(2.75 ± 0.27) L/d,(8.0 ± 0.3) d and (57.63 ± 14.15) h,(2.97 ±0.49) L/d,(10.0 ± 0.4) d,which was significantly decreased compared with those in group C [ ( 98.27 ± 30.35 ) h,( 3.63 ± 0.38 ) L/d,( 19.0 ± 1.1 ) d ] (P ＜ 0.05 ).Postoperative intestinal function recovery in group A was significantly increased compared with those in group B (P ＜ 0.05 ).Alanine aminotransferase,aspartate aminotransferase,Gamma-glutamine transferase,body temperature,white blood cell count,total bilirubin,postoperative biliary fistula,common bile duct residual stones,stenosis of the common bile duct had no significant differences among three groups (P ＞ 0.05). ConclusionsPrimary suture of common bile duct and early intermittented clamping of T-tube can accelerate recovery of intestinal function,avoid electrolyte disturbance,reducing fluids,electrolytes and nutrition support,reducing the length of stay and costs,it has changed the traditional way of surgical treatment of bile duct,and is safe,efficient,also has significance of clinical application.

Revaluation of the stent in the bile duct / 国际外科学杂志

It is a consensus to place stent after cutting bile duct in the hepatobiliary surgery in the past.However,as the development of bile physiological research and surgical technique,especially the raise of medical concepts of rapid recovery,the negative effects which are caused by the placement of stent have been taken seriously gradually.Up to now,whether the stent should be placed after the bile duct is cut has no definite answer yet.

Sutura primaria e ileostomía transcecal en urgencias quirúrgicas del colon izquierdo / Primary suture and transcecal ileostomy in surgical emergencies of left colon

Introducción: existe una controversia sobre la alternativa quirúrgica para la solución de las urgencias quirúrgicas en el colon izquierdo. Objetivo: comparar la sutura primaria e ileostomía transcecal con una sonda de colostomía convencional en los pacientes operados del colon izquierdo. Métodos: se realizó un estudio analítico, observacional, prospectivo y longitudinal. Universo: se diagnosticaron 70 pacientes con enfermedades quirúrgicas urgentes del colon izquierdo. Muestra: 34 pacientes del Hospital General Docente Abel Santamaría Cuadrado y Hospital Clínico Quirúrgico León Cuervo Rubio, operados entre enero de 2006 y 2010. Se formaron aleatoriamente dos grupos: grupo A (muestra), 34 pacientes con sutura o resección intestinal y anastomosis primaria e ileostomía transcecal con sonda; grupo B (control) 36 pacientes con resección intestinal y colostomía convencional. Se aplicó la prueba Ji cuadrado con un nivel de significación de 0,05 y porcientos. Resultado: predominaron las perforaciones sigmoideas traumáticas 37,1% y el vólvulo del sigmoide con un compromiso vascular 31,4% en ambos grupos, prevalencia en el género masculino y la edad de 51-60 años. En el grupo A el 11,7% de los pacientes presentaron complicaciones no relacionadas con dehiscencia de la anastomosis; en el grupo B alcanzaron el 55,5% predominando la infección de la herida y las generales. La mortalidad global de la sutura primaria con ileostomía transcecal fue de 2,9% y 11,1% en la colostomía convencional. La sonda de ileostomía se retiró como promedio a los 7 días, y la calidad de vida de estos pacientes es satisfactoria en la actualidad. Conclusiones: La sutura primaria e ileostomía transcecal tiene menos complicaciones y mortalidad, minimiza la injuria psicológica, y es la alternativa quirúrgica más fisiológica.

Introduction: a controversy about surgical alternative to the solution of surgical emergencies of left colon gives rise. Objective: to compare primary suture and transcecal ileostomy with a conventional colostomy probe in patients operated on left colon. Methods: an analytical, observational, prospective and longitudinal study. Target group: 70 patients having the diagnosis of surgical emergencies due to left colon conditions. Sample: 34 patients who underwent left colon surgeries from January 2006 and 2010 at "Abel Santamaria Cuadrado" and "Leon Cuervo Rubio" Provincial General University Hospitals. Two groups chosen at random were included: group-A (sample), 34 patients with suture or intestinal resection plus primary anastomosis and transcecal ileostomy with probe; group-B (control) 36 patients with intestinal resection and conventional colostomy. Chi square test with a significance level of 0,05 and percentages were applied. Results: traumatic sigmoid perforations prevailed (37,1%) and sigmoid volvulus with vascular compromise (31,4%) in both groups, male sex and ages from 51 to 60 predominated. In group-A the 11,7% of patients presented complications that were not related to dehiscence of anastomosis; in group-B the complications reached 55,5% prevailing the infection of surgical wound and the general ones. Global mortality of the primary suture with transcecal ileostomy was 2,9% and 11,1% with conventional colostomy. The probe of the ileostomy was removed at 7 days on average; currently the quality of life of these patients is satisfactory. Conclusion: primary suture and transcecal ileostomy present much less complications as well as mortality, it minimizes psychological damage, and this is the most physiologic surgical alternative.