Management of bile duct injuries: comparative study between Roux-en-Y hepaticojejunostomy and primary repair with stent placement

Bile duct injury [BDI] is a major complication in biliary surgery such as laparoscopic cholecystectomy. The management of major BDI is a surgical challenge even for experienced hepatobiliary surgeons. The aim of this study was to introduce a new surgical technique for reconstruction of the biliary duct by primary repair after stent placement. The present study was carried out on a selected group of BDI patients [34 patients], who were referred for management of BDIs. Patients were divided into two equal groups: group A underwent primary repair of the bile duct by placement of a plastic stent [which is used in endoscopic retrograde cholangiopancreatography] and group B underwent Roux-en-Y hepaticojejunostomy. The study included 34 patients, 10 men [30.9%] and 24 women [69.1%] with a mean age of 40.84 years, whose main presentations were postoperative jaundice [82%] and bile leak [15%]. All the patients underwent surgery successfully. There was no intraoperative mortality and bile leakage during the observation period, but primary repair of the bile duct with plastic stent placement was associated with better results as regards operation time, hospital stay, cost, safety, and postoperative complications. Primary repair of the bile duct with stent placement showed good results, involved minimal morbidity, hospital stay, and cost; and helped avoid the drawbacks of Roux-Y hepaticojejunostomy. It also replaced exploration of the common bile duct with a T-tube, with advantages of function of the Oddis sphincter

Role of MDCT colonography and conventional colonoscopy in evaluation of colo-rectal neoplasms

The study was conducted to evaluate the role of MDCT colonography in diagnosis of cob-rectal neoplasms compared to conventional colonoscopy. Fifty patients were included in the present study 28 males and 22 females with age ranged from 2 1-75 years old. Patients were presented with variable-size large bowel masses examined by MDCT colonography and conventional colonoscopy. Twenty three-cases were diagnosed by CT colonography as colonic malignancy, 18 cases diagnosed by colonoscopy as colorectal benign polyps "8 polyps measured less than 5mm, 6polyps from 5-10mm and 4 more than 10mm", those were correlated with findings of CT colonography which revealed only 12 benign polyps with size ranged from 6mm to more than 10 mm. The other 9 cases proved to be extra colonic metastases. MDCT colonography allows more definitive evaluation of the different cob-rectal and extra-colonic masses as it is anon-invasive modality. It has a higher sensitivity for detecting a clinically suspected colonic neoplastic mass. The conventional colonoscopy may still have an advantage of detecting very small and superficial mucosal lesions and taking biopsy from the suspected superficial areas