The Safety and Feasibility of Laparoscopic Exploration of Common Bile Duct and Choledochoscope in the Magagement of Patients with Choledocholithiasis

PURPOSE: Traditionally, the main treatment for common bile duct (CBD) stones and gallstones is ERCP combined with a laparoscopic cholecystectomy (LC). However, this procedure is generally performed in 2 stages, which makes the patients uncomfortable and unsatisfied. It also can result in the need for several procedures if it fails, and sometimes the surgery is warranted. Recently in the laparoscopic era, the laparoscopic skill has been developed quite rapidly. In the case of CBD stones, there are many reports involving laparoscopic procedures. We reviewed the safety and feasibility of removing CBD stones using a laparoscope and choledochoscope. METHOD: This retrospective study reviewed 40 cases who underwent a laparoscopic cholecystectomy and choledocholithotomy for bile duct stones between Feb. 2002 and Aug. 2004. RESULTS: Of the 40 patients who underwent the laparoscopic procedure, 25 were combined with gallstones, and 12 underwent the transcystic duct approach. The average operation time and average hospital stay was 141.2 mins and 11.3 days, respectively, and the average age was 69.4 year old. There was 1 case of a major complication, where bile leakage occurred for more than 14 days due to a shincter stenosis. This case was improved by an endoscopic sphincterotomy. Of them, 30 underwent a primary closure and 8 underwent T-tube drainage, 2 underwent a biliary stent. CONCLUSION: The laparoscopic cholecystectomy and choledocholithotomy using a choledochoscope are quite safe and feasible, can reduce the patient's anxiety, and increase their level of satisfaction.

A Case of Heterotopic Pancreas on the Fundus of Stomach by Gastrofiberscopy / 대한소화기내시경학회지

The Heterotopic pancreas is defined as the presence of pancreatic tissue lacking anatomical and vascular continuity with the main body of pancreas. Heterotopic pancreas or ectopic pancreas is found in 0.55% to 13.7% of autopsy series and also found one in approximately every 500 operations in abdominal surgery. The most common sites are the antrum of stomach, duodenum, and proximal jejunum. Most masses of heterotopic pancreas in stomach were encountered in the distal one third, usually within 5 or 6 cm of pylorus. We have recently experienced a case of hetertopic pancreas that was located in fundus which is not the usual site. Gastrofiberscopy revealed a 2 2.5 cm sized protruding mass on the fundus. There was apperared an umbilical shaped dimple on the center with a relatively normal mucosa. Endoscopic ultrasonography revealed a 2.5 cm sized hypoechoic mass of fundus, originating from submucosal and muscular layer. It was considered a submucosal tumor, such as leiomyoma, and subsequently wedge resection was performed. Histologic finding showed pancreatic acni.