Surgical Experience with Intrahepatic Duct Stones

BACKGROUND: Stones in the biliary tree situated proximal to the origin of the common hepatic duct are considered intrahepatic duct stones. This condition causes serious problems, including cholangitis, obstructive jaundice and liver abscess. METHODS: This study was a clinical review of the results from 178 patients with intrahepatic stones who were surgically treated at the Department of Surgery, Gyeongsang National University Hospital from January 1991 to December 1997. RESULTS: The sex ratio of males to females was 1:2.1, and the most prevalent age group was the 6th decade. Common symptoms and signs were RUQ pain (83.2%) and tenderness (64.7%). Common laboratory findings were elevated alkaline phosphatase (56.6%), elevated serum GOT (47.4%), leukocytosis (44.5%) and hyperbilirubinemia (36.4%). C. sinensis was identified in 22 (12.4%) of the operation cases. Intrahepatic stones were located in the left hepatic duct in 87 cases (48.9%), the right duct in 27 cases (15.2%), and both intrahepatic ducts in 64 cases (35.9%). A partial hepatectomy was performed in 94 cases (52.8%); other procedures without a hepatectomy were performed in 84 cases (47.2%). The remaining stones were noted in 57 (32%) of the operation cases. Among them, 39 cases (68%) were in the non-hepatic resection group, and 18 cases (32%) were in the hepatic resection group. The postoperative complication rate in hepatic resection group (29.8%) was higher than that in the non-hepatic resection group (15.5%). The most common complication was wound infection. The operative mortality was 2.1% in the hepatic resection group and 2.4% in the non-hepatic resection group. The follow-up study showed that 146 cases (82%) were graded as a good result, 7 cases (3.9%) as fair, and 25 cases (14%) as poor and that the relative incidence of good results in the hepatic resection group(88.3%) was higher than that in the non-hepatic resection group (75%). CONCLUSIONS: We conclude that a hepatic resection, rather than a biliary bypass procedure alone, is satisfactory as an initial treatment for hepatolithiasis.

A Study on the Tolerability of Early Postoperative Feeding in Patients with Colorectal Cancer

BACKGROUND: Resolution of postoperative ileus has traditionally been the moment at which bowel function returns. The re-start of postoperative oral feeding usually occurs after that. Recently, many reports have been published on early postoperative feeding in patients operated on laparoscopically and even in patients receiving a laparotomy. The aim of this study was to scrutinize the validity of early postoperative feeding. METHODS: Fiftyfour colorectal cancer patients who had undergone radical resective surgery for cure were included in this study and were divided into two group. Group 1 included 32 patients who were fed in a traditional manner. Group 2 consisted of 22 patients who received a regular diet on the first postoperative day. The mean age was 62, the male-to-female ratio was 1.2:1. Thirteen tumor were located on the right side colon, 4 on the left side colon, 10 on the rectosigmoid, 27 on the rectum. Operative methods were 13 right hemicolectomies, 4 left hemicolectomies, 19 low anterior resections, and 18 abdominoperineal resections. The possible problems associated with early oral feeding were well understood by the patients and consents were obtained. Immediately after the operation, the nasogastric tube was removed in the operation room, and The time of complete recovery from anesthesia was 3 to 5 hours later. At that time, liquid drink was given; then, liquid food or blended food was allowed. RESULT: Early oral intake was tolerable in 14 patients out of 21 (67%); in 8 patients a nasogastric tube was reinserted due to severe nausea, vomiting, and/or abdominal distension. All those minor problems were resolved after reinsertion of the nasogastric tube and returning to the traditional method. In one patient, who had a received a low anterior resection, a serious complication, anastomatic leakage, developed. Early oral intake was not thought to be the exact cause of the leakage, but it made the problem more complicated. A huge amount of feces soiled the peritoneal cavity and the already dissected retroperitoneum. CONCLUSIONS: The tolerability of early postoperative oral intake was 67%. In the remainder of patients, all the minor problems except one, were relieved by simply returning to the traditional method. However, early postoperative oral intake should be used with caution for patients who experience difficulty with anastomosis or have an intraoperative technical breakdown and in whom the possibility of leakage exists.

Surgical Experience for Intrahepatic duct Stones / 한국간담췌외과학회지

BACKGROUND: The stones in the biliary tree situated proximal to the origin of the common hepatic duct are considered intrahepatic duct stone. This conditon causes the serious problems including cholangitis, obstructive jaundice and liver abscess. AIM AND METHOD: This study is a clinical review for the results of surgical treatment in 178 cases of patients with intrahepatic stones in the Department of Surgery, Gyeongsang National University Hospital from January 1991 to December 1997. RESULTS: Sex ratio of male to female was 1 : 2.1 and most prevalent age group was 6th decade. Common symptom and sign was RUQ pain(83.2%) and tenderness(64.7%). Common laboratory finding were elevated alkaline phosphatase(56.6%), elevated serum GOT(47.4%), leukocytosis (44.5%) and hyperbilirubinemia(36.4%). C. Sinensis was identified in 22 cases(12.4%) of operation cases. Intrahepatic stones were located in the left hepatic duct in 87 cases(48.9%), the right duct in 27 cases(15.2%) and both intrahepatic duct in 64 cases (35.9%). Partial hepatectomy was performed in 94 cases(52.8%), non-hepatectomy was performed in 84 cases(47.2%). The remained stone was noted in 57 cases(32%) of operation cases. Among them, 39 cases(68%) were non-hepatic group, 18 cases(32%) were hepatic group. Postoperative complication rate in hepatic resection group(29.8%) was higher than that in non-resection group(15.5%). Most common complication was wound infection and operative mortality was 2.2%. The follow-up study showed that 146 cases(82%) were graded as good, 7 cases(3.9%) as fair and 25 cases(14%) as poor result and relative incidence of good result in hepatic resection group(88.3%) was higher than that in non-hepatic group(75%). CONCLUSIONS: We conclude that hepatic resection rather than biliary bypass procedure alone as an initial treatment for hepatolithiasis is satisfactory treatment.