Résumé
Objective To explore the clinical value of laparoscopy combined with choledochoscopy in repeat surgery for hepatolithiasis. Methods The clinical data on 86 patients who had undergone repeat surgery for hepatolithiasis during January 2010 to December 2015 were retrospectively analyzed. 36 patients received laparoscopy combined with choledochoscopy(laparoscopy group),while 50 patients received laparotomy(laparotomy group). Surgical duration,intraoperative blood loss,intraoperative transfusion,stone clearance rates,length of postopera-tive hospital stay,and rate of complications were observed and analyzed. Results There were no significant differ-ences in surgical duration,intraoperative blood loss,intraoperative transfusion,stone clearance rates,and rate of complications between the two groups(P>0.05). Length of postoperative hospital stay was significantly shorter in the laparoscopy group than in the laparotomy group(P 0.05). Conclusions Use of laparoscopy combined with choledochoscopy in repeat surgery for hepatolithiasis is safe and feasible and has a satisfactory efficacy.
Résumé
We designed this study to analyze the causes of repeat surgery in the low back disorder after primary procedure, to evaluate the risk factors and to suggest the rational approachs can prevent and solve the problems related with repeat surgery. We retrospectively reviewed the medical record and radiographs of 24 patients who had sustained persistent or recurrent pain, failed to extended conservative therapy, showing abnormal myelogram and/or CT scan with nerve root compression, and with segmental instability consistent with patients symptom and sign after the primary procedures. We evaluated the functional outcome according to Kims(1986) criteria. The causes of remained or recurrent pain with neurologic symptom were persistent or aggravated lumbar spinal stenosis in 10 cases(42%), recurrent disc herniation in 4 cases(17%), infection in 3 cases(12%), instability in 2 cases(8%) and others in 5 cases(20%). Satisfactory outcome was recorded in 79%(19/24) of patients. The characteristics of the patients associated with satisfactory outcome were those who operated by recurrent disc herniation, instability, retained disc, metal malposition, and nerve root compression by bone chip. But the characteristics of the patients associated with unsatisfactory outcome were those who operated by infection, lumbar spinal stenosis aggravated by degenerative spondylosis and multiple herniated disc, inadequate decompression of lateral and/or foraminal stenosis in aged patients. The most common lesion site was on L4-5 disc, and unsatisfactory result was expected at the upper lumbar spine involvement. Favorable outcome could be expected in the presence of a pain-free interval more than 1 year from the date of the previous operation or persistent symptoms immediately after the initial operaion. We were expected the risk factors leading to repeat surgery were old aged(more than 60) patients, upper lumbar spine involvement and multiple lumbar disc herniation. Postoperative diskitis or osteomyelitis, pain free interval more than 1 month or less than 1 year, and those who had a revision on the lumbar spine previously could be considered as a poor prognostic indicators. When surgery is indicated for degenerative lumbar spinal disorders, adequate diagnostic tests and the execution of appropriate procedures based upon this information should be carried out to prevent the repeat surgery in the low back disorders. Adequate postoperative management can reduce the occurrence of failed back surgery syndrome and in cases necessitating repeat surgery, thorough analysis of causes following proper surgical stabilization can reduce the operative morbidity with early return to daily life.