The Factors Influencing the Treatment Results of Residual & Recurrent Biliary Stones / 한국간담췌외과학회지

BACKGROUND/AIMS: There has been a lot of controversy about the treatment methods in the management of residual & recurrent biliary stones. So we performed the study to clarify the important factors in choosing the treatment modality of the residual & recurrent biliary stones. METHODS: 154 patients who were diagnosed as residual or recurrent biliary stone between January 1995 and August 2000 were divided into 4 groups according to their first re- treatment methods (surgery, stone removal via T-tube, PTBD*, ESTP**) and analyzed the results of these treatments to determine what is the significant factor affecting the prognoses. RESULTS: The necessity of the second re-treatment for residual & recurrent stones was affected by the complete- ness of stone removal only, and no other factors affected it in view of multivariate analysis. The rate of residual & recurrent stones among the patients who have had the first operation in our department was 6.7%. Furthermore the clearance rate of residual & recurrent stones was relatively high value (82.2%), as a result of multidisciplinary treatments. CONCLUSION: Thus, as long as the residual stones can be removed completely, any treatment modality can be applied to these patients. We don't have to insist on surgery.

The Significance of Retroperitoneal Drainage for the Patients of Acute Infected Pancreatic Necrosis / 한국간담췌외과학회지

BACKGROUND/AIMS: To introduce and review the results of the different treatment modalities of infected pancreatic necrosis and abscess that have been used during a 1-year period. As well, to assess the technique and indications of retroperitoneal drainage that is selectively performed for the management of peripancreatic necrosis because of the problem of intraperitoneal drainage. METHODS: Five patients with infected pancreatic necrosis or abscess were operated on from July 1997 to June 1998. Two undrewent surgical necrosectomy and retroperitoneal drainage and 3 had a classical procedure of multiple intraperitoneal drainage after necrosectomy. RESULTS: Two of 5 patients that had retroperitoneal drainage performed were successful of wide ranging necrosectomy of retroperitoneal necrosis or abscess through one drainage site and the left flank, resulting in a decreased rate of intraperitoneal contamination, discomfort and disability. CONCLUSION: The advantages of retroperitoneal drainage for wide ranging retroperitoneal pancreatic necrosis are made possible by draining the retroperitoneal route from the retroperitoneal cavity to the same retroperitoneal external opening. The use of retroperitoneal drainage seemed to be a significant factor for improvement by providing a reliable drainage of retropancreatic areas and by avoiding the opening of the peritoneal cavity