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Objective To study the diagnosis and treatment of choledocholithiasis in patients with low left and right posterior hepatic duct confluence.Methods Clinical data of 12 patients suffering from cholelithiasis with a low confluence of the left and right posterior hepatic ducts admitted between January 2000 to June 2013 were retrospectively analyzed.Results Of the 12 cases,the left and right posterior hepatic ducts joined between 2 cm below hilus hepatis and the superior border of the duodenum in 8 cases,below the superior border of the duodenum in 4 cases.Seven cases had a low confluence of the right and left hepatic ducts,and 5 cases had right posterior duct low confluence.As for bile duct stricture:the opening stricture at the junction of the right and left hepatic ducts were found in 4 cases,the opening stricture in the right hepatic ducts were found in 3 cases,the opening stricture of the left hepatic duct were found in 2 cases.There were left and right bile duct stones in 7 cases,right intrahepatic bile duct stones in 3 cases,left intrahepatic bile duct stones in 2 cases.Cystic duct joined the right hepatic duct in 5 cases,left hepatic duct in 2 cases.Seven cases with a low confluence of the right and left hepatic ducts were with double T tube drainage; five of low right hepatic duct confluence were treated by T tube drainage.The right posterior branch of hepatic ducts were injured in four cases and right hepatic duct was injured in one.Conclusions Low confluence of left and right posterior hepatic ducts often leads to misdiagnosis during surgery of cholelithiasis.Magnetic resonance cholangio-pancreatography or endoscopic retrograde cholangiopancreatography was helpful before cholecystectomy to avoid iatrogenic injury of biliary tract.
RESUMO
Objective To investigate the feasibility and technique in laparoscopic cholecystectomy and exploration of common bile duct (CBD) in patients who have previous subtotal gastrectomy.Methods From January 2001 to October 2010,22 patients who had a history of subtotal gastrectomy received laparoscopic cholecystectomy and CBD exploration in our hospital.In addition,these patients received cholangioscopic lithotomy,electrohydraulic lithotripsy,T-tube drainage,or primary suturing of the CBD wound.Results The procedures were completed successfully in 18 patients.In 4 patients,conversion to laparotomy was necessary because of multiple stones in a stenosed CBD (n=1),severely congested CBD wall with edema (n=1),CBD carcinoma associated with impacted stones (n=1) or Mirzzi syndrome (n =1).T tube drainage was employed in 16 patients,and primary suturing in 2 patients at the end of the operation.There was no hemorrhage,biliary leakage or abdominal infection.At a mean follow-up of 13 (range 3 to 60) months there was no residual stone,biliary stenosis or cholangitis.In 3 patients Stone recurred,and another 3 patients were lost to follow-up.Conclusions A history of subtotal gastrectomy is not a contradiction to laparoscopic cholecystectomy and CBD exploration.With choledocoscopy,surgery can be safe and feasible even for patients with previous gastectomy.