Variables affecting quantitative biliary scintigraphy in asymptomatic cholecystectomized volunteers.

BACKGROUND/AIMS: Quantitative cholescintigraphy has been used to evaluate biliary emptying and, by some, as a screening test for sphincter of Oddi dyskinesia in cholecystectomized patients. Our aim was to identify variables that might effect the interpretation of the scintigraphy in asymptomatic cholecystectomized volunteers. METHODOLOGY: Quantitative cholescintigraphy was performed in 37 volunteer. There were 11 males and 26 females with a median age of 49 years (range: 32-82). The time interval from cholecystectomy ranged from 1 month to 30 years (median: 5 years). Eight subjects had also undergone choledocholithotomy during the cholecystectomy operation. RESULTS: From the time of the injection of the radioisotope to the maximum activity in the liver, the percentage of clearance and the hepatic hilum-duodenal transit time were measured to be 45 and 60 min, respectively. The maximum activity obtained in the liver was 17 +/- 10 min (mean +/- SD), and the percentage of clearance at 45 min was 52 +/- 22% and at 60 min 67 +/- 20%. Hilum-duodenal transit time was 12 +/- 11 min. The gender of the volunteer and previous choledocholithotomy did not correlate with the parameters studied. The age of the volunteer and the follow-up time had a positive correlation to the time of maximum activity and negative correlation to percentage of clearance. The follow-up time also had a positive correlation to hilum-duodenal transit time. In the multivariate analysis, the time interval since cholecystectomy was the only independent variable affecting study parameters. CONCLUSIONS: The length of the time interval since cholecystectomy but not the gender, age, or previous choledocholithotomy should be taken into consideration when the results of quantitative cholescintigraphy are interpreted.

Long-term effects of transduodenal sphincterotomy: symptoms and hepatobiliary function.

BACKGROUND/AIMS: Endoscopic sphincterotomy is widely used in treating common bile duct stones, but the long-term effects of destroying the sphincter of Oddi are not known. This study investigated the long-term (15-20 years) effects of transduodenal sphincterotomy on gastrointestinal symptoms and hepatobiliary function in a retrospective controlled study. METHODOLOGY: Between 1974 and 1977, choledocholithotomy was performed in 131 patients either transduodenally (60 patients) or via choledochotomy (71 patients). For the retrospective part of the study, all hospital records, death certificates and autopsy reports were reviewed. Twenty-seven patients who could be reached and volunteered to participate (12 and 15, respectively) were re-examined. In the re-examination part of the study, a standard questionnaire interview, laboratory tests, quantitative cholescintigraphy and ultrasonography were performed. RESULTS: The hospital mortality for the primary operations was 0.8%, 0% for the transduodenal sphinterotomies and 2% for the choledochotomies; the difference was not significant. During the follow-up period, no significant differences could be seen in the death rate or in the causes of death between the study groups. During re-examination, flatulence was found to be more common in the choledochotomy subgroup (7/15 vs 2/12, p<0.05). In the laboratory tests, conjugated bilirubin and serum aspartate amino transferase levels were higher in the transduodenal subgroup than in the choledochotomy subgroup (3.3 umol/L, SD 0.4 vs 2.2 umol/L, SD 0.2, p<0.02; and 25 U/L, SD 12.6 vs 18.6 U/L, SD 5.0, p<0.05, respectively). Furthermore, 6/12 (50%) of the transduodenal subgroup had elevated serum alanine aminotransferase, aspartate aminotransferase or amylase levels, as compared to 1/15 (7%) in the choledochotomy subgroup (p<0.02). In terms of ultrasonography, in the choledochotomy subgroup, the common bile duct diameter was larger than 8 mm in 8/15 (53%) patients, as compared to 1/12 (8%) in the transduodenal subgroup (p<0.02). In terms of quantitative cholescintigraphy, in 9/12 (75%) patients of the transduodenal subgroup, the hilum-duodenum transit time was less than 10 minutes, as compared to 4/12 (47%) of the choledochotomy subgroup. CONCLUSIONS: Transduodenal sphincterotomy results in decreased flatulence and enhanced common bile duct drainage, even in the long-term period, but slightly higher serum liver funtion tests, when compared to supraduodenal choledochotomy.

Cholecystectomy: comparison of minilaparotomy and laparoscopy.

Laparoscopic cholecystectomy (LC) has become the most popular method of removing the gallbladder. Because it is an expensive operation requiring special training for the team, LC has been challenged by other methods of minimal-access surgery, e.g. by minilaparotomy (MC). This study was planned to be a single-surgeon prospective random study to compare minilaparotomy cholecystectomy (MC) and laparoscopic cholecystectomy (LC), but was never done over the pilot phase. Twenty-four cholecystectomies were included, eight MC and 16 LC, the patients being comparable between the groups. In the MC group three patients (37%) had complications versus no complications in the LC group (p = 0.028). Postoperative hospital stay was longer in the MC group (median three days) than in the LC group (median one day), even when the patients with complications were excluded. Due to these discouraging experiences the extended random study was never done, and MC was abandoned.

Conventional cholecystectomy in elderly patients.

One hundred and seventy two consecutive patients of 70 years or older undergoing cholecystectomy at laparotomy for gallbladder stone disease during a five-year period in Tampere University Hospital were studied to evaluate the present safety of "conventional" cholecystectomy in the elderly. One hundred and six (62%) underwent emergency or urgent cholecystectomy for acute cholecystitis and 66 (33%) elective cholecystectomy. The mortality was zero per cent in elective operations as compared to 5% in emergency/urgent operations (P < 0.001). The complication rate was 8% in elective operations compared to 25% in emergency/urgent operations (P < 0.001). These results suggest that conventional cholecystectomy is a very safe operation in the elderly, when performed electively. The development of new methods to treat gallbladder stone disease, such as laparoscopic cholecystectomy, must be undertaken from this background.