Primary common bile duct closure after choledochotomy / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the rationality and feasibility of primary closure of the common bile duct after choledochotomy for common bile duct calculi.</p><p><b>METHODS</b>From January 1990 to June 2001, 386 patients with the evidence of stones in the common bile duct underwent choledochotomy. Among them, 215 received primary closure of the common bile duct (group A) and 171 T-tube drainage (group B). The patients with emergency operations were excluded. Intraoperative choledochoscopy or cholangiography was routinely performed to rule out the possibility of retained stones. The duct was meticulously stitched using 0/3 to 0/5 absorbent sutures for primary closure. A T-tube was placed in the subhepatic space in the patients of both groups.</p><p><b>RESULTS</b>Postoperative bile leakage was seen in 9 patients of group A and in 5 of group B, respectively (P > 0.05), and no reoperations were necessary. After surgery, the average time and volume of transfusion was 4.9 days and 9.1 liters in group A, versus 7.3 days and 12.8 liters in group B (P < 0.01). The patients in group B had a longer postoperative hospital stay than the those in group A (average 17.6:10.0 days, P < 0.01). T-tube removal resulted in bile peritonitis in 5 patients at day 16, 17, 19, 21 and 22 after surgery in group B, and 3 patients required repeated surgery.</p><p><b>CONCLUSIONS</b>Primary closure of the common bile duct after choledochotomy is safe, effective, and inexpensive in selected patients with common bile duct calculi, and should be regarded as an alternative procedure.</p>

Complications of small bowel tumors / 中国普通外科杂志

Objective To study the complications of small bowel tumors (SBT) and their diagnosis and treatment. Methods A retrospective study was carried out among 47 SBT patients suffering from complications of SBT during the last two decades. Results Thirty-three cases (70%) were of malignant tumors. Complications included bleeding in 17 cases, perforation in 8, intussusception in 11, bowel obstruction in 8, volvulus, internal hernia and volvulus plus intussusception in one each. Abdominal pain was the most common presenting sign and symptom (40 cases). The mean interval from the onset of signs and symptoms to exploration was 4.7 months for those with malignant SBT and 3.1 months for benign ones. Roentgenography was the mainstay for diagnosis. Ultrasound, CT and MRI were also helpful. Benign tumors were treated with segmental resection of the affected bowel. Out of 33 malignant SBT patients, curative resection was performed in 26 and palliative resection in 7. Two patients died postoperatively.Conclusions Most patients with SBT were not correctly diagnosed until complications popped up. Surgery remains as the therapy of choice. [