Diagnosis and surgical treatment of intrahepatic hepatolithiasis combined with cholangiocarcinoma.

BACKGROUND: The aim of the present study was to describe the clinical features and to assess surgical treatment of intrahepatic hepatolithiasis combined with cholangiocarcinoma (IHCC). METHODS: A total of 107 patients with histopathologically proven IHCC were included in the study and were divided into four groups as follows: the curative resection (CR) group, the palliative resection (PR) group, the radiofrequency ablation (RA) group, and the simple laparotomy group. Demographics, symptoms, and treatment were described and survival data were retrospectively analyzed. RESULTS: The overall survival rates were 45.4, 29.8, and 20.2% at 1, 3, and 5 years. The cumulative survival rates in the CR group at 1, 3, and 5 years were 71.1, 57.9, and 50.0%, respectively, which was significantly higher than for the other three groups (P < 0.01). The survival rates in the PR group at 1, 3, and 5 years were 50.0, 19.2, and 0%, and those in the RA group were 46.2, 8.3, and 0%. There was no statistically significant difference between the two groups. In the CR group, the cumulative survival rates of the patients with stage III tumor at 1, 3, and 5 years were 74.1, 63.0, and 59.3%, which were significantly higher than those of the patients with stage IV disease (P = 0.043). CONCLUSIONS: The prognosis of IHCC is poor. Curative resection should be considered first, and radiofrequency ablation is a good choice for the patients for whom resection is impossible.

Primary closure versus T-tube drainage after common bile duct exploration for choledocholithiasis.

PURPOSE: The aim of this study was to evaluate the benefits and harms of primary closure versus T-tube drainage after common bile duct (CBD) exploration for choledocholithiasis. METHODS: A literature search of MEDLINE (PubMed), EMBASE, and the Cochrane Library was done to identify randomized controlled trials assessing the benefits and harms of primary closure versus T-tube drainage after CBD exploration from Jan. 1990 to Apr. 2010. A meta-analysis was set up to distinguish overall difference between the primary closure and the T-tube drainage group. RESULTS: There were statistically significant differences between groups: biliary complications (odds ratio (OR) 95% confidence interval (CI), 0.42 (0.19-0.92); P = 0.03), main complications (OR 95% CI, 0.46 (0.23-0.90); P = 0.02), operating time (weighted mean difference (WMD) 95% CI, -19.53 (-29.35 to -9.71); P < 0.0001), and hospital stay (WMD 95% CI, -4.16 (-7.07 to -1.24); P = 0.005) except peri-operative mortality (OR 95% CI, 0.83 (0.11-6.37); P = 0.86), residual stones (OR 95% CI, 0.70 (0.22-2.25); P = 0.55), and abdominal collections (OR 95% CI, 1.93 (0.34-10.76); P = 0.46). And the result of wound infection (OR 95% CI, 0.38 (0.14-1.02); P = 0.05) tended to favor the primary closure group. CONCLUSION: The primary closure might be as effective as T-tube drainage after choledochotomy in the prevention of the development of post-operative complications.

Efficacy of mechanical bowel preparation with polyethylene glycol in prevention of postoperative complications in elective colorectal surgery: a meta-analysis.

PURPOSE: The aim of this study was to estimate efficacy of mechanical bowel preparation with polyethylene glycol (PEG) in prevention of postoperative complications in elective colorectal surgery. METHOD: A literature search of MEDLINE (PubMed), EMBASE, and the Cochrane Library was done to identify randomized controlled trials involving comparison of postoperative complications after mechanical bowel preparation with PEG (PEG group) and no preparation (control group). A meta-analysis was set up to distinguish overall difference between the two groups. RESULTS: A total of five randomized controlled trials was identified according to our inclusion criteria. The use of PEG for mechanical bowel preparation did not significantly reduce the rate of surgical site infection (SSI; odds ratio (OR) 95% confidence interval (CI), 1.39 (0.85-2.25); P = 0.19) including incisional SSI (OR 95% CI, 1.44 (0.88-2.33); P = 0.15), organ/space SSI (OR 95% CI, 1.10 (0.43-2.78); P = 0.49), anastomotic leak (OR 95% CI,1.78 (0.95-3.33; P = 0.07), mortality (OR 95% CI, 1.24 (0.37-4.14; P = 0.73), infectious complications (OR 95% CI, 1.14 (0.62-2.08); P = 0.67), and hospital stay (weighted mean difference 95% CI, 2.17 (-2.90-7.25); P = 0.40) except main complications (OR 95% CI, 1.76 (1.09-2.85); P = 0.02), of which the rate increased significantly in the PEG group. CONCLUSION: The use of mechanical bowel preparation with PEG does not significantly lower postoperative complications in elective colorectal surgery.