RESUMO
Objective To present the experience with scarf-liking esophagojejunal anastomosis to decrease the anastomotic leak. Methods An analysis of the clinical outcome of 86 consecutive patients from January 2000 to October 2008 who underwent scarf-liking esophagojejunal anastomosis after total gastrectomy for advanced gastric carcinoma. Results Two of these patients died, the operative mortality rate was 2.3%. Eighty-four survivals were followed up for 2-95(44±3) months. None of the survivals developed anastomotic leak and reflux esophagitis. Anastomotic strictures occurred in 4 patients (4.8%) treated before December 2004, and transgastroscopy dilatation was effective treatment. There was no anastomotic stricture developed after surgical technology improved. Conclusion The new scarf-liking esophagojejunal anastomosis has more advantages to reduce anastomotic complications and total gastrectomy for advanced gastric carcinoma, is safe and effective.
RESUMO
Objective To study the prevention and management of early post-cholecystectomy jaundice.Methods The dinical data of 43 cases of jaundice occurring within one week after simple open cholecystectomy in 11 226 cases were retrospectively analyzed.Results The incidence of jaundice at one week after operation was 0.38% in simple open cholecystectomy,among them,medical jaundice accounted for 18 cases,and surgical jaundice for 25cases.Ultrasound,ERCP,MRCP,liver enzyme profile and reoperation confirmed the folowing: Extra-hepatic bile duct or the right hepatic duct was ligated in 9 cases,common bile duct residual stone in 6,partial gallbladder or gallbladder duct stone in 4,biliary leak in 4,cholangitic hepatitis in 4,hepatitis B or posthepatitis cirrhosis in 5,icterus after blood transfusion in 2,hemobilia in 2,ligation of right branch of hepatic artery in 2,and icterus of unknown causes in 5 cases.Reoperation was done in 8 cases,with one mortality.Conclusions Detailed case history,adequate examination before operation,and careful operative technique are the essential prerequisites to prevent early post-cholecystectomy jaundice.Early post-cholecystectomy jaundice should be treated according to the different causes.
