Choledochoduodenostomy. Analysis of 71 cases followed for 5 to 15 years.

To investigate the long-term effectiveness of choledochoduodenostomy (CDD), the experience with 71 patients followed for 5 or more years after CDD was analyzed retrospectively. From 1968 to 1984, 134 patients underwent CDD. Eight patients (6%) died in the immediate postoperative period, 55 left the hospital, 8 of them were lost to follow-up, and 47 were followed but died before 5 years elapsed after CDD. The remaining 71 patients form the data base for this analysis: 38 were followed for more than 5 years, 25 were followed for more than 10 years, and 8 were followed for more than 15 years (mean 12.1 years +/- 1.3 SEM). Choledocholithiasis, chronic pancreatitis, and postoperative stricture were the indications for CDD. Cholangitis was observed in only three patients. The diameter of the common bile duct (CBD) was large in most patients (mean 18 mm +/- 0.9 SEM). These results infer that CDD is effective to treat non-neoplastic obstructing lesions of the distal CBD on a long-term basis and that the presence of a dilated CBD (more than 16 mm) that allows the construction of a CDD more than 14 mm is essential to obtain good results.

Confiabilidad de pruebas pre e intraoperatorias para litiasis biliar

Se analizaron 242 pacientes operados consecutivamente por litiasis biliar para determinar la confiabilidad de la colecistografía oral (CGO), ultrasonido (US) y colecintigrafía (HIDA) para detectar cálculos biliares. Las interpretaciones preoperatorias fueron correlacionadas con los hallazgos quirúrgicos. CGO practicada en 138 pacientes fue precisa en el 92 por ciento de los casos. US practicado en 150 fue correcto 89 por ciento. La exactitud del HIDA fue de 92 por ciento en colecistitis aguda contra 78 por ciento en colecistitis crónica. La colangiografía intraoperatoria (CIO) practicada en 173 pacientes demostró la necesidad de explorar la vía biliar en 24; 21 tenían coledocolitiasis. Por lo tanto, CGO y US son muy exactos más no infalibles, para diagnosticar colelitiasis. US debería ser el primer examen; si hay duda alguna, la adición de CGO permite el diagnóstico preoperatorio de cálculos en 97 por ciento de los casos. HIDA es muy exacta para detectar colecistitis aguda calculosa, pero igualmente no infalible. La CIO es muy confiable detectando coledocolitiasis por lo tanto su uso rutinario es justificable

Lateral pancreaticojejunostomy for pain relief in chronic pancreatitis: analysis of effectiveness in 19 patients.

To assess the relief of pain provided by a side-to-side lateral pancreaticojejunostomy (LPJ), we analyzed 19 patients with chronic pancreatitis operated on from 1973 to 1983. Fourteen patients were chronic alcoholics; abdominal pain was the indication for the operation in most patients; one patient died postoperatively. The pain was relieved in all 18 survivors, from 12 to 72 months in 15; in three the pain has recurred, suggesting that LPJ is effective in ablating the pain in patients with chronic pancreatitis, provided the pancreatic duct measures more than 6 mm in diameter, the length of the LPJ is at least 6 cm, and patients abstain from alcohol ingestion. CT adequately assesses pancreatic duct dilatation. One fourth of the patients also required choledochoduodenostomy to relieve biliary obstruction caused by the chronic pancreatitis.

Extrarectal colonic carcinoma: analysis of 138 cases with long-term follow-up.

To identify factors that determine long-term survival after resection of extrarectal colonic cancer, we analyzed 138 such patients operated upon in a five-year period. Because rectal tumors have lower survival rates, they were excluded hoping to enhance the prognostic accuracy of the study. The sigmoid colon was the most common location of the tumor (59%) followed by the ascending (19%), the transverse (15%), and the descending colon (9%). In 95 patients (69%), operation was curative. In 12 patients (9%), a resection even with palliative aims could not be done. The five-year survival rates were 87% for 23 patients with Dukes' A and B lesions, 62% for 32 patients with Dukes' B2 lesions, 36% for 42 patients with Dukes' C1 lesions, and 0% for 34 patients with Dukes' C2 or higher. The overall five-year survival rate was 42%. These results emphasize the prognostic reliability of pathologic staging methods and bring into focus the importance of enhancing efforts for detecting extrarectal colonic cancers at early stages of development when curative resection offers maximal chances for cure.

Reliability of pre- and intraoperative tests for biliary lithiasis.

The records of 242 patients, operated consecutively for biliary lithiasis, were analyzed to determine the reliability of oral cholecystography (OCG), ultrasonography (US), and HIDA in detecting biliary calculi. Preoperative interpretations were correlated to operative findings. OCG obtained in 138 patients was accurate in 92%. US obtained in 150 was correct in 89%. The accuracy of HIDA was 92% in acute and 78% in chronic cholecystitis. Intraoperative cholangiography (IOC) done in 173 patients indicated the need for exploratory choledochotomy in 24; 21 had choledocholithiasis. These observations suggest that OCG and US are very accurate, but not infallible, in detecting cholelithiasis. US should be done first; when doubt persists, the addition of OCG allows the preoperative diagnosis of gallstones in 97% of the cases. HIDA is highly accurate but not infallible in detecting acute calculous cholecystitis. IOC is very reliable in detecting choledocholithiasis; thus, its routine is justifiable.