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PURPOSE: Duodenal stump leakage (DSL) is a potentially fatal complication that can occur after gastrectomy, but its underlying risk factors are unclear. This study aimed to investigate the risk factors and management of DSL after laparoscopic radical gastrectomy for gastric cancer (GC).MATERIALS AND METHODS: Relevant data were collected from several prospective databases to retrospectively analyze the data of GC patients who underwent Billroth II (B-II) or Roux-en-Y (R-Y) reconstruction after laparoscopic gastrectomy from 2 institutions (Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, and HwaMei Hospital, University of Chinese Academy of Sciences). The DSL risk factors were analyzed using univariate and multivariate analysis regression.RESULTS: A total of 810 patients were eligible for our analysis (426 with R-Y, 384 with B-II with Braun). Eleven patients had DSL (1.36%). Body mass index (BMI), elevated preoperative C-reactive protein (CRP) level, and unreinforced duodenal stump were the independent risk factors for DSL. DSL was diagnosed in 2–12 days, with a median of 8 days. Seven patients received conservative treatment, 3 patients received puncture treatment, and only 1 patient required reoperation. All patients recovered successfully after treatment.CONCLUSIONS: The risk factors of DSL were BMI ≥24 kg/m², elevated preoperative CRP level, and unreinforced duodenal stump. Nonsurgical treatments for DSL are preferred.
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Objective To summarize our experience in the prevention and treatment of right accessory hepatic duct and right hepatic duct injury during laparoscopic cholecystectomy. Methods The clinical data of 21 cases with right accessory hepatic duct or right hepatic duct during laparoscopic cholecystectomy were reviewed retrospectively. Result According to anatomy identified by preoperative work-up and selective cholangiography during the operation, 18 cases had the right accessory hepatic duct,eleven of them were confirmed intraoperatively. The accessory hepatic ducts were conserved in 3 cases and clipped without biliary leaks postoperativly in 7 cases; One case had biliary leaks postoperatively with the duct sutured intraoperatively, and recovered well conservative therapy. Accessory hepatic ducts were accidentally injuried in 7 cases, two patients were transferred to open surgery; three cases were confirmed to be injuried and clipped by second laparoscopic exploration because of biliary leaks postoperatively. Three cases had a low confluence of the right and left hepatic duct with the gallbladder duct joining the right bile duct, the ducts were conserved in 2 cases and injuried in one. Postoperatively all these 21 cases were followed up for 2 years, without jaundice or liver dysfunction. Conclusions To prevent injury of right accessory hepatic duct and right hepatic duct. High vigilance and familiarity with the anatomic variants of the biliary tree and intraoperative cholangiography in selective cases are fundmental.
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3 d in 16)were converted to open surgery because of massive adhesion at the Calot's triangle(13 cases),severe wound hemorrhage(4),common bile duct stones(4),gallbladder-duodenum fistula(2),gallbladder-colon fistula(1),or Mirizzi syndrome(1).During the operation,no bile duct injury occurred.None of the patients had intra-abdominal haemorrhage,biliary leak,or subhepatic abscess after the operation.The 279 patients were followed up for 5 to 24 months with a mean of 12 months,during which no patients complained of abdominal pain or jaundice.Conclusions The success of LC depends on early treatment and strict selection of patients.Intraoperative hemorrhage and bile duct injury can be avoided by sufficiently exposing the Calot's triangle and using the technique of flush-suction blunt dissection.Conversion to open surgery is necessary when LC is difficult.
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Objective To evaluate the feasibility and efficacy of laparoscopic splenectomy(LS). Methods In this study 41 cases were enrolled including 10 cirrhotic splenomegaly cases and 17 idiopathic thrombocytopenic purpura cases. The clinical data of 41 cases undergoing LS was retrospectively reviewed. KG2Result Two cases were shifted to open surgery, LS was successful in 39 cases with average operating time of 238 min, the average spleen weight was 389 g, blood loss 318 ml, postoperative GI movement started from 12 to 24 hrs. The average postoperative hospital stay was 4 days. Postoperative complications occurred in 3 cases including intraabdominal bleeding, subcutaneous emphysema, and stabbing-caused abdominal wall bleeding in one each. Conclusion LS is safe and less traumatic in selected patients indicated for splenectomy, especially for those suffering from haemotologic diseases.
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ObjectiveTo evaluate the effect of laparoscopic cholecystectomy (LC) combined with intraoperative cholangiography (IOC) and intraoperative endoscopic sphincterotomy (IOEST) for the diagnosis and treatment of choledocolithiasis. Methods Statistical analysis was carried out for 106 patients with cholecystocholedocolithiasis diagnosed and treated by LC-IOC-IOEST. Results Sixty-four (60.4%, 64/106 ) patients with preoperative diagnosis of simple gall stone were found with complicated choledocholithisis; LC-IOC -IOEST was successfully performed in 99(93.4%, 99/106) cases. Six cases (6.1%) suffered from mild postoperative acute pancreatitis. Duodenal perforation, bile leakage, peumothorax (0.9%) developed in one each. Duodenal adenocarcinoma was overlooked in one case, and 2 cases (1.8%) suffered from gastric paralysis. Conclusion LC combined with IOC and IOEST was a safe, effective approach to the diagnosis and minimally invasive treatment of choledocholithiasis.
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Objective To analyze risk factor of bile duct injury (BDI) during laparoscopic cholecystectomy (LC). Methods A retrospective population-based cohort study was carried out on 13878 patients undergoing LC from Apr 1994 to Dec 2003. Patients were divided into BDI group and non-BDI group. Factors with statistically significant differences between groups in anivariable analysis were selected to construct a multivariate logistic regression mode. Result Among 13878 LC procedures 38 BDI (0.27%) were identified. Factors which were of significant differences between groups in anivariable analysis includ diameter of common bile duct(?~2=5.92, P
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Objective To analyze the diagnosis and treatment of pancreatic pseudocyst. Method This study included 46 pancreatic pseudocyst cases, 7 received conservative therapy, 12 received internal drainage, 9 received external drainage, 5 received sequential internal and external drainage and 13 received partial pancreatectomy. Result Cases receiving conservative therapy recovered well without recurrence, one case receiving internal drainage suffered from postoperative pancreatic fistula, one receiving external drainage was complicated with pancreatic fistula and recurrence developed in another 2 cases, one case undergoing partial pancreatectomy was complicated with postoperative pancreatic fistula. Conclusion Pancreatic pseudocyst should be managed individually according the course and patients' clinical condition.
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Objective To evaluate the maneuvre of curettage and aspiration(LTCA) in laparoscopic hepatectomy. MethodsWe used Peng′s multifunctional operative dissector(PMOD) to perform laparoscopic liver transection by maneuvre of curettage and aspiration in 20 cases undergoing laparoscopic hepatectomy. Results Procedures were all successful. The recovery was uneventful without any complications. Mean operative time was 105 minutes, the average bleeding volume was 420 ml, the largest excised sample size was 10 cm?9 cm?7 cm. All patients were discharged within one week. ConclusionsThe new technique-LTCA can be used in laparoscopic hepatectomy, it has the advantages of clear anatomy, good exposure of canal construction, rapid liver transection, satisfactory hemostasis and clear operative field.