Efficacy of emergency exploratory laparotomy in incarcerated obturator hernia.

BACKGROUND: Incarcerated obturator hernia (IOH) is a scarce type of acute surgical disease, but the mortality rate is the highest in abdominal hernias. The aim of this study was to evaluate the efficacy of emergency exploratory laparotomy (EEL) in treating incarcerated obturator hernia (IOH). METHODS: We conducted a retrospective study of 12 female patients with IOH underwent EEL between January 2014 and March 2016. The variables which included patient characteristics, findings of CT, operative time, postoperative complications, length of hospital stay, ICU admission rate, 30-day readmission rate and mortality were analyzed. RESULTS: The age of patients was 82.5 ± 4.2 years and the median body mass index (BMI) was 20.6 kg/m2 (IQR, 18.7-21.5 kg/m2). There were 10 patients (83.3%) underwent partial intestinal resection due to partial small bowel necrosis or perforation. The total operation time was 85.7 ± 8.7 min. The time to initiation of a soft diet was 3.9 ± 0.7 days and the median length of stay was 15.0 days (IQR, 14.0-17.5 days), respectively. CONCLUSIONS: The EEL is a clinically safe and necessary choice for early diagnosis and treatment in IOH. EEL may improve the curative effect of IOH significantly.

A comparative study of the diagnostic accuracy of the medical image three-dimensional visualization system, MRCP, CT and US in hepatolithiasis.

BACKGROUND/AIMS: The aim of this study was to compare the results of the Three-Dimensional Visualization System (MI-3DVS or 3D) in the diagnostic accuracy of hepatolithiasis. METHODOLOGY: From February 2007 to March 2013, forty-eight patients with hepatolithiasis were admitted to our department. Meanwhile, choosing forty-one patients without hepatolithiasis as controlgroup. MI-3DVS, MRCP, CT, and US were performed and the results of these imaging methods in detecting calculi distribution, bile duct dilatation/stricture, and liver atrophy/hypertrophy were analyzed. RESULTS: The total display accuracy on bile duct stricture/dilatation using by 3D was higher than using by MRCP, CT, US. The total accuracy of 3D in detecting the liver atrophy was 96.6%, which was superior to that of US (p=0.009) and CT (p=0.044), and there was no significant difference compared with MRCP (P=0.120). The results on diagnosis of calculi distribution by 3D was better than US (p=0.003) and MRCP (p=0.029), but had no significantly difference compared with CT (P=0.246), and they were all close to intraoperative findings. CONCLUSIONS: MI-3DVS could be used to select patients with hepatolithiasis as a supplement approach to other imaging methods and as an innovative means in pre-operative assessment and post-operative follow-ups in hepatolithiasis.

Management complicated hepatolithiasis with operative rigid choledochoscope guided by computed tomography (CT)-based 3D reconstruction technique.

BACKGROUND: Treatment of complicated hepatolithiasis is complex and difficult. In this report, we present a novel approach to manage complicated hepatolithiasis using the rigid choledochoscope guided by CT-based 3D reconstruction technique with or without hepatectomy. METHODS: Between February 2012 to December 2013, 25 patients with complicated hepatolithiasis underwent rigid choledochoscope guided by CT-based 3D reconstruction technique combined with or without hepatectomy. 27 patients with complicated hepatolithiasis underwent a traditional operation (traditional method group) from June 2011 to January 2012. All operations were performed by the authors. RESULTS: The final stone clearance rate of the rigid choledochoscope group was 96%, whereas that of the traditional method group was 74.1% (P=0.032). There was no patient died of postoperative mortality in two groups. Moreover, the operative time in the traditional method group was significantly longer than that in the rigid choledochoscope group (P=0.010). Recurrent intrahepatic bile duct stones were not found during the follow-up period in the two groups. CONCLUSIONS: Operative rigid choledochoscope guided by CT-based 3D reconstruction technique combined with or without hepatectomy may be an effective and safe treatment for complicated hepatolithiasis.

3D Reconstruction Aids Surgery For Complicated Hepatolithiasis.

BACKGROUND/AIMS: Three-dimensional (3D) imaging may improve surgical interventions for complicated hepatolithiasis. METHODOLOGY: Between July 2008 and December 2012 a total of 131 patients with complicated hepatolithiasis underwent surgical therapy in the Department of Hepatobiliary Surgery Zhujiang Hospital, Southern Medical University. 77 patients received preoperative planning using a computed tomography (CT)-based 3D reconstruction technique, and 54 received treatment based on preoperative planning with traditional imaging (CT, ultrasonography, magnetic resonance imaging/magnetic resonance cholangiography). Perioperative and long-term outcomes were analyzed. RESULTS: 3D reconstruction facilitated significantly more accurate diagnosis of pathological morphology than conventional imaging methods, as confirmed during surgery. Patients that received 3D reconstruction preoperative planning had significantly better clinical outcomes. The immediate stone clearance rates were 92.2% and 61.1%, respectively. Additional postoperative choledochoscopic lithotripsy raised the clearance rates to 94.8% and 81.5%, respectively. The hospital mortality rates were 0% and 1.9%, respectively, and the complication rates were 33.8% and 44.4%, respectively. With a median follow-up of 28 months (5-38 months), the long-term overall asymptomatic survival rates were 80.5% and 46.3%, respectively. 3D reconstruction preoperative planning was a significant prognostic protective factor of long-term asymptomatic survival for the patients with complicated hepatolithiasis (Cox regression analysis, RR = 0.348, 95% confidence interval 0.185-0.657, p = 0.001). CONCLUSION: Surgical therapy conducted following preoperative planning using 3D reconstruction achieved better clinical outcomes than conventional imaging techniques. Whilst conventional imaging techniques accurately identify intrahepatic stones, they are less capable of identifying bile duct stricture.

Efficacy of emergency laparoscopic appendectomy in treating complicated appendicitis for elderly patients.

To assess the therapeutic effects of emergency laparoscopic appendectomy (LA) in treating complicated appendicitis (CA) for elderly patients (defined as age 65 years and above). Methods: We conducted a retrospective study of 115 elderly patients with CA who underwent surgical therapy in the Affiliated Huizhou Hospital of Sun Yat-Sun University, Huizhou, Guangdong Province, China between September 2014 and August 2016. Of these, 59 patients consented to open appendectomy (OA), and LA was performed in the other 56 patients. The perioperative and follow-up variables of the 2 groups were analyzed. Results: The operative time in the LA group was longer than the OA group (LA: 70.5±16.0 min versus [vs.] OA: 59.3±12.0 min, p greater than 0.001). The LA group had lower chances of incision infections (LA: 8.9% vs OA: 28.8 %, p=0.007) and shorter hospital stay (LA: 6.1± 2.5 days vs. OA: 9.6±3.5 days, p greater than 0.001). Return to soft diet (LA: 1.4 ± 0.8 days vs OA: 3.0 ± 1.6 days, p greater than 0.001) and time to out of bed (LA: 1.3±0.5 days vs OA: 2.5±0.9 days, p greater than 0.001) was faster in the LA group. The incidence of complications and 30-day readmission rate in the LA group was much lower than the OA group. Conclusion: Emergency LA in treating elderly patients with CA has the advantages of less trauma, definite curative effect, low complication rates, and fast recovery when compared with OA.