Laparoscopic Partial Splenectomy: A Safe and Feasible Treatment for Splenic Benign Lesions.

PURPOSE: The purpose of this study was to explore the safety and feasibility of laparoscopic partial splenectomy in treating splenic benign lesions (SBL). MATERIALS AND METHODS: A total of 16 SBL patients clearly diagnosed before surgery (8 cases of splenic cysts, 5 cases of splenic lymphangioma, and 3 cases of splenic hemangioma) underwent 2D or 3D laparoscopic partial splenectomy from October 2013 to August 2016. The diameters of the SBL were 5 to 17 cm with an average of 8.7 cm; 12 cases were located in the upper pole of the spleen, and 4 cases were located in the lower pole of the spleen. RESULTS: All 16 patients successfully completed laparoscopic partial splenectomy, and no patients required conversion to an open operation. There were 3 cases of resection using the 3D laparoscope. There were 14 cases of resection of half of the spleen and 2 cases of partial resection of the lower spleen. The operation time was 110 to 195 minutes with an average time of 157 minutes. The amount of intraoperative blood loss was 80 to 200 mL, and no patients required blood transfusion. The postoperative abdominal drainage time was 3 to 5 days, and no abdominal bleeding, pancreatic leakage, subphrenic infection, or other complications occurred; the postoperative hospital stay lasted 5 to 6 days. CONCLUSIONS: Laparoscopic partial splenectomy is safe and feasible for the treatment of splenic benign lesions.

Duodenum-preserving pancreatic head resection vs. pancreatoduodenectomy for benign lesions and low-grade malignancies of the pancreatic head.

BACKGROUND/AIMS: To compare the postoperative results of duodenum-preserving pancreatic head resection (DPPHR) techniques with those of conventional pancreatoduodenectomy (PD). METHODOLOGY: We retrospectively reviewed the records of 58 patients who underwent DPPHR or PD at Jinhua central hospital between May 1998 and May 2011. RESULTS: Eighteen patients underwent DPPHR (Group 1) and 40 conventional PD (Group 2). They were followed up for more than 6 months. Operation time in Group 1 was longer (290±18 min vs 269±14 min, p=0.001). Estimated blood loss in Group 1 was more (633±88 mL vs. 495±131 mL, p=0.003). Intraoperative transfusion in Group 1 was more (533±88 mL vs. 335±218 mL, p=0,001). However, postoperative transfusion was Iess (141±162 mL vs. 440±193 mL, p=0.000). Group 1 had a lower short-term complication rate (16.67% vs. 50.0%, p=0.0 16) and long-term complication rate (11.11% vs. 45.0%, p=0.012). Hospital mortality of both groups were 0. CONCLUSIONS: DPPHR for benign or premalignant lesions is a difficult procedure, but with a lower complication rate than conventional PD. Preserving the entire duodenum and a normal biliary tree allows better short-term and long-term results. DPPHR will be suitable for only a small group of patients and should be performed by experienced surgeons.

Preoperative assessment of hilar cholangiocarcinoma: combination of cholangiography and CT angiography.

BACKGROUND: Hilar cholangiocarcinoma is one of the most difficult carcinomas to manage because of the location of the main tumor at the hepatic hilus and the complex anatomy of the biliary, arterial, and portal systems. To plan an operation, it is important to acquire accurate information about the relationship between hilar cholangiocarcinoma and adjacent vessels. This study aimed to evaluate the clinical value of cholangiography combined with spiral CT three-dimensional (3D) angiography for a preoperative assessment of hilar cholangiocarcinoma. METHODS: From March 2007 to August 2009, cholangiography was performed in 13 patients with hilar cholangiocarcinoma. Meanwhile, contrast-enhanced abdominal scanning was performed using 16-slice spiral CT, and the 3D images of the hepatic artery and portal vein were acquired. The level and range of invasion of the hepatic artery, the portal vein, and the bile duct, the preoperative Bismuth classification, and T-staging were recorded and compared with those after surgical exploration. RESULTS: The hepatic artery and portal vein were reconstructed successfully in all these patients. Percutaneous transhepatic cholangiography was performed in 9 patients, endoscopic retrograde cholangiopancreatography in 1, and magnetic resonance cholangiopancreatography in 3. The CT angiography records of invasion of the hepatic artery were consistent with the results of explorations in these patients. The data from 5 of the 13 patients were consistent with those on invasion of the portal vein. The results of the Bismuth classification and the T-staging system were consistent with those of surgical exploration in 12 of the 13 patients. Seven of 8 patients who were estimated to be suitable for operation based on images were curatively treated and 5 who were judged to be unsuitable for curative operation by cholangiography and CT angiography were confirmed intraoperatively and underwent palliative procedures. CONCLUSIONS: Cholangiography combined with multi-slice spiral 3D CT angiography can satisfactorily delineate the local invasion of hilar cholangiocarcinoma and accurately evaluate the resectability. This approach, therefore, contributes to the planning of safe operation.

[Surgical treatment for hepatic metastases from colorectal carcinoma].

OBJECTIVE: To explore the indications and effect of surgical resection for hepatic metastases from colorectal adenocarcinoma and to discuss the implications of clinicopathologic features on the prognosis. METHODS: A retrospective study of 61 patients undergoing hepatectomy for metastatic tumors from colorectal adenocarcinoma from January 1991 to December 2000 in our hospital was performed retrospectively. RESULTS: The 1-, 3- and 5-year survival rates after hepatic resection were 72.13%, 58.10% and 26.01% respectively. Complications occurred in 8 cases. Tumor pesudomembrance was found in 20 cases. Dukes stage, pathologic type,the number of hepatic metastases and tumor pesudomembrance were all significant factors for prognosis after surgery (P< 0.05). The 3-year survival rate of the patients with postoperative comprehensive treatment was higher than that with non-postoperative treatment (P< 0.05). The size of hepatic metastases and the resecting time didn't affect the prognosis (P > 0.05). CONCLUSION: The hepatic metastases from colorectal cancer should be treated by a surgical approach. The earlier stage of clinical pathology,higher differentiation extent, metastases less than 3, the formation of pesudomembrance of the metastatic tumor and the postoperative comprehensive treatment predict a better survival.

[Primary common bile duct closure after choledochotomy].

OBJECTIVE: To investigate the rationality and feasibility of primary closure of the common bile duct after choledochotomy for common bile duct calculi. METHODS: From January 1990 to June 2001, 386 patients with the evidence of stones in the common bile duct underwent choledochotomy. Among them, 215 received primary closure of the common bile duct (group A) and 171 T-tube drainage (group B). The patients with emergency operations were excluded. Intraoperative choledochoscopy or cholangiography was routinely performed to rule out the possibility of retained stones. The duct was meticulously stitched using 0/3 to 0/5 absorbent sutures for primary closure. A T-tube was placed in the subhepatic space in the patients of both groups. RESULTS: Postoperative bile leakage was seen in 9 patients of group A and in 5 of group B, respectively (P > 0.05), and no reoperations were necessary. After surgery, the average time and volume of transfusion was 4.9 days and 9.1 liters in group A, versus 7.3 days and 12.8 liters in group B (P < 0.01). The patients in group B had a longer postoperative hospital stay than the those in group A (average 17.6:10.0 days, P < 0.01). T-tube removal resulted in bile peritonitis in 5 patients at day 16, 17, 19, 21 and 22 after surgery in group B, and 3 patients required repeated surgery. CONCLUSIONS: Primary closure of the common bile duct after choledochotomy is safe, effective, and inexpensive in selected patients with common bile duct calculi, and should be regarded as an alternative procedure.