Safety and Effectiveness Analysis of Different Surgical Methods for Intrahepatic Bile Duct Stones.

BACKGROUND: Intrahepatic bile duct stones, a prevalent condition within hepato-biliary diseases, present a considerable challenge due to the high rates of recurrence, complications, and difficulty in treatment. Selecting an optimal surgical approach is vital for effective stone clearance and minimizing patient morbidity. While laparoscopic hepatectomy and percutaneous transhepatic choledochoscopy are established modalities, their comparative efficacy and safety profiles necessitate further investigation to inform clinical decision-making. OBJECTIVE: To explore the effectiveness and safety of different surgical methods for intrahepatic bile duct stones.  Methods: The clinical data of 65 patients with intrahepatic bile duct stones admitted to Nanchong Central Hospital, China, from January 2021 to January 2022 were retrospectively analyzed. According to the differences in surgical methods, patients undergoing laparoscopic hepatectomy were included in the laparoscopic group (n = 33), and patients undergoing percutaneous transhepatic choledochoscopy were included in the percutaneous transhepatic group (n = 32). The differences in perioperative indicators, inflammatory factors, postoperative complications, and one-year follow-up recurrence rates between the two groups were compared. RESULTS: Compared with percutaneous transhepatic group, laparoscopic group had significantly shorter operation time and hospitalization time (p < 0.05), and significantly higher blood loss (p < 0.05). After the operation, C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) in the laparoscopic and percutaneous transhepatic groups were significantly lower than those in the same group before the operation (p < 0.05). CRP, TNF-α, and IL-6 in the laparoscopic group were significantly lower than in the percutaneous transhepatic group (p < 0.05). There was no significant difference in the incidence of postoperative complications and the recurrence rate of one-year follow-up between the laparoscopic group and the percutaneous transhepatic puncture group (p > 0.05). CONCLUSION: Laparoscopic hepatectomy and percutaneous transhepatic choledochoscopy are both practical and safe, and the appropriate surgical scheme should be selected according to the patient's specific condition.

Preventive effect of omental flap in pancreaticoduodenectomy against postoperative complications: a meta-analysis.

BACKGROUND/AIMS: To systematically determine the effect of omental flap in pancreaticoduodenectomy against postoperative complication through metaanalysis of published studies. METHODOLOGY: Thorough literature search in Ovid-MEDLINE and EMBASE databases was conducted to identify studies whether the use of Omental Flap to prevent postoperative complications. Review of 14 article candidates, identified 4 eligible articles with a total of 2971 patients for meta-analysis. Dichotomous data regarding distinction between omental roll-up and nonmental roll-up were pooled using random effects model to obtain the diagnostic odds ratios and their 95% confidence intervals (CIs). RESULTS: 1129 patients in omental roll-up group, 1842 patients in nonomental group. Omental roll-up during pancreaticoduodenectomy could not prevent postoperative pancreatic fistula (OR=0.81, 95%CI 0.40-1.63, P=0.56). it also could not prevent postoperative intra-abdominal bleeding (OR=0.67, 95%CI 0.28-1.59, P=0.37). We use the sensitivity analysis which found The pancreatic fistula was lower in the nonomental roll-up group than in the omental roll-up group (OR=1.24, 95%CI 1.03-1.50, P=0.02). CONCLUSIONS: The use of omental roll-up could not decrease the risk of pancreatic fistula after pancreaticoduodenectomy. Further randomized controlled trials are needed to identify the effect of omental roll-up technique for pancreaticoduodenectomy.

Anticoagulation therapy prevents portal-splenic vein thrombosis after splenectomy with gastroesophageal devascularization.

AIM: To compare the incidence of early portal or splenic vein thrombosis (PSVT) in patients treated with irregular and regular anticoagulantion after splenectomy with gastroesophageal devascularization. METHODS: We retrospectively analyzed 301 patients who underwent splenectomy with gastroesophageal devascularization for portal hypertension due to cirrhosis between April 2004 and July 2010. Patients were categorized into group A with irregular anticoagulation and group B with regular anticoagulation, respectively. Group A (153 patients) received anticoagulant monotherapy for an undesignated time period or with aspirin or warfarin without low-molecular-weight heparin (LMWH) irregularly. Group B (148 patients) received subcutaneous injection of LMWH routinely within the first 5 d after surgery, followed by oral warfarin and aspirin for one month regularly. The target prothrombin time/international normalized ratio (PT/INR) was 1.25-1.50. Platelet and PT/INR were monitored. Color Doppler imaging was performed to monitor PSVT as well as the effectiveness of thrombolytic therapy. RESULTS: The patients' data were collected and analyzed retrospectively. Among the patients, 94 developed early postoperative mural PSVT, including 63 patients in group A (63/153, 41.17%) and 31 patients in group B (31/148, 20.94%). There were 50 (32.67%) patients in group A and 27 (18.24%) in group B with mural PSVT in the main trunk of portal vein. After the administration of thrombolytic, anticoagulant and anti-aggregation therapy, complete or partial thrombus dissolution achieved in 50 (79.37%) in group A and 26 (83.87%) in group B. CONCLUSION: Regular anticoagulation therapy can reduce the incidence of PSVT in patients who undergo splenectomy with gastroesophageal devascularization, and regular anticoagulant therapy is safer and more effective than irregular anticoagulant therapy. Early and timely thrombolytic therapy is imperative and feasible for the prevention of PSVT.