Transumbilical single-incision laparoscopic subtotal gastrectomy and total intracorporeal reconstruction of the digestive tract in the treatment of benign peptic ulcers.

BACKGROUND: Single-incision laparoscopic surgery is being applied increasingly in many surgical specialties. However, few reports are available regarding its use in the treatment of benign peptic ulcer disease. METHODS: We report here on nine patients with gastric or duodenal ulcers who underwent transumbilical single-incision laparoscopic subtotal gastrectomy (SILSG) between November 2010 and June 2013. All procedures were performed with conventional laparoscopic instruments placed through a single operating portal of entry created within the umbilicus. Total intracorporeal gastrojejunostomy or gastroduodenostomy was then performed for reconstruction of the digestive tract. RESULTS: Only one case required conversion from single-incision to multiple-incision surgery. Among the eight patients who successfully underwent SILSG, total intracorporeal gastroduodenostomy was performed in two and gastrojejunostomy in six. The mean operation time was 290 ± 50 min (range 230-360 min), and blood loss was 200 ± 66 mL (range 100-300 mL). The patients recovered fully, and the single umbilical scars healed well. CONCLUSIONS: We believe this is the first report of SILSG with total intracorporeal gastrojejunostomy or gastroduodenostomy in the treatment of benign peptic ulcers. On the basis of this initial experience, SILSG for this indication in the hands of experienced surgeons appears to be feasible and safe.

Pure NOTES transvaginal appendectomy with gasless laparoscopy.

BACKGROUND: The vagina is the most widely used approach to natural orifice transluminal endoscopic surgery. However, a gas leak can significantly affect transvaginal operations during pneumoperitoneum laparoscopy. We tried to establish the proper technique for transvaginal appendectomy under gasless laparoscopy. MATERIALS AND METHODS: Five patients with chronic appendicitis were selected to receive gasless laparoscopic transvaginal appendectomy with concurrent vaginal hysterectomy. An abdominal wall-lifting device was applied after removal of the uterus, and the appendix was removed transvaginally. Clinical data such as operative duration, bleeding volume, morbidity, and hospital stay duration were analyzed. RESULTS: All procedures were performed successfully, without intraoperative or major postoperative complications. The appendectomy portion of the procedure took approximately 20-30 minutes, with minimal blood loss. All patients were discharged, scar-free, 3 d after surgery. CONCLUSIONS: Transvaginal appendectomy with gasless laparoscopy after vaginal hysterectomy appears to be a feasible and safe modification of established techniques, with acceptable outcomes.

Feasibility and safety of single-incision laparoscopic splenectomy: a systematic review.

OBJECTIVE: The aim of this review was to evaluate the feasibility, safety, and potential benefits of single-incision laparoscopic splenectomy (SILS-Sp). METHODS: We conducted a systemic review of literature between 2009 and 2012 to retrieve all relevant articles. RESULTS: A total of 29 studies with 105 patients undergoing SILS-Sp were reviewed. Fifteen studies used a commercially available single-port device. The range of body mass index was 14.7-41.4 kg/m(2). Six studies described combined operations including cholecystectomy (n = 8), mesh-pexy (n = 1), and pericardial devascularizaion (n = 1). The ranges of operative times and estimated blood losses were 28-420 min and 0-350 mL, respectively. Of 105 patients, three patients (2.9%) required additional ports, two patients (1.9%) were converted to open, and three patients (2.9%) to conventional multiport laparoscopic splenectomy (overall conversion rate, 4.8%). Postoperative bleeding occurred in two patients (1.9%) who both required reoperation. Overall mortality was 0% (0/105). The length of postoperative stay varied across reports (1-11 d). Among four comparative studies, one showed greater estimated blood loss and lower numeric pain rating scale score in the SILS-Sp group than in the multiport laparoscopic splenectomy group (206.25 ± 142.45 versus 111.11 ± 99.58 mL) and (3.81 ± 0.91 versus 4.56 ± 1.29), respectively. Another comparative study showed that SILS-Sp was associated with a shorter operative time (92.5 versus 172 min; P = 0.003), lower conversion rate, equivalent length of hospital stay, reduced mortality, similar morbidity, and comparable postoperative narcotic requirements. CONCLUSIONS: In early series of highly selected patients, SILS-Sp appears to be feasible and safe when performed by experienced laparoscopic surgeons. However, as an emerging operation, publication bias is a factor that should be considered before we can draw an objective conclusion.

Transvaginal laparoscopic appendectomy simultaneously with vaginal hysterectomy: initial experience of 10 cases.

BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES) involves the introduction of instruments through a natural orifice into the peritoneal cavity to perform surgical interventions. The vagina is the most widely used approach to NOTES. We report the utilization of the vaginal opening at the time of vaginal hysterectomy as a natural orifice for laparoscopic appendectomy. MATERIAL AND METHODS: We reviewed cases of 10 patients with chronic appendicitis who underwent transvaginal laparoscopic appendectomy simultaneously with vaginal hysterectomy. A laparoscopic approach was established after removal of the uterus, and the appendix was removed transvaginally. Among the 10 cases, 5 were conducted under gasless laparoscopy by using a simple abdominal wall-lifting instrument. RESULTS: All procedures were performed successfully without intraoperative or major postoperative complications. The appendectomy portion of the procedure took approximately 21 minutes to 34 minutes. All patients were discharged less than 4 days after surgery, without external scars. CONCLUSIONS: Transvaginal appendectomy with rigid laparoscopic instruments following vaginal hysterectomy appears to be a feasible and safe modification of established techniques, with acceptable outcomes.

Safety and application of transumbilical single-incision laparoscopic gastrectomy for GIST: SILS in benign gastric disease.

BACKGROUND: The authors report a new technique of umbilical single-incision laparoscopic surgery (SILS) in the treatment of gastrointestinal stromal tumors (GISTs) of the stomach using conventional laparoscopic instruments. METHODS: Preliminary experience with umbilical SILS operation in 13 patients with GIST was introduced. RESULTS: Umbilical SILS operation for GISTs was feasible with conventional laparoscopic instruments. No intraoperative or postoperative complications, such as secondary hemorrhage, anastomotic leakage, or obstruction, were recorded. The patients fully recovered and the single umbilical scar healed well. CONCLUSION: SILS for GISTs is a feasible and safe technique when performed by experienced laparoscopic surgeons. With advanced surgical technology and technique, truly minimally invasive surgical procedures, such as SILS, are feasible.

Single-incision laparoscopic resection of Bismuth I hilar cholangiocarcinoma.

INTRODUCTION: Laparoscopic hilar cholangiocarcinoma is rarely performed because of its aggressive growth and complicated anatomy. The authors successfully performed single-incision laparoscopic resection of Bismuth I hilar cholangiocarcinoma in 2 cases. METHOD: Two cases with Bismuth I cholangiocarcinoma were chosen for the laparoscopic surgery. Segmental bile duct resection and hepatoduodenal ligament lymphadenectomy were performed using single-incision laparoscopic technique with conventional instruments. RESULTS: Two operations were successfully performed without conversion. The operation time was 300 and 350 minutes, respectively. The margins of proximal and distal bile ducts were negative. The hospital stay was 6 and 9 days, respectively. One dosage of analgesic was administered after surgery. The abdominal wound recovered very well with good cosmesis. CONCLUSION: Single-incision laparoscopic surgery cholangiocarcinoma resection can be optional in strictly selected patients with Bismuth I cholangiocarcinoma. Long-term follow-up and more data are needed to evaluate its benefits.

[Transvaginal appendectomy with traditional laparoscopic tools].

OBJECTIVE: To establish the technique and methodology of appendectomy through transvaginal natural orifice transluminal endoscopic surgery(NOTES)under laparoscopy. METHODS: Three cases of chronic appendicitis were selected to receive laparoscopic transvaginal resection of appendixes with concurrent vaginal hysterectomies for uterine fibroids at Shengjing Hospital of China Medical University from November 2010 to November 2011. The procedure was performed by a multidisciplinary team composed of surgeons and gynecologists. The clinical data such as operative duration, bleeding volume, morbidity and stay duration were collected and analyzed. RESULTS: Appendectomies were performed with the working laparoscopic tools inserted through vagina. The en bloc resection was removed transvaginally through laparoscope. It took 34, 23 and 26 minutes respectively to complete the appendectomies. And the blood loss volume was minimal. There were no postoperative complications. And the patients were discharged scar-free after 3 days. CONCLUSIONS: Transvaginal appendectomy is both feasible and safe when performed by a multidisciplinary team. As an emerging innovation, natural orifice transluminal endoscopic surgery is mini-invasive, better tolerated and more respectful of esthetics.

The safety and feasibility of laparoscopic approach for the management of intrahepatic and extrahepatic bile duct stones in patients with prior biliary tract surgical interventions.

The purpose of this study was to compare the efficacy and safety of laparoscopic and open reoperation for intrahepatic and extrahepatic bile duct stones patients with previous biliary tract surgical procedures. The clinical data were retrospectively analyzed of intrahepatic and extrahepatic bile duct stones patients with previous biliary tract surgical procedures who underwent reoperation in the Second General Surgery Department of China Medical University from January 2012 to February 2018. 44 eligible cases were selected. In accordance with the surgical procedures, they were divided into a laparoscopy group (n = 23) and an open surgery group (n = 21). No statistically significant differences were found in the preoperative general clinical data between the two group. Two patients in the laparoscopy group were converted to open surgery. Comparisons between the two groups showed that the intraoperative blood loss [90.87 ± 62.95 (ml) vs. 152.38 ± 118.82 (ml)], the proportion of postoperative analgesia [10/23 (43.5%) vs. 16/21 (76.2%)], and the length of stay [7.19 ± 5.32 (d) vs. 11.00 ± 4.66 (d)] in the laparoscopy group were significantly lower than those in the open surgery group (P < 0.05). Laparoscopic biliary reoperation for intrahepatic and extrahepatic bile duct stones was feasible. Compared with open surgery, laparoscopic surgery has the advantages of less bleeding, a shorter postoperative length of stay, and a lower rate of additional postoperative analgesia.

Developments in the Diagnosis and Management of Cholecystoenteric Fistula.

Background: Cholecystoenteric fistula (CEF) is a rare complication of cholelithiasis. CEF refers to one or more pathological perforations between the gallbladder and the adjacent gastrointestinal tract, first described by Bartholin in 1645. The aim of this review is to examine the etiology, symptoms, diagnosis, and treatment of CEF.Methods: A literature search was conducted according to a set of criteria in PubMed for historical and current peer-reviewed studies regarding CEF.Results: Clinical manifestations of CEF are always latent. Despite modern imaging studies and diagnostic methods, it is still very difficult to definitively diagnose CEF preoperatively. Instead, CEF is often accidentally discovered in the perioperative period or via intraoperative exploration.Conclusions: Without appropriate preoperative preparation, gastrointestinal injury and intraoperative bleeding often occur. CEF often goes unreported, and its diagnosis and treatment are still controversial. Early diagnosis of CEF is essential for effective treatment and improved outcome.

Sphincter of Oddi-preserving and T-tube-free laparoscopic management of extrahepatic bile duct calculi.

BACKGROUND: The current management of choledocholithiasis remains a controversial topic. Popular options for treatment include preoperative endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) followed by laparoscopic cholecystectomy (LC), or LC and laparoscopic common bile duct exploration (LCBDE) with T-tube decompression. Some concerns suggest that sphincterotomy has significant long-term complications as a result of sphincter of Oddi (SO) dysfunction, and T-tube decompression is historically associated with many complications and discomfort. The purpose of this study was to demonstrate our simple, safe techniques of LCBDE without a T-tube and with an intact SO. METHODS: Between April 2006 and July 2009, a total of 44 selected patients with common bile duct (CBD) stones underwent laparoscopic exploration at our institution. Of 44 laparoscopic choledochotomies, primary choledochorrhaphy was performed on patients with preoperatively installed endoscopic retrograde biliary drainage (ERBD) tubes (n = 10, 22.73%) or endonasobiliary drainage (ENBD) tubes (n = 10, 22.73%) and on patients with intraoperative biliary drainage C-tubes (n = 9, 20.45%) or pigtail J biliary drainage tubes (n = 15, 34.09%). RESULTS: The mean operating time for the ENBD, ERBD, J-tube, and C-tube groups were 97.8, 96.2, 102.1, and 98.7 min, respectively. There were no conversions to open surgery, and no intraoperative complications were experienced in any group. CBD clearance was achieved in 43 patients (97.73%). The mean lengths of follow-up for the ENBD, ERBD, J-tube, and C-tube groups were 27.0, 26.7, 23.8, and 30.4 months, respectively; and none of the patients developed major biliary complications including recurrent stones. CONCLUSIONS: Laparoscopic primary closure with internal and external biliary drainage tubes is safe and an effective alternative to T-tube placement, especially for younger patient groups able to endure bile duct exploration. Sphincter of Oddi function is well preserved to prevent recurrent bile duct stones and bile duct cancer. Procedures are safe with great feasibility.

Laparoscopic resection of Bismuth type I and II hilar cholangiocarcinoma: an audit of 14 cases from two institutions.

OBJECTIVE: To evaluate the feasibility and safety of laparoscopic resection of Bismuth type I and II hilar cholangiocarcinoma. BACKGROUND: Laparoscopic resection of hilar cholangiocarcinoma is uncommon. METHOD: Fourteen cases of Bismuth type I and II hilar cholangiocarcinoma were selected for laparoscopic resection. Eight cases involved local resection and 6 cases included partial hepatectomy. RESULTS: The mean operating time and blood loss were 305 min and 386 ml, respectively. The R0 resection rate was 100 and 60% in patients with type I and II lesions, respectively. The mean postoperative hospital stay was 9 days and 19 days in patients with type I and II tumor, respectively. In-hospital mortality and morbidity were 0 and 35.7% (5 of 14 patients), respectively. Bile leakage occurred in 1 of 7 (14.3%) and 3 of 5 (60%) patients with type I and II tumors, respectively. Port-site metastases were found in 2 cases of type II tumor. The survival rate during a 20-month follow-up period was 85.7% (12 of 14 patients). CONCLUSION: Laparoscopic resection is a potential alternative to open surgery for appropriately selected patients with Bismuth type I hilar cholangiocarcinoma. Due to the lower R0 resection and more complications, the value of laparoscopic resection for patients with type II tumors needs further evaluation.

Emergency transumbilical single-incision laparoscopic splenectomy for the treatment of traumatic rupture of the spleen: report of the first case and literature review.

AIM: The authors report 1 case of emergency splenectomy for the treatment of traumatic rupture of the spleen where a laparoendoscopic single-site surgery technique was performed. METHOD: A 17-year-old male with a diagnosis of traumatic rupture of the spleen underwent emergency transumbilical single-incision laparoscopic splenectomy. Three ports, including 5 mm and 10 mm ports, were placed through a transumbilical incision for the procedure. RESULTS: Intraoperative and postoperative courses were uneventful. The patient was discharged home 8 days after the surgery in a stable condition. Discussion. The Laparoendoscopic single site surgery technique is still in its infancy, but because of its reduced invasion and ideal aesthetic results, it is well received by patients. Improvements are needed to widen its application. CONCLUSION: To the authors' knowledge, this is the first report where an emergency laparoendoscopic single site surgery technique has been used in the management of a ruptured spleen.

[Laparoendoscopic single-site splenectomy in the treatment of different diseases of spleen].

OBJECTIVE: To summarize the clinical experiences of laparoendoscopic single-site splenectomy. METHODS: From January 2010 to June 2010, laparoendoscopic single-site splenectomy was performed in 4 patients, including traumatic rupture (n = 1), hypersplenism (n = 1), splenic aneurysm (n = 1) and cardia cancer with invasiveness to spleen (n = 1). RESULTS: All operations were successful with an operative duration 180 - 360 min, a volume of intraoperative blood loss 100 - 400 ml and a hospital stay 7 - 9 days. All patients stayed free of such postoperative complications as hemorrhage, pancreatic leakage, venous thrombosis and fever. The umbilical incision healed well with satisfactory cosmetics. CONCLUSION: Laparoendoscopic single-site splenectomy is both safe and feasible for experienced laparoscope surgeons.

Cholesterol gallstones: Focusing on the role of interstitial Cajal-like cells.

Cholesterol gallstone (CG) is a common, frequent biliary system disease in China, with a complex and multifactorial etiology. Declined gallbladder motility reportedly contributes to CG pathogenesis. Furthermore, interstitial Cajal-like cells (ICLCs) are reportedly present in human and guinea pig gallbladder tissue. ICLCs potentially contribute to the regulation of gallbladder motility, and aberrant conditions involving the loss of ICLCs and/or a reduction in its pacing potential and reactivity to cholecystokinin may promote CG pathogenesis. This review discusses the association between ICLCs and CG pathogenesis and provides a basis for further studies on the functions of ICLCs and the etiologies of CG.

Complications analysis with postoperative choledochoscopy for residual bile duct stones.

BACKGROUND: This study was designed to review the experience of this department with the treatment of post-common bile duct exploration residual stones using choledochoscopy and to analyze the complications of choledochoscopy and explore effective methods of prevention. METHODS: A choledochoscope (PENTAX fibercholedochoscope and electronic choledochoscope PENTAX ECN-1530) was used. A total of 2,882 postoperative percutaneous choledochoscopy (POC) sessions were performed on 986 patients with residual bile duct stones from 1980 to 2008 (408 men, 578 women; ages range, 21-82 years). Forty-five of these had undergone laparoscopic common bile duct exploration (LCBDE); the rest had open bile duct exploration. Seventy-six participants had choledochoscopy examination (for diagnosis only), and in 910 patients it was performed for both diagnosis and therapy (calculi extraction). In 68 cases, plasma shock wave lithotripsy (PSWL) was performed for larger stones before choledochoscopy extraction. RESULTS: The mean duration of choledochoscopy was 25 min (range, 10 min to 2 h), with a mean frequency of 2.85 times (range, 1-11). No mortalities occurred. The procedure was unsuccessful in 28 cases in which stones were not accessible because they were embedded in distal hepatic ducts or because they were in proximal ducts that were severely stenosed. Complications resulted in 13 cases and included perforated sinus, biliary peritonitis, sinus hypoplasia, destruction of the T-tube system leading to obstruction, basket incarceration, bleeding, and intestinal fistular. Choledochoscopic stone clearance was achieved in 95.5% of the cases. CONCLUSIONS: Choledochoscopy is an important treatment option for hepatolithus. It has a high efficiency for stone extraction and fewer complications. However, it should be noted that some of its complications are potentially life-threatening.

Liver injury in COVID-19: A minireview.

In December 2019, an outbreak of unexplained pneumonia was reported in Wuhan, China. The World Health Organization officially named this disease as novel coronavirus disease 2019 (COVID-19). Liver injury was observed in patients with COVID-19, and its severity varied depending on disease severity, geographical area, and patient age. Systemic inflammatory response, immune damage, ischemia-reperfusion injury, viral direct damage, drug induce, mechanical ventilation, and underlying diseases may contribute to liver injury. Although, in most cases, mild liver dysfunction is observed, which is usually temporary and does not require special treatment, the importance of monitoring liver injury should be emphasized for doctors. The risk of COVID-19 infection of liver transplantation recipients caused more and more concerns. In this article, we aimed to review the available literature on liver injury in COVID-19 to highlight the importance of monitoring and treating liver injury in COVID-19.

Effect of cholesterol on in vitro cultured interstitial Cajal-like cells isolated from guinea pig gallbladders.

BACKGROUND: Loss and/or dysfunction of interstitial Cajal-like cells (ICLCs) in the gallbladder may promote cholesterol gallstone formation by decreasing gallbladder motility. AIM: To study the effect of cholesterol on the proliferation and apoptosis of ICLCs from guinea pig gallbladders. METHODS: Guinea pig gallbladder ICLCs were isolated and cultured in vitro. The cells were exposed to cholesterol solutions at different concentrations (0, 25, 50, and 100 mg/L) for 24 h. Then, cell proliferation was detected by the CCK-8 method and the apoptosis rate was detected by flow cytometry. Further, the expression of the c-Kit protein was detected by Western blot and the expression level of c-Kit mRNA in the cells was detected by real-time quantitative PCR. RESULTS: After ICLCs were cultured with cholesterol at concentrations of 25, 50, and 100 mg/L, the proliferation rates decreased significantly (P < 0.05), whereas the apoptosis rates increased significantly (P < 0.05). Moreover, the expression of c-Kit protein and mRNA decreased significantly (P < 0.05). CONCLUSION: High cholesterol concentrations can inhibit the proliferation of ICLCs and promote apoptosis. This decrease in the ICLC proliferation rate might be caused by the inhibition of the stem cell factor/c-Kit signaling pathway.

Laparoscopic subtotal cholecystectomy as an alternative procedure designed to prevent bile duct injury: experience of a hospital in northern China.

PURPOSE: Experience and advances in laparoscopic techniques have made laparoscopic subtotal cholecystectomy (LSTC) a feasible option even in complex procedures. We report our experience of performing LSTC in the management of complicated cholecystitis. METHODS: Among 1558 patients scheduled to undergo laparoscopic cholecystectomy (LC) in our institute between July 2004 and December 2007, 48 underwent LSTC for complicated cholecystitis. We describe our tailored approach and the techniques we used to accomplish this. RESULTS: All 48 patients underwent retrograde cholecystectomy. Twenty (41.6%) required an additional port (the fourth port) to obtain adequate exposure of the hilum, 39 (81.3%) required suturing of the gallbladder infundibular remnant, and 4 (8.33%) experienced local complications. The mean operative time of LSTC was 61.7 +/- 17.5 min, the estimated operative blood loss was 72.0 +/- 32.8 ml, the time to resume oral intake was 27.8 +/- 14.9 h, and the mean postoperative hospital stay was 4.5 +/- 1.3 days. There was no bile duct injury or mortality in this series. CONCLUSION: Laparoscopic subtotal cholecystectomy is a safe and feasible alternative to conversion to open surgery during difficult laparoscopic cholecystectomy for patients with complicated cholecystitis. However, we emphasize that only experienced laparoscopic surgeons should perform this procedure when complete removal of the gallbladder is not possible.

Western blotting in the diagnosis of duodenal-biliary and pancreaticobiliary refluxes in biliary diseases.

BACKGROUND: Currently adopted diagnostic methods for duodenal-biliary and pancreaticobiliary refluxes carry many flaws, so the incidence of the two refluxes demands further larger sample size studies. This study aimed to evaluate Western blotting for the diagnosis of refluxes in biliary diseases. METHODS: An oral radionuclide 99mTc-DTPA test (radionuclide, RN) was conducted for the observation of duodenal-biliary reflux prior to measuring bile radioactivity and Western blotting for detecting bile enterokinase (EK). Pancreaticobiliary reflux was assessed by biochemical and Western blotting tests for biliary amylase activity and trypsin-1, respectively. In accordance with bile sample origin, our samples were classified into ductal bile and gall bile groups; based on each individual biliary disease, we further classified the ductal bile group into five sub-groups, and the gall bile group into four sub-groups. Western blotting was conducted to assess the two refluxes in biliary diseases. RESULTS: Consistencies were noted between EK and RN tests when diagnosing duodenal-biliary reflux (P<0.001). The amylase and trypsin-1 tests also showed consistency in diagnosing pancreaticobiliary reflux (P<0.001). Amylase and lipase levels within gall and ductal bile were strongly correlated (P<0.05). In the common bile duct pigment stone group, the EK and trypsin-1 positive rates were found to be insignificant (P>0.05); in the common bile duct cyst group, the EK positive rate was significantly lower than the trypsin-1 positive rate (P<0.05). CONCLUSIONS: Western blotting can accurately reflect duodenal-biliary and pancreaticobiliary refluxes. EK has greater sensitivity than RN for duodenal-biliary reflux. The majority of biliary amylase and lipase comes from the pancreas in all biliary diseases; pancreaticobiliary reflux is the predominant source in the common bile duct cyst group and duodenal-biliary reflux is responsible for the ductal pigment stone group.

Sphincter of Oddi hypomotility and its relationship with duodenal-biliary reflux, plasma motilin and serum gastrin.

AIM: To detect whether patients with a T tube after cholecystectomy and choledochotomy have duodenal-biliary reflux by measuring the radioactivity of Tc99m-labeled diethylene triamine penta-acetic acid (DTPA) in the bile and whether the patients with duodenal-biliary reflux have sphincter of Oddi hypomotility, by measuring the level of plasma and serum gastrin of the patients. Finally to if there is close relationship among sphincter of Oddi hypomotility, duodenal-biliary reflux and gastrointestinal peptides. METHODS: Forty-five patients with a T tube after cholecystectomy and choledochotomy were divided into reflux group and control group. The level of plasma and serum gastrin of the patients and of 12 healthy volunteers were measured by radioimmunoassay. Thirty-four were selected randomly to undergo choledochoscope manometry. Sphincter of Oddi basal pressure (SOBP), amplitude (SOCA), frequency of contractions (SOF), duration of contractions (SOD), duodenal pressure (DP) and common bile duct pressure (CBDP) were scored and analyzed. RESULTS: Sixteen (35.6%) patients were detected to have duodenal-biliary reflux. SOBP, SOCA and CBDP in the reflux group were much lower than the control group (t=5.254, 3.438 and 3.527, P<0.001). SOD of the reflux group was shorter than the control group (t=2.049, P<0.05). The level of serum gastrin and plasma motilin of the reflux group was much lower than the control group (t= -2.230 and -2.235, P<0.05). There was positive correlation between the level of plasma motilin and SOBP and between the level of serum gastrin and SOBP and CBDP. CONCLUSION: About 35.9% of the patients with a T tube after cholecystectomy and choledochotomy have duodenal-biliary reflux. Most of them have sphincter of Oddi hypomotility and the decreased level of plasma motilin and serum gastrin. The disorder of gastrointestinal hormone secretion may result in sphincter of Oddi dysfunction. There is a close relationship between sphincter of Oddi hypomotility and duodenal-biliary reflux.