• Journal of Digestive Cancer Research
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• v.5 no.1
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• pp.37-43
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• 2017

Laparoscopic cholecystectomy is of one the most common general surgical operations performed today. Concomitant choledocholithiasis occurs in roughly 10-20% of patients with symptomatic gallstones. Laparoscopic bile duct exploration (LBDE) offers a single-stage minimally-invasive solution to the management of choledocholithiasis. LBDE may be performed either via the transcystic route or via laparoscopic choledochotomy. A number of strategies to improve success are available to the surgeon to help in the problem of complicated choledocholithiasis, these range from simple maneuvers to the use of laser or mechanical lithotriptors. With the advances in laparoscopic surgery, it is also possible to handle complex surgical conditions such as Mirizzi syndrome or recurrent pyogenic cholangitis laparoscopically, even though these have yet to be accepted as standard of care. Following laparoscopic choledochotomy, options for closure include: primary closure, closure over a T-tube, and closure over an endobiliary stent. T-tube placement has been associated with increased operating time and hospital length of stay compared to primary closure, with no significant differences in morbidity. Based on the available literature, LBDE appears comparable to ERCP with regards to procedural efficacy and morbidity. LBDE remains relevant to the general surgeon and is best viewed as being complementary to endoscopic therapy in the management of choledocholithiasis.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.15 no.1
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• pp.57-61
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• 2012

Cholelithiasis and choledocholithiasis are uncommon pediatric diseases, although clinicians have seen them with increasing frequency in children in recent years. Moreover, no case of Epstein-Barr virus (EBV) infection with cholelithiasis and choledocholithiasis has been previously reported in the English literature. We report a pediatric patient with EBV infection, a gall bladder stone, and a common bile duct stone, may have had GB and CBD stones prior to her EBV infection, whom we successfully treated with antibiotics and laparoscopic cholecystectomy for cholecystitis.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.28 no.1
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• pp.42-47
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• 2024

Backgrounds/Aims: Hepatolithiasis and choledocholithiasis are frequent pathologies and unfortunately, with the current treatment strategies, the recurrence incidence is still high. This study aimed to assess the outcomes of laparoscopic choledochotomy using cholangioscopy via the percutaneous-choledochal tube for the treatment of hepatolithiasis and choledocholithiasis in Vietnamese patients. Methods: A cross-sectional study of patients with hepatolithiasis and/or choledocholithiasis who underwent laparoscopic choledochotomy using intraoperative cholangioscopy via percutaneous-choledochal tube at the Department of Hepatopancreatobiliary Surgery, 108 Military Central Hospital, from June 2017 to March 2020. Results: A total of 84 patients were analyzed. Most patients were females (56.0%) with a median age of 55.56 years. Among them, 41.8% of patients had previous abdominal operations, with 33.4% having choledochotomy. All patients underwent successful laparoscopic common bile duct exploration followed by T-tube drainage without needing to convert to open surgery. Most patients (64.3%) had both intrahepatic and extrahepatic stones. The rate of stones ≥ 10 mm in diameter was 64.3%. Biliary strictures were observed in 19.1% of patients during cholangioscopy. Complete removal of stones was achieved in 54.8% of patients. Intraoperative complications were encountered in two patients, but there was no need to change the strategy. The mean operating time was 121.85 ± 30.47 minutes. The early postoperative complication rate was 9.6%, and all patients were managed conservatively. The residual stones were removed through the T-tube tract by subsequent choledochoscopy in 34/38 patients, so the total success rate was 95.2%. Conclusions: Laparoscopic choledochotomy combined with cholangioscopy through the percutaneous-choledochal tube is a safe and effective strategy for hepatolithiasis and/or choledocholithiasis, even in patients with a previous choledochotomy.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.21 no.3
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• pp.203-208
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• 2018

Purpose: The aim of this study was to describe our treatment experiences with patients who had acute abdomen (AA) with common bile duct (CBD) dilatation. Methods: The treatment outcomes in children with AA and CBD dilatation were retrospectively reviewed. According to the shape of the intrahepatic bile ducts on ultrasonography (US), the origin of the pain was estimated as choledochal cyst (CC) complication or choledocholithiasis in normal CBD. Patients with complicated CC underwent surgery, and patients with choledocholithiasis in a normal appearing CBD underwent symptomatic treatment initially. Results: Of the 34 patients, 30 (88.2%) were female. The mean age of the patients was $6.4{\pm}4.9$ (range, 0.8-17) years. Seventeen (50.0%) patients had CBD stones and 17 (50.0%) did not. Surgical treatment was performed in 20 (58.8%) patients, 2 of whom underwent preoperative stone removal with endoscopic retrograde cholangiopancreatography and an operation. Conservative treatment was applied in 12 (35.3%) patients (8 with and 4 without stones), 1 of whom developed symptom relapse and underwent an operation. Among the 8 patients with CBD stones, 4 (4/17, 23.5%) had complete resolution of the stones and recovery of the CBD diameter after conservative treatment. US findings of patients with stone showed a fusiform or cylindrical shape of the CBD in 14 (82.4%) patients. Conclusion: The presence of stones in the distal CBD and the US features of CBD dilatation may be helpful to diagnose and treat the causes of biliary dilatation. Conservative treatment can be considered as initial therapy in patients with uncomplicated CBD dilatation with stone.

• The Korean Journal of Nuclear Medicine
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• v.21 no.1
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• pp.25-32
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• 1987

Authors analysed biochemical studies and scintigraphic findings of obstructive jaundice and nonobstructive jaundice in 44 cases of $^{99m}Tc-DISIDA$ scintigraphy with nonvisualization of biliary excretion till 120 min or 240 min after injection of $^{99m}Tc-DISIDA$. Causative diseases of $^{99m}Tc-DISIDA$ scintigraphy with nonvisualization of biliary excretion were in order to choledocholithiasis (25%), hepatitis (25%), cholangiocarcinoma (14%), cholangitis (14%) and pancreas head tumor (11%). In obstructive jaundice, statistically significant findings were elevated alkaline phosphatase above 300 IU/L on biochemical study and single lobe enlargement of the liver, irregular radioisotope uptake of the liver and concave indentation of the gall bladder fossa of the liver on scintigraphy. In nonobstructive jaundice, statistically significant findings were persistent renal excretion of $^{99m}Tc-DISIDA$ and more increased uptake density of the heart than the liver on scintigraphy.

• Journal of the Korean Society of Radiology
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• v.83 no.1
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• pp.224-229
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• 2022

Biliary cast syndrome is an unusual complication in patients who have previously undergone liver transplantation. It occurs in approximately 5%-18% of such patients. Rare cases of biliary cast syndrome in patients without liver transplants have also been reported. The pathogenesis of biliary cast has not been clearly identified, although etiologic factors including post-transplant bile duct damage, ischemia, biliary infection, and presence of a post-operative biliary drainage tube have been proposed. Here we present a case of biliary cast that developed in a 49-year-old male who underwent a non-liver surgery after endoscopic and percutaneous management of common bile duct stone.

• Clinical Endoscopy
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• v.56 no.1
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• pp.92-99
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• 2023

Background/Aims: There are few studies assessed the efficacy and mortality of endoscopic retrograde cholangiopancreatography (ERCP) for the removal of common bile duct (CBD) stones in the elderly aged ≥90 years. We aimed to assess the safety and efficacy of endoscopic removal of CBD stones in nonagenarians. Methods: We retrospectively reviewed ERCP reports for CBD stone removal. The endoscopic and therapeutic outcomes were collected. The length of stay (LOS), the total number of adverse events, and mortality rate were compared between groups. Results: A total of 125 nonagenarians were compared with 1,370 controls (65-89 years old individuals). The mean LOS for nonagenarians was significantly higher than in controls (13.6 days vs. 6.5 days). Completed intended treatment was similar in the nonagenarians and controls (89.8% and 89.5%, respectively). The overall complication rate did not differ between the groups. However, nonagenarians had a higher incidence of post-ERCP pneumonia (3.9%). None of the nonagenarians were readmitted to the hospital within 7 days. Four nonagenarians (3.2%) and 25 (1.8%) controls died within 30 days. Conclusions: Advanced age alone did not affect the decision to perform the procedure. However, prompt diagnosis and treatment of post-ERCP pneumonia in nonagenarians could improve the outcomes and reduce mortality.

• Clinical Endoscopy
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• v.56 no.6
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• pp.790-794
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• 2023

Background/Aims: Situs inversus viscerum (SIV) is a congenital condition defined by left-to-right transposition of all visceral organs. This anatomical variant has caused technical challenges in endoscopic retrograde cholangiopancreatography (ERCP). Data on ERCP in patients with SIV are limited to case reports of unknown clinical and technical success rates. This study aimed to evaluate the clinical and technical success rates of ERCP in patients with SIV. Methods: Data from patients with SIV who underwent ERCP were retrospectively reviewed. The data were collected by querying the nationwide Veterans Affairs Health System database for patients diagnosed with SIV who underwent ERCP. Patient demographics and procedural characteristics were collected. Results: Eight patients with SIV who underwent ERCP were included. Choledocholithiasis was the most common indication for ERCP (62.5%). The technical success rate was 63%. Subsequent ERCP with interventional radiology-assisted rendezvous has increased the technical success rate to 100%. Clinical success was achieved in 63% of cases. Among cases of subsequent rendezvous ERCP after conventional ERCP failure, clinical success was achieved in 100%. Conclusions: The clinical and technical success rates of ERCP in patients with SIV were both 63%. In patients with SIV in whom ERCP fails, interventional radiology-assisted rendezvous ERCP can be considered.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.23 no.5
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• pp.430-438
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• 2020

Purpose: We investigated the clinical features and factors affecting the choice of treatment modality and the course of pediatric gallstone (GS) disease. Methods: We retrospectively analyzed the medical records of 65 patients diagnosed with GS using imaging studies between January 2009 and December 2017 were included. Results: This study included 65 patients (33 boys and 32 girls; mean age, 8.5±5.3 years; range, 0.2-18 years) who primarily presented with abdominal pain (34%), jaundice (18%), and vomiting (8%). Idiopathic GS occurred in 36 patients (55.4%). The risk factors for GS included antibiotic use, obesity, hemolytic disease, and chemotherapy in 8 (12.3%), 7 (10.8%), 6 (9.2%), and 4 patients (6.2%), respectively. We observed multiple stones (including sandy stones) in 31 patients (47.7%), a single stone in 17 (26.2%), and several stones in 17 (26.2%). GS with a diameter of <5 mm occurred in 45 patients (69.2%). Comorbidities included hepatitis, choledocholithiasis, cholecystitis, and acute pancreatitis in 20 (30.8%), 11 (16.9%), 11 (16.9%), and 4 patients (6.2%), respectively. Ursodeoxycholic acid (UDCA) was administered to 54 patients (83.1%), leading to stone dissolution in 22 patients (33.8%) within 6 months. Cholecystectomy was performed in 18 patients (27.7%) (mean age, 11.9±5.1 years). Most patients treated surgically had multiple stones (83%) and stones measuring <5 mm in size (89%), and 66.7% of patients had cholesterol stones. Conclusion: Cholecystectomy is feasible in patients with small-sized or large numbers of GS and those with persistent abdominal pain and/or jaundice. UDCA administration with close follow-up is recommended in patients with uncomplicated GS.

• The Journal of the Korean life insurance medical association
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• v.4 no.1
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• pp.77-85
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• 1987

We'd performed the upper gastrointestinal study for a total of 1,033 insureds-male 630, female 403 persons-who were examined at medical dept. of Dae Han Kyoyuk Insurance Co., Ltd., from August, 1986 to January, 1987. The results on diverticulum were as follows; 1. The incidence rate of duodenal diverticulum is exceptionally higher than esophageal diverticulum. 2. In all of 53 insured who have duodenal diverticulum and esophageal diverticulum, there was little difference between male and female in the incidence rate of diverticulum; 5.08% in male, 5.21% in female. 3. The possessing rate of both diverticulums increased by age regardless of sex. ; 0.71% in 20yrs, 2.12% in 30yrs, 11.11% in 40yrs, 12.75% in 50yrs, 30.43% in 60yrs more. 4. The possessing rate of both diverticulums in male is 0% in 20yrs, 1.97% in 30yrs, 7.21% in 40yrs, 15.09% in 50yrs, 27.27% in 60yrs more and in female, 1.16% in 20yrs, 2.40% in 30yrs, 7.87% in 40yrs, 10.20% in 50yrs, 33.33% in 60yrs more. 5. Those who have duodenal diverticulum 47 insureds felt the following subjective symptoms; uncomfortable 8.51%, heartburn and tingling each 4.26%, sore throat 2.13%and esophageal diverticulum's heartburn 16.67%. 6. There occurred the following complications in 47 insureds with duodenal diverticulum-gastric polyp, erosive gastritis, antral gastritis, cascade stomach, fatty liver, polyp in GB and choledocholithiasis; each 2.13% and cholelithiasis 6.38% and cascade stomach. 7. All duodenal diverticulum occurred in duodenal inlet. 8. The number of lesion was single in all esophageal diverticulum, but there was each one case with 2 lesions and 3 lesions in duodenal diverticulum.