Treatment Of Biliary Tract Disease Research Articles

Nonoperative treatment of biliary tract disease.

The rise of minimally invasive surgical techniques during the past 20 years has been one of the more dramatic developments in modern medicine. Minimally invasive procedures are now widely accepted for treatment of diseases involving many different organ systems. Minimally invasive procedures may be more common and more accepted in the treatment of diseases of the biliary tract than in any other area. The development of laparoscopic cholecystectomy serves as a benchmark for minimally invasive procedures, and it is now the standard of care for the treatment of cholelithiasis. Today, not only is laparoscopic cholecystectomy one of the most common operations performed in the United States, but many new techniques have been developed that allow minimally invasive treatment of a variety of biliary tract diseases. The development of nonoperative techniques for treatment of biliary tract disease has accompanied the rapid developments in minimally invasive surgical techniques. This article describes the nonoperative treatment of biliary tract disease.

Treatment of Recurrent Spontaneous Pneumothorax

Thoracoscopy is a natural extension of laparoscopic techniques that have proved to be useful in the treatment of biliary tract disease and other general surgery problems. Similar to the experience with laparoscopic surgery, thoracoscopy also provides for early recovery and return of normal activity. The treatment of spontaneous pneumothorax under thoracoscopic guidance represents a major advance in thoracic surgery. Recently developed endoscopic stapler devices allow for both the excision and closure of ruptured blebs in a fashion identical to the traditional approach with open thoracotomy. Presented in this report are 17 consecutive cases of pneumothorax that were treated using a thoracoscopic approach. No postoperative complications were encountered and no recurrences have been identified. The surgical methods and techniques are outlined.

Case report: Subcutaneous herniation of gall-bladder with spontaneous cholecystocutaneous fistula

Spontaneous cholecystocutaneous fistula is now a clinical rarity due to improvements in the treatment of biliary tract diseases. This case report describes a 67-year-old woman in whom subcutaneous herniation of a pathologically dilated gall-bladder was followed by spontaneous discharge of pus and mucus with formation of a cholecystocutaneous fistula. The use of serial computed tomography examinations enabled this unusual diagnosis to be made.

Surgical treatment of biliary tract diseases with juxta-papillary duodenal diverticula

Surgical treatment of biliary tract diseases with juxta-papillary duodenal diverticula

Advances in Diagnosis and Surgical Treatment of Biliary Tract Disease

Medical texts seem to come in one of two sizes: very thin or grossly obese. Neither cost nor value correlates with the total body weight. This slim volume is both good and expensive. It must be considered demeaning for a publisher to charge less than $40 for a medical textbook despite the remarkable savings in printing costs that result from electronic typesetting and the word processor. As in so many recent medical texts, this is a collection of reports that were presented at a symposium; this symposium was held during the Digestive Disease Week at the 1982 meeting of the Society of Surgery of the Alimentary Tract. The book includes the following unique features. An all-star cast of authors who know how to write and operate. Extraordinarily tight editing—there must have been a lot of high-level confused feelings after the submitted manuscripts had been debrided by the editors. It

Sphincteroplasty in the treatment of biliary tract disease. A prospective study of 46 cases.

Forty-six patients in whom sphincteroplasty was performed by an original technique are presented. In 43 cases the indication was oddian stenosis (associated or not with cholelithiasis or hepatic hydatid disease). Only in three patients a "security" operation was performed. Sphincteroplasty was achieved with the aid of an original probe, and average length of the incision of the ampullary area was 27 mm. The postoperative control, made by tube cholangiography and barium investigation, has evidenced the presence of a wide, open choledochoduodenal aperture. Amylase activity was also followed up in 25 patients. One case of acute pancreatitis, two upper digestive haemorrhages and one case of duodenal fistula were recorded as postoperative complications. Healing was obtained in all patients.

Endoscopic papillotomy in the treatment of biliary tract disease: 258 procedures and results.

Endoscopic papillotomy has been successfully performed in 258 of 267 patients (96.6%) presenting with common duct stones, papillary stenosis, or ampullary adenocarcinoma. A low morbidity was experienced (5%) while mortality was 0.77% (2 deaths). Surgical intervention was necessary in 2 patients. The mean age of the group is 66.4 years (range 26-95 years), while the mean hospital stay remains low at 3 days (range 1-12) days. The procedure has proven to be safe and effective, creating a permanent biliary enteric fistula comparable to standard surgical procedures, but does not require a laparotomy/duodenotomy. Eliminating the latter reduces morbidity, immobility, and convalescence. Papillotomy is not a procedure to be performed by inexperienced endoscopists as it is the only endoscopic procedure with predictable morbidity and mortality. In order to maintain the progress achieved to date, papillotomy should be performed by those with extensive endoscopic experience in the diagnostic area before embarking onto the therapeutic procedure.

Endoscopic Diagnosis and Treatment of Biliary Tract Disease

Endoscopic sphincterotomy has proved to be an effective, safe, and cost-efficient method for removal of common duct stones and relieving benign and malignant obstructions of the papilla of Vater. The success rate has been high (90.1 per cent), the morbidity low (8.6 per cent), and the mortality zero.

Percutaneous choledochoscopy and cholecystoscopy: diagnostic and therapeutic uses.

Accessibility to the common bile duct and gallbladder through sinus tracts formed after placement of a T-tube or cholecystostomy tube at surgery has until recently been restricted to special catheters and accessories for the extraction of stones. The procedure requires continuous fluoroscopy while contrast media is injected in order to identify defects and to place accessories. More recently this techniques has been accomplished with endoscopes which are advanced into the bile duct through these tracts. The results are comparable to the catheter technique but exposure to x-ray is reduced. The procedure has been performed with a bronchoscope (BF-4B2-Olympus Corporation of America), modified with an irrigation-suction valve, permitting direct examination, biopsy and entrapment of stones. With the bronchoscope in the bile duct, physiologic function and pathologic conditions can be assessed by advancing catheters through the ampulla into the duodenum, 1) the former to facilitate manometric recordings and, 2) the latter to calibrate the opening of the papilla. A catheter passed antegrade through the bronchoscope into the duodenum can be used as a guide for the simultaneous performance of sphincterotomy while the duodenoscope is in position. These new applications have placed choledochoscopy and cholecystoscopy in the armamentarium for the evaluation and treatment of biliary tract disease.

Sphincteroplasty (Not Sphincterotomy) in the Treatment of Biliary Tract Disease

Because of the similarity of the names sphincteroplasty and sphincterotomy, these terms have been used indiscriminately and interchangeably in the literature, making accurate evaluations impossible. The author discusses the anatomic considerations involved and defines and discusses these two procedures, along with others used to treat calculous disease of the bile ducts.

Medical aspects of diseases of the gallbladder and biliary tree

Cholelithiasis and its complications dominate disease of the biliary tract. An estimated 15 million people in the United States have gallstones [1]. One-fiftieth of these or 300,000 people undergo biliary tract operations each year. The magnitude of the problem has presented a challenge to clinical and basic scientists. Such studies have opened the clear possibility that gallstones and their sequelae may be prevented in the future. Efforts to prevent or even dissolve gallstones are on the horizon. Much can be done to reduce the morbidity and mortality of illness resulting from gallstones. The accumulation of large epidemiologic, roentgenologic, clinical and autopsy experiences have allowed constant reorientation by the physician in his attitude toward the diagnosis and treatment of biliary tract disease.

Gallstone Pancreatitis

In four cases of pancreatitis the etiology could not be determined by any of the accepted diagnostic measures. Only at exploration could associated biliary tract disease be demonstrated. Aspiration of bile during operation for detecting tiny stones was important. Common entrance of pancreatic and bile ducts was demonstrated in all four cases. Prompt treatment of biliary tract disease prevented the recurrence of attacks during follow-up of 18 to 30 months.

Surgical Treatment of Biliary Tract Disease

Surgical Treatment of Biliary Tract Disease

Surgical Treatment of Biliary Tract Disease

FRANK GLENN (M.D., University of Washington) is professor of surgery at Cornell University Medical College, New York City. He is former chairman of the American Board of Surgery.

Surgical Treatment of Biliary Tract Disease

FRANK GLENN (M.D., University of Washington) is professor of surgery at Cornell University Medical College, New York City. He is former chairman of the American Board of Surgery.

Current problems in the surgical treatment of the biliary tract

In a consideration of the current problems in the surgical treatment of biliary tract disease it has been emphasized that greater attention should be directed to diagnosis. The demonstration of gallstones or the failure of the gallbladder to be visualized by cholecystography does not exclude other conditions that may be the cause of the patient's symptoms. Common duct stones are one of the causes of the persistence or recurrence of symptoms following cholecystectomy. Intravenous cholangiography in those patients with a history indicative of or compatible with choledocholithiasis is suggested as an aid in securing evidence for exploration of the common duct in conjunction with cholecystectomy. Long-standing biliary tract disease is associated with many complications rarely or never seen in youth. Some of these, if unrecognized and as a result not treated, often end fatally. Biliary enteric fistula formation with gallstone ileus is an example. Its diagnosis and management is discussed as a condition that may be seen with increasing frequency as the old age fraction of our population increases. For the geriatric group data are presented that focus attention upon the need for precision management of patients undergoing surgical treatment for biliary tract disease. A realization of the hazards inherent in those individuals sixty-five years of age and over because of deficient function in one or more of the principal organs or systems should result in the preoperative preparation and exercising of caution in embarking upon therapeutic surgical procedures. Injury to the common duct in the course of the performance of cholecystectomy may be followed by consequences far more detrimental to the patient than the ordinary course of gallbladder disease. The technical steps believed to be most important in avoiding such inadvertent injury are presented in the description of retrograde cholecystectomy. Because biliary tract disease occurs in individuals of all ages and varies so much in its course, often giving rise to serious complications, it is looked upon by many as a complicated and somewhat confusing clinical condition. In an attempt to facilitate the recognition of the disease in any of its various stages, phases and associated developments, a simple classification for descriptive purposes is presented. This is based upon the morphology and course of disease rather than upon the grouping of patients according to age, sex or physical habitus.

Antibiotics in diseases of the biliary tract.

As new antibiotic or chemotherapeutic agents have been introduced into the therapeutic armamentarium, many of them have been used in the treatment of biliary tract disease. Improvement observed following the use of these drugs has often been attributed to them. This has been due to the fact that each of these drugs, in the course of pharmacological observations, has been shown to be excreted into the normal biliary tract of lower animals or humans. Until I began to study the excretion and concentration of antibiotic and chemotherapeutic agents in the abnormal human biliary tract, no one had approached the problem from that aspect. Since that time I have studied the excretion and concentration of the sulfonamides, penicillin, streptomycin, aureomycin, and, more recently, oxytetracycline (Terramycin). As a result of these investigations it became apparent that the excretion and concentration in the abnormal biliary tract was entirely different from that in the

Treatment of Biliary-Tract Disease

Treatment of Biliary-Tract Disease

The surgical treatment of biliary tract disease

The surgical treatment of biliary tract disease

The surgical treatment of biliary tract disease

Pathologically acute cholecystitis is frequently a progressive lesion proceeding to gangrene and perforation.