- Email: [email protected]
Double-valved hepatic protojejunostomy for biliary atresia
INTERNATIONAL ABSTRACTS
To evaluate the morphology of SMC in patients with anorectal malformations, an MRI score was designed. The factors scored were the thickness of SMC, the location of the pulled-through intestine in relation to the SMC, and the presence of perirectal fat and SMC interruption. High MRI score in low types and low score in high types were obtained. The fact that half of the patients showed a higher MRI score than a clinical one may show the discrepancy between the morphology and the function of SMC. --Takeshi Miyano ABDOMEN
505
anastomosis were performed in 6 cases. Liver biopsies showed normal histology in 30 cases, cirrhosis in 12, and congenital fibrosis in 3. There were a few early complications and one death on the eighth day after surgery. Three patients were reoperated for bile outflow obstruction. The long-term follow-up showed 35 patients without any complications, and 37 patients complaining of abdominal pain, cholangitis, and/or pancreatitis. In authors' opinion, the prognosis in children after surgery for choledochal cyst depends on the condition of the liver at the time of operation, the occurrence of cholangitis after operation, and the possible future development of cancer. --Jerzy I£. Niedzielski
Laparoscopic Cholecystectomy in Austria. W. Wayand, R. Woisetschliiger, and T. Gitter. Chirurg 64:303-306, 1993. The number of surgical units performing laparoscopic cholecystectomies in Austria increased from 24 hospitals (20%) in 1990 to 85 hospitals (70%) in 1991. During this interval of time a total of 7,351 laparoscopic cholecystectomies were performed. In 97% the outcome was uneventful. The conversion rate was 2.1%. In 0.85% a secondary laparotomy was necessary. Common bile duct lesions occurred in 0.5%. Mortality was 0.1% (n = 4). Because of the cooperation of all surgeons, Austria is the only country in Europe to present actual numbers concerning laparoscopic cholecystectomies. This article can be considered as providing basic information for laparoscopic cholecystectomy in children. -~GunterH. Willital
Intraoperative Sonography--an Alternative to Cholangiography in Laparoscopic Cholecystectomy. M. ROthlin, R. Schlumpf,
Double-Valved Hepatic Portojejunostomy for BUiary Atresia. R. Ohi, S. Yoshida, M. Nio, et al. J Jpn Soc Pediatr Surg 30:23-28, 1994. In an attempt to prevent cholangitis in the surgical treatment of biliary atresia, we used double-valved (spur-valve and intussuscepted valve) hepatic portojejunostomy in 20 patients with biliary atresia in the last 2 years. Postoperative bile flow was active in 15 cases and fair in 4. Among these 19 cases, 6 cases (32%) developed cholangitis during their postoperative courses. No patients died of cholangitis. Although these results are not fully satisfactory, doublevalved hepatic portojejunostomy, for the time being, is thought to be the choice procedure for the prevention of cholangitis in the treatment of biliary atresia. --Takeshi Miyano
H.P. Klotz, et al. Chirurg 64:387-391, 1993. The aim of this prospective study was the comparison of laparoscopic sonography with intraoperative cholangiography (IOC) during laparoscopic cholecystectomies. A 360 ° sector scanner with a frequency of 5.5 MHz was used. The examination was successful in all 69 patients. In the beginning, 19 patients were examined sonographically without subsequent IOC. None of these patients had bile duct stones, and their postoperative courses were uneventful. In another 50 patients operated upon subsequently, both laparoscopic sonography and IOC were used. IOC was not performed because of technical failure in 4 patients and because of allergic reactions in one patient. Thirty-one patients showed normal bile ducts without stones in both examinations. Ten patients had dilated ducts without stones. In 3 cases, a stone was seen on IOC and during intraoperative sonography. In 1 case, a duodenal diverticulum shown by IOC was the reason for a false-positive sonographic finding. Sensitivity and specificity of laparoscopic sonography with regard to the visualisation of bile duct stones were 100%. The time necessary for the examination was significantly shorter for laparoscopic sonography than for intraoperative cholangiography (P = .0001). If these results can be reproduced in a larger population of patients, laparoscopic sonography can be considered as a safe, fast, and noninvasive alternative to intraoperative cholangiography. --Gunter H. Willital
Choledochal Cyst--12 Years" Experience With 69 Cases. A. Kaminski, A. Cedro, M. Szymczak, et aI. Surg Child Int 2:73-79, (April), 1994. Since 1981, 69 children, ages 2 months to 17 years, had operations for choledochal cyst. In the majority of patients (89%), the first symptoms occurred before the sixth year of life, the most common being abdominal pain, jaundice, nausea, vomiting, and fever. Cystic dilatation of the common bile duct was the most common type of choledochal cyst, with the diameter of cyst ranging from 1 to 20 cm. The routine procedure was total excision of the cyst with Roux-en-Y anastomosis to the common hepatic duct. Choledochocystoduodenostomy or choledochocysto Roux-en-Y
Intrahepatic Biliary Cysts and Cystic Dilatation in Biliary Atresia After Successful Portoenterostomy, M. Komura, Tsuchida, T. Honna, et aL Jpn J Pediatr Surg 26:215-219, 1994. The association of intrahepatic cysts Or bile lakes with biliary atresia has been described on autopsy for a long time. In recent years it has become a subject of medical or surgical treatment. In order to investigate the clinical characteristics of these cysts, a review was conducted, and 24 thoroughly described cases found in the English and Japanese literature. The clinical symptoms described included fever in 14 of the 24 cases, jaundice in 9, acholic stool in 1, negative or decreased bile flow in 3, and cholangitis in 6. The authors believe that all patients with symptoms of cholangitis after portoenterostomy for biliary atresia should have periodic computed tomography and/or ultrasound examination of the liver. Percutaneous transhepatic cholangiographic drainage (PTCD) should be tried first. If it fails, internal drainage would be the treatment of choice. --Takeshi Miyano
Splenic Abscess in Children With Sickle Cell Disease. A.H. A1-Salem, K.K. Mallaga, S. Quisaruddin, et al. Pediatr Surg Int 9:489-491, (August), 1994. The authors report four patients with sickle cell disease who developed splenic abscesses. Three of these patients showed thrombocytosis and Howell-Jolly bodies, and one patient showed no uptake on sulfar colloid technetium scan. Both ultrasound (US) and computed tomography (CT) scans showed splenomegaly with multiple areas of cystic changes with fluid collection suggestive of a splenic abscess. In two patients in whom it was difficult to differentiate between a splenic abscess and a large splenic infarction, needle aspiration under US guidance was confirmatory of abscess. All four patients underwent splenectomy after receiving prophylactic pneumococcal vaccine and antibiotics. The bacteriology of the abscesses revealed Salmonella in two and Enterobacter in one. --R. Surana
To evaluate the morphology of SMC in patients with anorectal malformations, an MRI score was designed. The factors scored were the thickness of SMC, the location of the pulled-through intestine in relation to the SMC, and the presence of perirectal fat and SMC interruption. High MRI score in low types and low score in high types were obtained. The fact that half of the patients showed a higher MRI score than a clinical one may show the discrepancy between the morphology and the function of SMC. --Takeshi Miyano ABDOMEN
505
anastomosis were performed in 6 cases. Liver biopsies showed normal histology in 30 cases, cirrhosis in 12, and congenital fibrosis in 3. There were a few early complications and one death on the eighth day after surgery. Three patients were reoperated for bile outflow obstruction. The long-term follow-up showed 35 patients without any complications, and 37 patients complaining of abdominal pain, cholangitis, and/or pancreatitis. In authors' opinion, the prognosis in children after surgery for choledochal cyst depends on the condition of the liver at the time of operation, the occurrence of cholangitis after operation, and the possible future development of cancer. --Jerzy I£. Niedzielski
Laparoscopic Cholecystectomy in Austria. W. Wayand, R. Woisetschliiger, and T. Gitter. Chirurg 64:303-306, 1993. The number of surgical units performing laparoscopic cholecystectomies in Austria increased from 24 hospitals (20%) in 1990 to 85 hospitals (70%) in 1991. During this interval of time a total of 7,351 laparoscopic cholecystectomies were performed. In 97% the outcome was uneventful. The conversion rate was 2.1%. In 0.85% a secondary laparotomy was necessary. Common bile duct lesions occurred in 0.5%. Mortality was 0.1% (n = 4). Because of the cooperation of all surgeons, Austria is the only country in Europe to present actual numbers concerning laparoscopic cholecystectomies. This article can be considered as providing basic information for laparoscopic cholecystectomy in children. -~GunterH. Willital
Intraoperative Sonography--an Alternative to Cholangiography in Laparoscopic Cholecystectomy. M. ROthlin, R. Schlumpf,
Double-Valved Hepatic Portojejunostomy for BUiary Atresia. R. Ohi, S. Yoshida, M. Nio, et al. J Jpn Soc Pediatr Surg 30:23-28, 1994. In an attempt to prevent cholangitis in the surgical treatment of biliary atresia, we used double-valved (spur-valve and intussuscepted valve) hepatic portojejunostomy in 20 patients with biliary atresia in the last 2 years. Postoperative bile flow was active in 15 cases and fair in 4. Among these 19 cases, 6 cases (32%) developed cholangitis during their postoperative courses. No patients died of cholangitis. Although these results are not fully satisfactory, doublevalved hepatic portojejunostomy, for the time being, is thought to be the choice procedure for the prevention of cholangitis in the treatment of biliary atresia. --Takeshi Miyano
H.P. Klotz, et al. Chirurg 64:387-391, 1993. The aim of this prospective study was the comparison of laparoscopic sonography with intraoperative cholangiography (IOC) during laparoscopic cholecystectomies. A 360 ° sector scanner with a frequency of 5.5 MHz was used. The examination was successful in all 69 patients. In the beginning, 19 patients were examined sonographically without subsequent IOC. None of these patients had bile duct stones, and their postoperative courses were uneventful. In another 50 patients operated upon subsequently, both laparoscopic sonography and IOC were used. IOC was not performed because of technical failure in 4 patients and because of allergic reactions in one patient. Thirty-one patients showed normal bile ducts without stones in both examinations. Ten patients had dilated ducts without stones. In 3 cases, a stone was seen on IOC and during intraoperative sonography. In 1 case, a duodenal diverticulum shown by IOC was the reason for a false-positive sonographic finding. Sensitivity and specificity of laparoscopic sonography with regard to the visualisation of bile duct stones were 100%. The time necessary for the examination was significantly shorter for laparoscopic sonography than for intraoperative cholangiography (P = .0001). If these results can be reproduced in a larger population of patients, laparoscopic sonography can be considered as a safe, fast, and noninvasive alternative to intraoperative cholangiography. --Gunter H. Willital
Choledochal Cyst--12 Years" Experience With 69 Cases. A. Kaminski, A. Cedro, M. Szymczak, et aI. Surg Child Int 2:73-79, (April), 1994. Since 1981, 69 children, ages 2 months to 17 years, had operations for choledochal cyst. In the majority of patients (89%), the first symptoms occurred before the sixth year of life, the most common being abdominal pain, jaundice, nausea, vomiting, and fever. Cystic dilatation of the common bile duct was the most common type of choledochal cyst, with the diameter of cyst ranging from 1 to 20 cm. The routine procedure was total excision of the cyst with Roux-en-Y anastomosis to the common hepatic duct. Choledochocystoduodenostomy or choledochocysto Roux-en-Y
Intrahepatic Biliary Cysts and Cystic Dilatation in Biliary Atresia After Successful Portoenterostomy, M. Komura, Tsuchida, T. Honna, et aL Jpn J Pediatr Surg 26:215-219, 1994. The association of intrahepatic cysts Or bile lakes with biliary atresia has been described on autopsy for a long time. In recent years it has become a subject of medical or surgical treatment. In order to investigate the clinical characteristics of these cysts, a review was conducted, and 24 thoroughly described cases found in the English and Japanese literature. The clinical symptoms described included fever in 14 of the 24 cases, jaundice in 9, acholic stool in 1, negative or decreased bile flow in 3, and cholangitis in 6. The authors believe that all patients with symptoms of cholangitis after portoenterostomy for biliary atresia should have periodic computed tomography and/or ultrasound examination of the liver. Percutaneous transhepatic cholangiographic drainage (PTCD) should be tried first. If it fails, internal drainage would be the treatment of choice. --Takeshi Miyano
Splenic Abscess in Children With Sickle Cell Disease. A.H. A1-Salem, K.K. Mallaga, S. Quisaruddin, et al. Pediatr Surg Int 9:489-491, (August), 1994. The authors report four patients with sickle cell disease who developed splenic abscesses. Three of these patients showed thrombocytosis and Howell-Jolly bodies, and one patient showed no uptake on sulfar colloid technetium scan. Both ultrasound (US) and computed tomography (CT) scans showed splenomegaly with multiple areas of cystic changes with fluid collection suggestive of a splenic abscess. In two patients in whom it was difficult to differentiate between a splenic abscess and a large splenic infarction, needle aspiration under US guidance was confirmatory of abscess. All four patients underwent splenectomy after receiving prophylactic pneumococcal vaccine and antibiotics. The bacteriology of the abscesses revealed Salmonella in two and Enterobacter in one. --R. Surana