Prospective evaluation of magnetic resonance cholangiography in patients with suspected common bile duct stones before laparoscopic cholecystectomy

OBJECTIVE: To evaluate the predictive value of magnetic resonance cholangiography (MRC) in selected patients before laparoscopic cholecystectomy (LC). METHODS: Patients with risk factors for common bile duct (CBD) stones scheduled for elective LC from March 1999 to May 2001, underwent MRC followed by endoscopic retrograde cholangiography (ERC) to detect the stones and the accuracy of MRC. Selection of suspected patients was based on clinical, ultrasonographic, and laboratory criteria. RESULTS: During a 26-month period, a total of 267 patients were studied. Seventy-eight MRC identified patients were found to have CBD stones by ERC or laparoscopic cholangiography in the study. Seven of 78 patients were misdiagnosed as having CBD stones by MRC. In this study, MRC had a sensitivity of 100%, a specificity of 96.3%, a positive predictive value of 91.8%, and a negative predictive value of 100% for the detection of common bile duct stones. CONCLUSIONS: With the use of LC, ERC is frequently performed before LC to detect CBD stones; but it is invasive with a well-documented complication rate. MRC is a simple non-invasive method for preoperative screening for CBD stones in at-risk patients. In this study if ERC had been limited to patients with a positive MRC, it would have reduced the need for ERC by 68.2%, and the complications of preoperative examination would be minimized significantly.

Management of aberrant bile duct during laparoscopic cholecystectomy

Objective: To investigate the incidence of aberrant bile duct and its management during laparoscopic cholecystectomy (LC). Methods: In 10 000 patients undergoing laparoscopic cholecystectomy from 1992 to July 2001, 3 had the involvement of the right accessory hepatic duct. In patient 1, the aberrant duct drained into the cystic duct was confirmed by open operation. In patient 2, the aberrant duct, which drained to the common bile duct (CBD), was injured and treated with suture and ligature under laparoscopy. In patient 3, the ab- errant duct, which also drained to the CBD, was confirmed and preserved. Results: All patients recovered well except patient 1 who had a transient elevation of ALT. No bile leak- age or other complication occurred. Conclusions: Only variation near the confluence and the entrance of the cystic duct into the bile duct is discovered during laparoscopic cholecystectomy. Right accessory hepatic duct is common and should be preserved during the operation. The accidentally injured small accessory hepatic duct can be treated with ligature without severe disturbance to liver func- tion.

Laparoscopic adjustable gastric banding:a report of 228 cases

Objective:To evaluate the surgical outcomes and complications after laparoscopic adjustable gastric banding(LAGB)in obese patients.Methods:This retrospective study included 228 patients(73 males and 155 females,mean age,32.5±10.3 years)who underwent LAGB at the Changhai Hospital of the Second Military Medical University from June 2003 to June 2011.The body weight and postoperative complications were followed up.Results:The pre-operative mean body mass index(BMI)was 39.5±6.3 kg/m^(2).Except in one case of inadequate exposure of the stomach,all laparoscopic procedures were successfully accomplished,with no conversion to open surgery.The mean operation time was 65.0±20.3 min.The mean hospital stay was 2.7±0.9 days.Early postoperative complications(<30 days)occurred in five cases(2.2%)and late complications(>30 days)occurred in 75 cases(32.9%),including 56 cases(24.6%)with band-associated complications.The percentage of excess weight loss(EWL%)at 1,3 and 5 years was 40.5±30.5%,59.5±41.5%and 58.9±46.4%,respectively.The percentages of patients with EWL%>25%,>50%and>75%were,respectively,60%,33%and 0%at 1 year follow-up,43%,39%,and 16%at 3 years follow-up and 40%,34%and 16%at 5 years follow-up.Conclusion Although LAGB has low peri-operative mortality and morbidity rates,it is associated with a high late complication rate and unsatisfactory weight loss.It may be optional,but not the first choice,for the treatment of obesity.