Benign disease of the common bile duct

Abstract

The incidence of common bile duct (CBD) pathology in a group of patients with benign biliary disease (n = 505) was found to be 23.2 per cent. The spectrum included 111 patients (90.2 per cent) with CBD stones, 37 of whom (33.3 per cent) had no symptoms or findings pre-operatively indicating CBD involvement. Five patients had papillary stenosis, three had postoperative CBD strictures, one had a choledochal cyst and one had an external biliary fistula. Of the 100 CBDs measuring more than 10 mm in diameter, 90 harboured calculi. In the remaining 23 CBDs measuring less than 10 mm, calculi were present in 21. The presence of CBD calculi was demonstrated by intra-operative cholangiography in 49 patients. In the remaining patients (n = 74), the diagnosis of CBD pathology was made either by percutaneous transhepatic cholangiography, endoscopic retrograde cholangio-pancreatography, T-tube cholangiography or peroperative palpation. The surgical procedures performed included choledochotomy and T-tube drainage (n = 74), transduodenal sphincteroplasty (n = 27) and choledochoduodenostomy (n = 18). The overall mortality and morbidity of CBD exploration was 3.3 per cent and 24.4 per cent respectively, which was significantly greater than that for cholecystectomy alone (0.3 per cent and 8.6 per cent respectively). Transduodenal sphincteroplasty carried a much higher mortality (11 per cent) and morbidity (52 per cent) when compared with other procedures.

Open Biliary Tract Surgery: Multivariate Analysis of Factors Affecting Mortality

“…In our experience, a high blood pressure had no independent impact on operative mortality; this conclusion differs from the one reported by Roslyn et al [2]. Heart disease, however, was significantly more frequent among patients who died (p < 0.05), such as other authors found [1, 4, 9, 17]. The risk of death was 4.5 times higher for patients with heart disease (odds ratio 4.5); it was also confirmed as an independent risk factor affecting operative mortality (p = 0.03) which is consistent with other reports [1, 12].…”

“…The mean age of our patients was 70 ± (SD) 13 years which is consistent with other reports [16]. The mean age (79.3 years) of the 12 patients who died was significantly higher than in survivors (p < 0.001), such as other authors have reported [1, 4, 5, 8, 17, 18]. However, because older patients sustain more associated disorders, and because their biliary disease is usually long-standing and more severe [1, 6], we believe it is important to determine the influence of age adjusted to other variables.…”

“…The overall mortality rate for simple cholecystectomy is currently 0.17% [2]. However, common bile duct (CBD) exploration, performed in about 15% of the patients operated on for biliary disease [3], is associated with a 6% increase in the mortality rate [4]. After the development of minimally invasive surgery, open CBD exploration is less frequently indicated.…”

Bile Duct Cysts: Modern Aspects of Surgical Treatment and Clinical Observation of a Rare Case

“…В последние годы, в т. ч. по причине разработки нового диагностического обо-рудования, интерес к этой форме патологии возрос. Учитывая невысокую частоту встречаемости (1:100 000-1:150 000 новорожденных) [1,2], а также возможную малигнизацию в будущем [1,2], определение согласо-ванного подхода к диагностике и лечению различных типов кист холедоха крайне важно.…”

“…Встречаются чаще у детей и женщин. В детском возрасте выявляются 80% всех кист желчных протоков [1]. Забо-левание наиболее распространено в Восточной Азии.…”