and intraoperative cholangiogram under fluoroscopy (IOC) is performed to delineate the anatomy. Choledochotomy is performed and using combination technique with forceps, biliary fogarty successfully retrieved the sludge/stones followed by irrigation of the ducts. Completion IOC shows no remaining stones and filling of the duodenum with contrast. The choledochotomy is closed primarily. Conclusion: Minimally invasive common bile duct exploration is a rescue operation after failed ERCP. It is safe and feasible. The Da Vinci system provides a stable platform with 3-D visualization and improved ergonomics, which facilitate dissection of the common bile duct despite distorted anatomy and primary closure of the choledochotomy.
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archetypal pro-inflammatory Th1 cytokine, yet IFNg has not been shown to be elevated in AP studies and the role of TNFa remains controversial. We hypothesized that the fundamental inflammatory response observed during the initial stages of acute pancreatitis is not a Th1 but rather a Th17 response. Methods: Seven patients with mild acute pancreatitis according to the modified Atlanta grading system presenting within three days of symptom onset were recruited. Peripheral blood was drawn for five consecutive days and plasma Th1/Th2/Th17 cytokine levels compared to eleven healthy controls with no history of acute or chronic pancreatitis.Plasma cytokine measurements were performed using Th1/Th2/Th17 Cytokine Bead Array assay and data quantified using FCAPArray software. Results: IFNg and TNFa levels were low at all time-points in both groups; IL-6 levels were significantly elevated in AP patients compared to controls; IL-10 levels were significantly elevated by day 3; IL17A levels increased on day 2 and significantly elevated at day 3 compared to controls declining to non-significant levels by day 4. Conclusion: Neither IFNg nor TNFa Th1 cytokines were elevated, however IL-17A and IL-10 (an anti-inflammatory cytokine implicated in suppressing Th17 cytokines secreted by macrophages and T cells) were elevated by day 3. Additionally IL-6, which helps drive development of Th17 cells, was significantly elevated at all time-points. These preliminary results imply that the underlying AP induced systemic inflammation is polarized to a Th17 rather than a Th1 response. Introduction: Application of minimally invasive techniques in acute necrotizing pancreatitis (ANP) treatment is very important in modern pancreatology. Open surgery for infected pancreatic necrosis is associated with considerable morbidity and mortality. Methods: We have analyzed the results of treatment of 392 patients with ANP, treated in our clinic during the period of 2006e2014 years. There were 98 (25,0%) female patients and 294 (75,0%) male patients, with age ranging from 18 to 79 years. Infected necrosis with septic complications was diagnosed in 173 (44,1%) patients. Percutaneous necrosectomy (video guided drainage of retroperitoneum with nephroscope) was done in 18 patients with ANP, mostly with separated necrosis. Necrosectomy was done in 16 patients with left peripancreatic fluid collections, and in 2 patients with right retroperitoneal abscess. Drainages were taken away after complete stop of fluid outflow. Results: Retroperitoneal necrosectomy was successful in 18 patients. Reoperation was needed in 2 patients 8 and 12 days after procedure due to the progression of the disease. Drainages were taken away on 5e34 postoperative days. No postoperative mortality and no procedure-depending complications were observed in main group of patients. Pancreatic pseudocyst occurred in 2 patients and chronic pancreatic fistula formed in 1 patient in the late postoperative period. Conclusion: Minimally invasive percutaneous necrosectomies are recommended for patien...
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