An experimental study on rabbit sclerosing cholangitis (SC) secondary to direct injection into the biliary tract of the chemical substances commonly employed for intraoperative sterilization of the hydatid cyst content is reported. Among the various substances utilized, 10% formalin and 30% hypertonic solution caused gross and microscopic lesions compatible with less advanced forms of sclerosing cholangitis. The authors present their hypothesis on the development of SC in operated hydatid cysts of the liver.
The results of the long-term follow-up of 202 patients with Roux-en-Y hepaticojejunostomy (Roux-en-Y HJ) and 19 with hepaticojejunoduodenostomy (HJD) are reported. The mortality, morbidity, and the incidence of postoperative anastomotic stenosis were comparable in both groups. One hundred forty patients with Roux-en-Y HJ and 19 with HJD were followed with barium meal and endoscopy. An incidence of 5% postoperative duodenal ulcer was noted in the first group, while no ulcer was seen in the patients with HJD. Preoperative and postoperative gastric acid secretion (basal acid secretion and maximal acid secretion) and serum gastrin levels (basal and after protein meal) were measured in 25 cases with Roux-en-Y HJ and 19 with HJD. The serum gastrin levels were similar initially and remained unchanged after surgery in both groups. However, the mean levels of basal and maximal acid output, which was similar before surgery in both groups, increased significantly only in patients who had Roux-en-Y HJ (p less than 0.001). In conclusion, HJD should be adopted as the preferred type of anastomosis in patients with benign pathology and long-life expectancy.
The authors report their experience with 66 patients operated on for iatrogenic strictures of the bile ducts. Among the factors that are considered to predispose to or to cause iatrogenic strictures, all of which have been accurately analyzed, urgent operations for acute cholecystitis have particular importance. The percutaneous transhepatic and duodenoscopic retrograde cholangiographies represent a complementary means for a precise diagnosis of the stricture. Treatment consists of a Roux‐en‐Y hepaticojejunostomy, but in recent years, a biliary‐duodenal interposition utilizing a defunctionalized jejunal limb was preferred. Postoperative morbidity was 22.7%, mortality 3%. Consideration is given to the technique of anastomosis and to the use of transanastomotic drainage. Finally, the results of follow‐up with particular reference to the treatment of strictures of the hepaticojejunostomy, with an incidence of 15.4% in this series of patients, have been analyzed.
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