Bile leak in the presence of an intact common duct shown on cholangiogram should raise the suspicion of an RPSD injury. Expertise is needed to interpret the absence of RPSD in these cases. Drain tube cholangiogram is an important adjunctive investigation. In selected cases, the results of nonoperative management alone is comparable with the results of reconstruction.
This paper discusses the possibility for a surgical trainee to acquire the necessary experience in gastric operations for his fellowship in general surgery. All operations of the stomach performed at the surgical unit of Lucerne Hospital between January 1994 and September 1997 were analysed retrospectively. Of 184 operations performed only nine were done by a trainee, four of which were gastrostomies and five operations of a perforated ulcer. These results prove the difficulties for a trainee to achieve the required number of operations. Possible solutions would be the acknowledgement of assisted operations for the fellowship in general surgery and/or the limitation of gastric operations performed by the trainee himself to the curriculum for the fellowship in visceral surgery.
In order to assess the patency and function of biliary-enteric anastomoses performed in our Department of Surgery, 21 patients entered the following study, provided an informed consent was obtained. All the patients were affected by benign biliary tract diseases and underwent either Roux-en-Y hepaticojejunostomy (11 cases), or side-to-side choledochoduodenostomy (10 cases). The 21 patients were evaluated with Tc-99m-HIDA scanning at intervals of 20 days-36 months after the surgical procedure (mean 14 months). The images were obtained after intravenous injection of the radioactive medium (5 mCi) and the scans were taken at min (1 frame/s), 3 min (1 frame/10s), and 56 min (1 frame/2 min). The data were analyzed by a Digital PDP 11/34 Computer System. This method allowed us to assess each individual patient for the patency of the anastomosis and, by computer analysis, to build up a profile of the timing of the passage of the radioactive medium through the anastomosis; a delayed passage across the anastomosis was always pathological.In conclusion, the 99m-Tc-HIDA scanning used in our study for long-term follow-up of biliary-enteric anastomoses is reliable and allows an assessment of prognosis.
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