2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
P198–Hepatobiliary/Pancreatic
Surgery
SURGICAL TREATMENT OF BILE DUCT INJURIES FOLLOWING
LAPAROSCOPIC CHOLECYSTECTOMY, Faton T Hoxha,
University Clinical Center, Surgery Clinic, Hepato-biliary
Service, Medical Faculty of Prishtina, Kosovo
Background: Bile duct injuries remain one of the most devastating
injuries during Laparoscopic cholecystectomy. In a retrospective
study, we analyses the clinical presentation, diagnostic,
therapeutic treatment and results of ten patients with bile
duct injuries.
Methods: Retrospective analysis of patients requiring biliary
reconstruction with bile duct injuries during Laparoscopic
cholecystectomy at our Center and other Regional Centers
between 2000-2003.
Results: Three patients presented with circumferential bile
duct injuries( one with wall defect); two tangential lesions, one
bile stricture after suture of the lesion; Less severe injuries (
four were bile leaks from Luschka canals). According to the
Strasberg classification are 2 patients - E1; 1-E2; 1-E4; 2-D, and
4-A injuries. According to Stewart-Way Classification of
Laparoscopic bile duct injuries are 2 patients -I Class; 1-II; 2-III
and 1- IV class. All of them were treated surgically. Suture at 4
patients with Luschka canals, and suture with T drainage at
tangential lesions at two patients and one with thermal lesion ;
Hepatico-duodenostomy with good mobilization of duodenum
at one patient with T drain, and two R-Y hepatico ?jejunostomy.
Patients were dismissed from Hospital after a median of
24 days after operation. Signs of cholangitis presents at three
patients .
Conclusions : High morbidity, prolonged hospitalization is
present at Bile duct injured patients. Early recognition of injury
and early referral to more experienced center is then main
determinant of the success.
P199–Hepatobiliary/Pancreatic
Surgery
LAPAROSCOPIC HEPATECTOMY FOR METASTATIC LIVER
TUMOR AFTER LAPAROSCOPIC COLECTOMY - REPORT OF 2
CASES., Hitoshi Inagaki MD, Tsuyoshi Kurokawa MD,Hiroshi
Nagata MD,Katsuhiro Kotake MD,Yoshihiro Owa MD,Ichiro
Horikoshi MD,Mari Tsubamoto MD,Takashi Arikawa
MD,Toshiaki Nonami MD, Department of Surgery, Aichi
Medical University
From December 1997 to August 2004, we performed in a total
of 54 laparoscopic hepatectomies. Among them were 7
patients with metastatic liver tumor. Two of these cases had a
past history of laparoscopic colectomy for primary disease.
The first patient was a 60-year-old man who was diagnosed
with a metastatic liver tumor located in segment 6 after right
colectomy for the ascending colon cancer. The second patient
was a 73-year-old man with a metastatic liver tumor located in
segment 5 after sigmoidectomy for the sigmoid colon cancer.
The operative therapy for primary disease was pathologically
curative. Both liver tumors were solitary.
There was little adhesion to the abdominal wall in both
patients, and no recurrence in the port sites. In the first patient
we used hand-assisted laparoscopic surgery (HALS), and we
made a small incision for HALS to confirm the existence of
adhesion. In the second patient we did not use HALS. Both
patients began to walk at post operative day 1. Their hospital
stay after operation was 11 days and 14 days, respectively.
Although the indications for laparoscopic hepatic resection are
determined, we believe that laparoscopic hepatectomy is also
one useful strategy for metastatic liver tumor, especially after
laparoscopic colectomy for primary tumor.
P200–Hepatobiliary/Pancreatic
Surgery
TOTALLY LAPAROSCOPIC MANAGEMENT OF CHOLEDOCHAL
CYST USING 4 HOLES METHODS, JY Jang MD, SW Kim
MD,HS Han MD,YS Yoon MD,MG Choi MD,YH Park MD,
Department of Surgery, Seoul National University College of
Medicine, Seoul, Korea
178 http://www.sages.org/
Objectives: Choledochal cyst is a rare benign disease in a biliary
tract. However it must be excised with gallbladder (GB)
due to the risk of cancer development in biliary tree including
GB. Here we introduce new surgical technique for totally
laparoscopic excision of choledochal cyst and hepaticojejunostomy
using 4 holes methods.
Methods: Between October 2003 and September 2004, we performed
totally laparoscopic choledochal cyst excision in seven
patients. All were female with mean age 32.5 (range:19-46)
years old. According to the Todani classification, four were
type Ia, one type Ic and two type IV. Choledochal cyst excision
and Roux-en-Y hepaticojejunostomy was entirely performed
laparoscopically using 4 port technique.
Results: The mean operation time was 272 (200~330) minutes.
There was no operative or postoperative transfusion. An oral
diet was started on the 3rd operative day. The average length
of hospital stay was 5.5 days. There was no morbidity associated
with anastomosis leakage or obstruction. All patients
have showed no specific symptoms or laboratory abnormalities
during 5~9 months follow-up periods.
Conclusions: Considering that choledochal cyst is common in
young ages and females, who are especially interested in cosmetic
results as well as cure of disease, laparoscopic management
of choledochal cyst can be an attractive treatment
option.
P201–Hepatobiliary/Pancreatic
Surgery
CALCULOUS CHOLECYSTITIS AFTER LIVER TRAUMA IN A
CHILD, Jin Kim PhD, Min Young Cho PhD,Chong Suk Kim
PhD,Young Chul Kim PhD,Cheung Wung Whang PhD,Sung
Ock Suh PhD, Korea University Hospital
Gallbladder disease is quite uncommon during childhood and
adolescence. Cholelithiasis is not often given serious consideration
in differential diagnosis of abdominal pain. We report the
development of calculous cholecystitis after hepatic injury in a
4 year-old child. He got hepatic grade III injury in a traffic accident.
After a period of conservative treatment, the patient
complained of abdominal pain. Follow-up computed tomography
of abdomen showed multiple stones in gallbladder which
had not been shown in the initial study. He was successfully
treated with laparoscopic cholecystectomy. A review of the literature
indicates that calculous cholecystitis is associated with
hemobilia and parenteral nutrition in children .
P202–Hepatobiliary/Pancreatic
Surgery
NEEDLESCOPIC CHOLECYSTECTOMY, Fumito Kuranishi PhD,
Yoshinori Kuroda PhD,Yuzou Okamoto PhD,Masahiro
Nakahara PhD,Shuuichi Wada PhD,Mizukami Taketomo
MD,Toshikatu Fukuda PhD,Masataka Banshoudani MD,Manabu
Shimomura MD,Junnko Nanbu MD, Onomichi General
Hospital
?yINTRODUCTION?zWe have introduced laparoscopic cholecystectomy(LC)
from 1992,and performed it 800
cases.?@According to the development of peripheral equipment
we have started needlescopic cholecystectomy(NC) from
1997. Conventional laparoscopic cholecystectomy has done by
four trocar method(12,12,5,5:Group A), needlescopic cholecystectomy(NC)
has done by four trocar method(12,3,3,3:Group
B).?@First trocar was inserted ?@infraumbilically,another
three was inserted by rotation.We compared conventional
laparoscopic cholecystectomy (Group A) and needlescopic
cholecystectomy(NC:Group B) in several aspects.We report the
detail about it.
?yOBJECT?zFrom 1997, we have done 328 cases of
LC.?@Exclusion criteria was combined
operation(25cases:Modified radical mastectomy etc),open conversion(29cases),complication(3cases).
Therefore we estimated
271cases of LC(Group A 223 cases,Group B 48cases).
?yRESULT?zAbout first walking, first flatus, intestinal murmur,
first stool and laboratory data(WBC,CRP) there was no significant
difference.
But post opearative analgesics(Group A 2.6?}1.8
times,?@Group B 1.9 ?}1.7
times, p =0.02),oral intake (Group A 1.2?}0.5 days,?@Group