Editorial comment

Article Abstract:

The common bile duct is formed by the junction of ducts coming from the gallbladder and liver before they empty into the small intestine. The most reliable method for diagnosing common bile duct stones is the use of cholangiography, X-rays of the bile ducts taken after injection of a radio-opaque contrast dye; this procedure is done during surgery. Cholangiography would be unnecessary if there were another method of determining that the common bile duct is free of stones. There is currently some controversy over the routine use of this procedure. In an article in the April 1990 issue of The American Journal of Surgery, Shively and colleagues support the routine use of cholangiography based upon its ability to identify an unsuspected stone, the avoidance of unnecessary bile duct exploration if it shows no stones, and the fact that it adds only an additional 10 minutes to the duration of surgery. Those advocating selective, rather than routine, use of the procedure point out that only one out of ten patients with common duct stones suffers symptoms from them. Selective use of cholangiography in two large studies reported the incidence of retained common duct stones to be 0.2 and 0.3 percent. It is possible to analyze the duct diameters and the numbers of gallbladder stones in order to classify accurately 89.5 percent of patients having bile duct stones. This can be performed on gallbladder surgery patients using a pocket calculator. Gallstones should be diagnosed using ultrasound examination. This examination allows the number and size of stones and the diameter of the common duct to be measured. In conclusion, selective use of cholangiography would seem to be preferable to routine use; with the former approach the risk of significant symptomatic postoperative bile duct stones is under 0.5 percent, and 70 percent of patients would be able to avoid cholangiography. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Bile ducts, editorial, Biliary tract diseases

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Management of hepatocellular carcinoma presenting as obstructive jaundice

Article Abstract:

Hepatocellular carcinoma (HCC) is a rapidly growing malignant tumor of the liver that occurs more frequently in Africa and the Far East than in Western countries. Jaundice (yellow appearance of the skin and eyes) is present at the time of diagnosis in 19 to 44 percent of patients; this is usually caused by liver cirrhosis, a degenerative disease of the liver. Jaundice may also be a sign of impending death. It is unusual for jaundice caused by obstruction of the biliary system to be the main symptom at the time of diagnosis; however, if this is recognized and treated, the patient may survive longer than one year. Data obtained during treatment of 11 patients with HCC and obstructive jaundice are reported. These patients represented 3 percent of the 340 patients treated for HCC over a four-year period. In eight of the 11 patients, tumor had infiltrated the major bile ducts. The jaundice was relieved and the patients survived an average of 35 days. The other three patients had tumor fragments in the bile ducts. Two patients underwent liver resection after the biliary system was decompressed; one of them remained free of tumor on follow-up at 24 months and the other patient had recurrence at 17 months. The third patient had unresectable tumor, but survived for 17 months having undergone multiple procedures. It is concluded that not all patients with obstructive jaundice due to HCC are terminally ill. Some patients may have good palliation (control of pain and discomfort), and occasionally a cure is possible. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Prognosis, Cholestasis, Liver cancer, Jaundice, Obstructive

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Is reperitonealization of the gallbladder bed a ritual or necessity?

Article Abstract:

This paper questioned the need to reline the area of the gallbladder with lining (mesothelial cells) following the surgical removal of the gallbladder (cholecystectomy). Eighty-eight patients undergoing elective removal of the gallbladder were randomly divided into two groups. In one, the raw surface that resulted from the removal was left uncovered, in the other group the area was resurfaced with lining cells. No significant difference in the amount of local drainage could be demonstrated in the two groups.

Evaluation, Surgery, Unnecessary, Unnecessary surgery, Peritoneum

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