Surgical treatment of congenital biliary duct cyst

<p>Abstract</p> <p>Background</p> <p>It is acknowledged that total cyst excision is a safe and ideal surgical treatment for congenital biliary duct cyst, compared to simple internal drainage. The aim of this study was to determine the optimal operation occasion and the effect of laparoscopy on congenital biliary duct cyst based upon total cyst excision.</p> <p>Methods</p> <p>From January 2002 to January 2011, 217 patients were admitted to Southwest Hospital for congenital biliary duct cyst. To determine the optimal surgery occasion, we divided these subjects into three groups, the infant group (age ≤ 3 years), the immaturity group (3 < age ≤ 18 years), and the maturity group (age > 18 years), and then evaluated the feasibility, risk and long-term outcome after surgery in the three groups. To analyze the effect of laparoscopic technique on congenital biliary duct cyst, we divided the patients into the laparoscopy and the open surgery groups.</p> <p>Results</p> <p>Among the three groups, the morbidity from cholangiolithiasis before surgical treatment had obvious discrepancy (p < 0.05) (lowest in the infant group), and intraoperative blood loss also had apparent diversity (p < 0.05). Furthermore, long-term outcomes (secondary cholangiolithiasis, stoma stenosis and cholangiocarcinoma) showed no significant difference between different groups (p > 0.05).</p> <p>Similarly, no significant discrepancy was observed in the morbidity from postoperative complications or long-term postoperative complications (p > 0.05) between the laparoscopic and the open surgery groups.</p> <p>Conclusions</p> <p>We conclude that total cyst excision should be performed as early as possible. The optimal treatment occasion is the infant period, and laparoscopic resection may be a new safe and feasible minimally invasive surgery for this disease.</p

The total costs of a displaced femoral neck fracture: comparison of internal fixation and total hip replacement: A randomised study of 146 hips

We randomised 143 patients –age 75 years or older–with displaced femoral neck fracture to either internal fixation or total hip replacement (THR) and compared the socio-economic consequences. In the internal fixation group, 34 of 78 hips underwent secondary surgery. In the THR group, 12 of 68 hips dislocated, the majority in mentally impaired patients. We calculated the total hospital costs for two years after operation. When secondary surgery was included, there was no difference in costs between the internal fixation and THR groups, or between the mentally impaired and lucid subgroups. The costs to the community were calculated comparing the baseline cost before surgery with the average cost per month during the first postoperative year. No difference was found between the treatment groups. The Harris hip scores were higher in the THR group, and pain was more common in the internal fixation group. In lucid patients, THR gives a better clinical result at the same cost

Arthroplasty or internal fixation for displaced femoral neck fractures: which is the optimal alternative for elderly patients? A meta-analysis

We conducted an up-to-date meta-analysis of 20 eligible randomised controlled trials (RCTs) containing 3,109 patients to compare arthroplasty with internal fixation of displaced femoral neck fractures regarding the effect on clinical outcomes. Computerised databases were searched for RCTs published from January 1979 to May 2008. The results showed that compared to internal fixation arthroplasty led to significantly fewer surgical complications at two and five years postoperatively and reduced the incidence of reoperation at one, two and five years postoperatively (P < 0.001). However, arthroplasty was associated with greater risk of deep wound infection, longer operating time and greater operative blood loss. Arthroplasty substantially increased the risk of reoperation following deep wound infection (P < 0.05). For mortality, there was increased postoperative risk for arthroplasty compared with internal fixation, but there was no statistically significant difference between the two groups at the different follow-up times. For pain at one year postoperatively, the result showed no statistically significant difference