5 research outputs found
Surgical Management of Calcified Hydatid Cysts of the Liver
Hydatid disease of the liver is still a major cause of
morbidity in Greece. Beside the common complications
of rupture and suppuration, calcification of the
hepatic cysts represent a not well studied, less frequent
and sometimes difficult surgical problem. In
the present study 75 cases with calcified symptomatic
liver echinococcosis were operated on in the
1st Propedeutic Surgical Clinic between 1964 to
1996. Twenty-eight patients were male and 47 female
with ages from 23 to 78 years. The diagnosis was
based mainly on the clinical picture and radiological
studies. In 5 cases the operative method was
cystopericystectomy. We performed evacuation of
the cystic cavity and partial pericystectomy and
primary closure of the residual cavity in 6 cases,
omentoplasty or filling of the residual cavity with a
piece of muscle of the diaphragm in 4 cases and
external drainage by closed tube, in 60 cases. In 12 of
those with drainage, after a period of time, a second
operation with easy, removal of most of the calcareous
wall plaques was performed. The mortality rate
was 2%
Hanging Noncalculous Gallbladder
The removal of acalculous and not acutely inflamed gall-bladder in patients with typical biliary pain
remains a questionable procedure. This study was conducted to present our experience. In the period 1982-
90, 1089 cases of calculous and acalculous gallbladder disease were treated in our clinic. In this period, 27
patients were subjected to cholecystectomy because of an acalculous, non inflamed gallbladder which was
elongated lying in an abnormal position with a long cystic duct. The mean duration ofsymptoms supportive
of cholelithiasis, was 5 years. Oral cholecystogram and ultrasonography led to the diagnosis and other
causes ofchronic abdominal pain were excluded. There were 13 lumbar, 9 pelvic and 5 iliac gallbladders, with
poor function in 20 of them. During cholecystectomy, the organ was invested by peritoneum and suspended
in 7 cases from a mesentery. On pathological examination mild chronic inflammation was reported in
19 cases and minimal changes in 8. The minimum follow up was one year and the maximum 9 years. Complete
relief of symptoms was achieved in all the cases. In conclusion, cholecystectomy should be offered in these
symptomatic "hanging" gallbladders
Subtotal Cholecystectomy
Subtotal cholecystectomy has been carried out in 34 patients from 1972 to 1992. In the same period 1620 total cholecystectomies were performed. The indications were severe inflammation and/or severe fibrosis in 31 patients, and Mirizzi syndrome type in 3 patients. The morbidity was insignificant, but one patient died, due to severe sepsis. In follow up studies ranging from 6 months to 9 years, there was one patient with retained stones in the common bile duct. No other post cholecystectomy sequelae were noticed in the remaining 32 patients. Subtotal cholecystectomy is a safe, feasible and definitive operation in patients for whom the standard operation could be dangerous. This operation is less burdensome to the patient, and is accompanied by fewer complications than ordinary cholecystostomy