Repeated operations in the treatment of cancer of the extrahepatic biliary tracts]

Repeated interventions in carcinoma of the ducts were carried out upon 14 patients. The operations happened to be very beneficial for the most of patients and raised the survival period by 3 month to 2 years 4 months. The clinical course of carcinoma of the gallbladder is the most unfavorable. Only in 1 of 3 cases with mechanical jaundice--an aftermath of carcinoma of the gallbladder--the repeated intervention resulted in the formation of the biliodigestive anastomosis. Repeated interventions in carcinoma of the extrahepatic bile ducts are expedient and should enter the scope of routine interventions.     

Roentgenological examination of the biliary system during emergency surgery]

The drip-infusion cholegraphy carried out within 24 hours after the onset of cholecystitis ensures timely diagnosis or adds to the already established clinical diagnosis. The combination of the cholegraphy with the infusion therapy simplifies a lot the method of examination and expands its possibilities. This combination helps, in particular, to avoid the necessity of the test-injection. The patients tolerate well this method of examination which conveys information on the status of the biliferous system within 1--1.5 hours after infusion.     

Recent acquisitions in surgery of the extrahepatic biliary passages

Recent advances in the diagnosis and surgical management of cases involving the extrahepatic bile ducts are illustrated. Particular stress is laid on the universally recognised importance of preoperative cholangiography, the usefulness of the flexible choledochoscope, and the employment of cold light to visualise calculi undetected by cholangiography. The scope of and indications for direct surgery on the papilla, derivative operations, and reconstruction of the duct are discussed. Lastly, reference is made to the use of endoscopic sphincterotomy, and the suitability of continuous perfusion of the ducts in the destruction of calculi.     

Reoperations on biliary tracts

Analysis of treatment of 386 patients in whom a total of 922 operations on biliary ducts were carried out is presented. In 201 patients biliary ducts' strictures were of iatrogenic origin, neglected stones of ducts were in 68 patients, neolithiasis--in 35 patients, the others had inflammatory lesions of the ducts. In cases of high strictures the operation of choice should be hepato--or hepaticojejunostomy with isolated intestinal loop.