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Sump syndrome is a rare complication of side-to-side choledochoduodenostomy (CDD) and occasionally occurs after spontaneous gallbladder-bile duct-digestive tract fistula or end-to-side choledochojejunostomy. Before the development of minimally invasive surgery, conventional surgical operation used to be the most important treatment method. This article reviews the research advances in sump syndrome in recent years and points out that endoscopic retrograde cholangiopancreatography is the major diagnostic method for this disease, and endoscopic sphincterotomy combined with bile duct debridement is the most simple and effective measure for the treatment of sump syndrome. Meanwhile, this article briefly reviews sump syndrome with reference to related literature and clinical practice, in order to raise the awareness for sump syndrome. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of obstructive jaundice on hepatectomy., Methods: 120 Wistar rats underwent ligation of the common bile duct to establish animal model of obstructive jaundice. On days 1 after ligation 20 rats underwent 30% hepatic resection + choledochojejunostomy (Group 1) and 20 rats underwent 70% hepatic resection + choledochojejunostomy (Group 2); on day 3 after ligation 10 rats underwent 30% hepatic resection + choledochojejunostomy (Group 3) and 10 rats underwent 70% hepatic resection + choledochojejunostomy (Group 4); on day 5 20 rats underwent 30% hepatic resection + choledochojejunostomy (Group 5) and 20 rats underwent 70% hepatic resection + choledochojejunostomy (Group 6); and on day 7 10 rats underwent 30% hepatic resection + choledochojejunostomy (Group 7) and 10 rats underwent 70% hepatic resection + choledochojejunostomy (Group 8). The serum total protein, albumin, total bilirubin (TBIL), direct bilirubin, and alanine transaminase (ALT) were detected. Then livers were taken out after the rats died or were killed, and the levels of ALT and Na+ K+(-)ATPase were measure., Results: The serum TBIL peaked on day 3. The survival rate after the operation of Groups 1, 2, 3, 4, 5, 6, 7, and 8 were 20% , 20%, 100%, 50%, 30%, 20%, 0, and 0 respectively., Conclusion: (1) It is the too short a time between two operations, but not liver dysfunction, that is responsible for the high death rate in Groups 1 and 2. (2) 30% hepatic resection + choledochojejunostomy performed 3 days after the ligation of common bile duct is safe with a survival rate of 100%. However, 70% hepatic resection + choledochojejunostomy is dangerous in this time with a survival rate of 50% only. (3) 30% and 70% hepatic resection + choledochojejunostomy performed 5 and 7 days after the ligation are very dangerous with a post-operational survival rate of zero.

Objective: To explore the feasibility of introduction of microvascular surgery into biliary reconstruction in living donor liver transplantation (LDLT) so as to reduce the incidence of postoperative biliary complications., Methods: The experience in the microvascular surgery performed on 32 patients undergoing LDLT, 8 children and 24 adults, including duct-to-duct anastomosis in 21 case, hepato-jejunostomy under surgical loupe in 13 cases, and hepato-jejunostomy under operative microscopy in 9 cases, totally 43 cases of biliary reconstruction manipulations., Results: Post-operative biliary complications occurred in 2 patients. One male patient who underwent hepato-jejunostomy under surgical loupe suffered from leakage from a bilioenteric anastomotic stoma 3 days after operation and laparotomy was performed to repair the leakage and carry out drainage. Mild stricture of the anastomotic stoma occurred in the other patient 3 months after operation and conservative treatment was given. Both patients recovered., Conclusion: Introduction of microvascular surgery to biliary reconstruction in LDLT, especially the use of operative microscopy for hepato-jejunostomy on very small hepatic ducts,

Objective: To explore the clinical feature and treatment efficiency of patients with early hepatic arterial insufficiency (HAI) and biliary complications (BC) following liver transplantation (LT)., Methods: The clinical data of 240 patients receiving LT from February 1999 to February 2004 were analyzed retrospectively. End-to-end choledococholocostomy was applied to 236 patients as the major biliary reconstructive method. Hemodynamic monitoring of the hepatic artery was performed to discover HAT, including hepatic arterial thrombosis (HAT) or hepatic arterial stenosis (HAS) in the first 3 months after transplantation., Results: In HAI Group, 7 cases of stricture of biliary tract and 4 cases of biliary leakage occurred; and 6 cases underwent endoscopic and/or intervention treatment, 4 cases underwent repair of anastomotic stoma and biliary drainage, 1 case underwent medication. Eight patients died and 3 were cured. A total of 32 patients (13.3%) developed biliary complications (BCs), Eleven of the 32 patients with BCs, biliary stricture in 8 cases and biliary leakage in 3 cases, had early HAI (HAI Group) with an incidence of 4.6% for BC with background of HAI (11/236). Another 21 patients with BCs (21/236, 8.7%) did not showed background of HAI (non-HAI Group). Preoperative serum total bilirubin levels were 373.3 +/- 93.9 micromol/L in HAI Group and 110.8 +/- 45.0 micromol/L in non-HAI Group (P = 0.008). Three cases with HAT underwent emergency thrombectomy then the hepatic arterial flow turned to normal. Two cases with HAS received short-term anticoagulant therapy. Recipients with BC underwent radiological and/or endoscopic interventional treatment (n = 6), surgical repair of leak site and biliary drainage (n = 4), and ordinary medication (n = 1). The 1 and 3-year survival rates of HAI Group were 54.6% and 16.4% respectively; both significantly lower than those of non-HAI Group (66.3% and 61.2%, both P = 0.042)., Conclusion: The recipients with BC following early HAI are associated with poor outcome. The monitoring protocol of hepatic hemodynamics by color dopplar ultrasonography should be enhanced, which contributes to urgent revascularization or recovery of hepatic hemodynamics. Interventional therapies should be immediately applied and transferred to surgical treatment or even retransplantation when necessary for patients with BC following early HAI.

Objective: To observe the effects of basic fibroblast growth factor (bFGF) on wound healing of bilioenteric anastomosis as to prevent postoperative biliary strictures., Methods: A model of choledochoduodenostomy in 31 dogs were constructed at first, then bFGF was administered on the local anastomosis (bFGF group) for 1 week after the operation as compared with sodium chloride solution (control group). Both groups were observed with light microscope (HE, Masson staining) and electron microscope 3 days, 1 and 3 weeks and 3 and 6 months after the operation (n=3). Hydroxyproline was measured at the same time., Results: bFGF group healed more quickly compared with control group. Good function of cells were detected by electron microscope. Better mucosa epithelia, fibroblast, and capillary vessel proliferation were detected by histological observation in bFGF group. In bFGF group, collagen fibers were arranged orderly. Three weeks after operation, collagen fibers in control group were orderless and in whirlpool. Hydroxyproline of bFGF group was lower than that of control group (P<0.05)., Conclusion: bFGF administered in local anastomosis is an effective method to prevent postoperative anastomotic stenosis.

Objectives: To investigate the selection of the types of anastomosis and to evaluate the therapeutic effects of portoenterostomy., Methods: From 1993 to 1998, 426 patients with obstructive jaundice underwent portoenterostomy. The patients included 236 cases (56%) of hilar strictures in hepatolithiasis, 98 cases (23%) of end-stage periampullary tumors, 64 cases (15%) of proximal cholangiocarcinoma, and 28 cases (6%) of congenital choledochus cyst. Reconstruction of biliary tract was performed after resection of affected duct or palliative bypass for end-stage carcinoma. The types of anastomosis included extra or hilar hepatic bilioenterostomy (160 cases, 37%), and intra-hepatic duct anastomosis with different type of hepatectomy (266 cases, 63%), in which anastomosis was performed by round ligament approach (34 cases, 8%), and anastomosis through gallbladder fossa (15 cases, 4%)., Results: Short- and 1-6 year follow-up showed that jaundice of patients was completely relieved by suitable type of bilioenterostomy., Conclusions: The good therapeutic effects of bilioenterostomy are based on the correct selection of anastomosis methods.

This paper shows that face acupuncture point (Liver point through gallbladder point) has significant effect of promoting bile secretion on the patients of cholecystectomy and choledochotomy and drainage. Special different point is that face acupuncture stimulation has very obvious posteffect comparing with other three body acupuncture groups and this posteffect lasts more than fifty minuts. The results also show that the successful rate of face acupuncture anesthesia is better than body acupuncture anesthesia during the ligation of oviduct and subtotal gastrectomy. The above results are all analysed statistically and there is a very significant difference among them. During the research on domestic dog anesthesiaed by face acupuncture, the successful rate is 86.5%, moreover the analgesic effect of face acupuncture can be blocked by blocking bilateral postganglionic fibre of trigeminal ganglion with 2% procaine. The results imply that trigeminal ganglion is the main afferent way of stimulation information of face acupuncture.

We report 16 patients of focalized pancreatitis. All patients presented mass in the head of pancreas and obstructive jaundice (13 patients), characterized by spontaneous mass shrinkage and jaundice subsidence within two weeks after admission without any surgical intervention. Sonography, ERCP, exploration and intraoperative biopsy are of value in differentiating FP from carcinoma. Six patients received conservative therapy. Operations aimed to drain the commonbile duct and pancreatic duct (T tube drainage of commonbile duct, choledochojejunostomy, pancretojejunostomy) were performed in 7 patients. Pancretoduodenectomy were performed in 3 patients on tentative diagnosis of carcinoma in the head of the pancreas. Follow-up in 12 patients showed satisfactory results.