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Background/aim: Optimization of quality of life is an important goal in the management of patients with unresectable peri-ampullary cancer. Herein, we share our two cases to demonstrate the feasibility of scarless transumbilical single-incision laparoscopic cholecystojejunostomy using conventional instruments in the management of unresectable peri-ampullary cancer.Cases and Methods: Two 58-year-old patients (one male) underwent transumbilical single-incision laparoscopic cholecystojejunostomies: The male and female patients were diagnosed with duodenal papillary carcinoma and pancreatic cancer, respectively. The hepatocystic junction was confirmed patent preoperatively in both patients. A 2-cm periumbilical incision was made for the placement of three trocars. Conventional rigid laparoscopic instruments were solely used throughout the procedure, and operative techniques were carried out in the same fashion as for conventional laparoscopic cholecystojejunostomy.Results: The procedures were completed uneventfully in 190 and 155 min, respectively, with no complications, and the blood loss was estimated at 80 and 20 ml, respectively. Postoperative pain scores on postoperative day 1 were 4/10 and 3/10. The patients were discharged from the hospital on postoperative days 3 and 5 with resolving jaundice.Conclusions: Transumbilical single-incision laparoscopic cholecystojejunostomy appears to be a technically feasible alternative to standard laparoscopic procedure and can be performed using conventional laparoscopic instruments. [ABSTRACT FROM AUTHOR]

Background: Currently adopted diagnostic methods for duodenal-biliary and pancreaticobiliary refluxes carry many flaws, so the incidence of the two refluxes demands further larger sample size studies. This study aimed to evaluate Western blotting for the diagnosis of refluxes in biliary diseases., Methods: An oral radionuclide 99mTc-DTPA test (radionuclide, RN) was conducted for the observation of duodenal-biliary reflux prior to measuring bile radioactivity and Western blotting for detecting bile enterokinase (EK). Pancreaticobiliary reflux was assessed by biochemical and Western blotting tests for biliary amylase activity and trypsin-1, respectively. In accordance with bile sample origin, our samples were classified into ductal bile and gall bile groups; based on each individual biliary disease, we further classified the ductal bile group into five sub-groups, and the gall bile group into four sub-groups. Western blotting was conducted to assess the two refluxes in biliary diseases., Results: Consistencies were noted between EK and RN tests when diagnosing duodenal-biliary reflux (P<0.001). The amylase and trypsin-1 tests also showed consistency in diagnosing pancreaticobiliary reflux (P<0.001). Amylase and lipase levels within gall and ductal bile were strongly correlated (P<0.05). In the common bile duct pigment stone group, the EK and trypsin-1 positive rates were found to be insignificant (P>0.05); in the common bile duct cyst group, the EK positive rate was significantly lower than the trypsin-1 positive rate (P<0.05)., Conclusions: Western blotting can accurately reflect duodenal-biliary and pancreaticobiliary refluxes. EK has greater sensitivity than RN for duodenal-biliary reflux. The majority of biliary amylase and lipase comes from the pancreas in all biliary diseases; pancreaticobiliary reflux is the predominant source in the common bile duct cyst group and duodenal-biliary reflux is responsible for the ductal pigment stone group.