Background: When common bile duct (CBD) stone removal by endoscopy fails, stone removal is a mandatory procedure for the surgeon. However, it is unclear that the laparoscopic procedure is the alternative treatment in this setting. The purpose of this study is to investigate the result of laparoscopic CBD exploration (LCBDE) following unsuccessful CBD stone removal by endoscopy. Subjects and Methods: This study is a retrospective analysis of 82 consecutive LCBDEs. Group 1 included patients who underwent secondary LCBDE after stone removal by endoscopic retrograde cholangiopancreatography (ERCP) failed. Group 2 was defined when primary LCBDE was performed without ERCP. Perioperative outcomes were compared between the two groups. Results: There were 44 patients in Group 1 and 38 patients in Group 2. There were no significant differences in demographics. Stone clearance was nearly complete in both groups. There was no significant difference between the two groups for operative time, hospital days, open conversion rate, recurrence rate, or complications. Conclusions: LCBDE is an acceptable alternative treatment when endoscopic CBD stone removal is impossible or incomplete.

It is new clinical interest higher serum amylase level with pancreatitis after pancreaticoduodenectomy (PD) correlates with postoperative pancreatic fistula (POPF). Nevertheless, its evidence and study were scarce. We aimed to investigate correlation of serum amylase level immediate after PD and POPF occurrence. Of 163 patients who underwent PD at between January 2009 and December 2019, retrospective analysis was conducted to identify risk factors including serum amylase level immediate after PD for POPF occurrence. Overall incidence of POPF (25/163) was 15.3%. The patients occurred a POPF had significantly higher level of serum amylase on POD0 compared to in whom without a POPF (414 vs 253, p < 0.001). In univariate analysis, ASA classification, post pancreatectomy acute pancreatitis (POAP, serum amylase on POD0 >285IU/L) and Fistula Risk Grade were correlated with POPF occurrence. In multivariable analysis, Fistula risk grade and POAP were significantly associated with developing POPF. In patients with higher serum amylase (>285IU/L) on POD0 with higher fistula risk grade, comprehensive management to achieve mitigation of POPF is important.

There is little evidence of clinical outcome in using antibiotics during the perioperative phase of acute cholecystitis with bactibilia. The aim of current study is to examine the effect of bactibilia on patients with acute cholecystitis and their perioperative clinical outcome. We performed a retrospective cohort analysis of 128 patients who underwent cholecystectomy for acute cholecystitis with moderate and severe grade. Patients who were positive for bactibilia were compared to bactibilia-negative group in following categories: morbidity, duration of antimicrobial agent use, in-hospital course, and readmission rate. There was no difference in morbidity when patients with bactibilia (n = 70) were compared to those without (n = 58) after cholecystectomy. The duration of antibiotics use and clinical course were also similar in both groups. In severe grade AC group (n = 18), patients used antibiotics and were hospitalized for a significantly longer period of time than those in the moderate grade AC group. The morbidity including surgical site infection, and readmission rates were not significantly different in moderate and severe grade AC groups. In moderate and severe AC groups, bactibilia itself did not predict more complication and worse clinical course. Antibiotics may be safely discontinued within few days after cholecystectomy irrespective of bactibilia when cholecystectomy is successful.

Background: Blumgart anastomosis (BA) during pancreaticoduodenectomy (PD) had reduced postoperative pancreatic fistula (POPF) after PD in literatures. The aim of this study is to report surgical results from a consecutive series of operation using the modified BA method. Methods: Data from 50 consecutive patients who underwent PD using modified BA between September 2011 and August 2018 were prospectively collected and retrospectively analyzed, regarding POPF, other morbidities, and mortality. Results: Overall incidence of POPF was 10.0%, the rate of grade B POPF was 8.0% (4/50) and grade C was 2.0% (1/50). Among 50 patients, 5 post pancreatectomy hemorrhages (PPHs) (10.0%) including 2 POPF related bleeding, and 4 abscesses including 2 related to POPF occurred. Fistula risk grades were as follows: 0 negligible, 6 low, 36 intermediate, and 8 high. Except for one patient, fistulas improved over the clinical course after radiologic intervention drainage and angiography. The mortality occurred due to POPF followed by jejunal detachment from the remnant pancreas stump. In this case, jejunum was too thin, compared to the pancreatic thickness. Conclusions: This retrospective single-center result demonstrated that the modified BA had an acceptable rate of POPF. Modified BA may be risky and potentially provoke fatal POPF, when joining a thin jejunum and thick pancreas.

Seung Eun Lee, Sung-Sik Han, Chang Moo Kang, Wooil Kwon, Kwang Yeol Paik, Ki Byung Song, Jae Do Yang, Jun Chul Chung, Chi-Young Jeong, Sun-Whe Kim; Committee of the Korean Surgical Practice Guideline for Pancreatic Cancer. Ann Hepatobiliary Pancreat Surg 2022;26:1-16. https://doi.org/10.14701/ahbps.22-009