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John Wong - One of the best experts on this subject based on the ideXlab platform.

  • Outcome of surgical treatment for Recurrent Pyogenic Cholangitis: a single-centre study.
    HPB : the official journal of the International Hepato Pancreato Biliary Association, 2009
    Co-Authors: Kit-fai Lee, John Wong, Ching-ning Chong, Yue-sun Cheung, Paul B.s. Lai
    Abstract:

    Background Recurrent Pyogenic Cholangitis (RPC) is still a common disease in East Asia. The present study reviews the operative results for this disease in a single centre.

  • The changing epidemiology of Recurrent Pyogenic Cholangitis
    Hong Kong medical journal = Xianggang yi xue za zhi, 1997
    Co-Authors: John Wong
    Abstract:

    Recurrent Pyogenic Cholangitis is prevalent in Hong Kong and East Asia. While the recent influx of Asian immigrants has resulted in more cases appearing in the West, over the past three decades, the overall incidence in East Asia has been in decline. The experience of the Queen Mary Hospital and other hospitals in the region has been confirmed by comprehensive surveys. The decline in incidence has been attributed to the improved economic situation and living standards with the associated westernisation of diet.

  • Recurrent Pyogenic Cholangitis: Current management
    World Journal of Surgery, 1991
    Co-Authors: St Fan, T.k. Choi, John Wong
    Abstract:

    Successful treatment of Recurrent Pyogenic Cholangitis depends on the ability to delineate the pathology of the entire biliary system and to eradicate all stones, strictures, and destroyed liver segments. Recent advances in imaging techniques and stone fragmentation technology have been applied successfully in the management of this condition. Apart from direct cholangiography and ultrasonography, valuable information can be obtained from computed tomography which is particularly helpful in patients with Recurrent disease after previous biliary surgery. Application of electrohydraulic lithotripsy in this disease solves the problem of difficult stone retrieval due to large size, impaction behind relative strictures and inside angulated segmental bile ducts. Together with construction of a hepaticocutaneous jejunostomy serving as a permanent access to the bile duct, it is anticipated that the incidence of recurrence and reoperation in the future can be reduced . Le succès du traitement de la cholangite récidivante à pyogènes dépend de la possibilité d'explorer entièrement les voies biliaires et d'enlever toute lithiase, sténose, et foie nécrosé. Les plus récents progrès d'imagerie et des techniques de fragmentation des calculs ont été appliqués avec succès dans le traitement de cette affection. Outre la cholangiographie et l'échographie, la tomodensitométrie est particulièrement utile chez les patients qui récidivent après une première intervention biliaire. Dans cette maladie, la lithotritie électro-hydraulique résoud le problème de la difficulté d'extraction des gros calculs retenus par une sténose ou dans un segment inaccessible des voies biliares. La réalisation d'une anastomose hépatojéjunale avec mise à la peau d'une branche de l'anse montée donnant accès permanent aux voies biliaires, prévient la récidive et la nécessité de réopération. El éxito en el tratamiento de la colangitis piogénica Recurrente depende de la capacidad de visualizar la patología de todo el sistema biliar y de erradicar y corregir la totalidad de los cálculos, las estrecheces, y los segmentos hepáticos que aparezcan destruídos. Los recientes avances en las técnicas de imagenología y de fragmentation de cálculos han sido aplicados exitosamente al manejo de esta entidad. A parte de la colangiografía directa y de la ultrasonografía, se puede obtener information valiosa mediante la tomografía computadorizada, la cual es de utilidad especial en pacientes con enfermedad Recurrente después de haber sido sometidos a cirugía biliar. La aplicación de la litotripsia electrohidráulica en esta enfermedad resuelve el problema de la remoción de cálculos que por su gran tamaño, por estar impactados proximales áreas de estrechés relativa o por su ubicación en canales biliares segmentarios angulados, representan seria dificultad. Las modernas técnicas de imagenología permiten la completa visualizatión de patología ductal y parenquimatosa. Con la disponibilidad de litotripsia electrohidraúlica para cálculos de difícil extractión y de la hepaticoyeyunostomía para acceso directo y permanente, se puede prever una disminución en la incidencia de enfermedad Recurrente y del número de reoperaciones.

  • Recurrent Pyogenic Cholangitis: current management.
    World journal of surgery, 1991
    Co-Authors: St Fan, T.k. Choi, John Wong
    Abstract:

    Successful treatment of Recurrent Pyogenic Cholangitis depends on the ability to delineate the pathology of the entire biliary system and to eradicate all stones, strictures, and destroyed liver segments. Recent advances in imaging techniques and stone fragmentation technology have been applied successfully in the management of this condition. Apart from direct cholangiography and ultrasonography, valuable information can be obtained from computed tomography which is particularly helpful in patients with Recurrent disease after previous biliary surgery. Application of electrohydraulic lithotripsy in this disease solves the problem of difficult stone retrieval due to large size, impaction behind relative strictures and inside angulated segmental bile ducts. Together with construction of a hepaticocutaneous jejunostomy serving as a permanent access to the bile duct, it is anticipated that the incidence of recurrence and reoperation in the future can be reduced.

  • Role of computed tomography in the management of Recurrent Pyogenic Cholangitis.
    The Australian and New Zealand journal of surgery, 1990
    Co-Authors: St Fan, T.k. Choi, F L Chan, Edward C. S. Lai, John Wong
    Abstract:

    A retrospective analysis was performed to define the indications and usefulness of computed tomography (CT) in the management of 62 patients with Recurrent Pyogenic Cholangitis. When performed in 18 patients in the acute phase for persistent fever inexplicable by ultrasonography and cholangiography, CT scans identified the cause of sepsis to be liver abscesses (n = 7), impacted stones in left lateral segments (n = 3) and right posterior inferior duct (n = 1). When performed in 44 patients during remission, CT scans detected impacted intrahepatic stones as the cause of non-opacification of segmental bile ducts on cholangiograms (n = 15), demonstrated liver volume changes (segmental atrophy, n = 31; hypertrophy, n = 5), differentiated intrahepatic stones from pneumobilia (n = 5) and revealed stones in segregated intrahepatic bile ducts (n = 4). Overall 75.8% of CT scans showed valuable intrahepatic findings which were useful in guiding the appropriate treatment for the intrahepatic pathology. In the others without demonstrable intrahepatic pathology on CT, patients were adequately treated for common bile duct pathology alone. It is recommended that CT should be performed when ultrasonography and cholangiography cannot elucidate the cause of persistent fever, when the cholangiogram shows non-opacification of segmental bile ducts, or fails to demonstrate the cause of Recurrent acute Cholangitis, particularly in patients who have had previous bilio-enteric drainage procedures.

Chung-ngai Tang - One of the best experts on this subject based on the ideXlab platform.

  • approach to manage the complications of choledochoduodenostomy robot assisted laparoscopic roux en y hepaticojejunostomy
    Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 2011
    Co-Authors: Eric C H Lai, Chung-ngai Tang, George P C Yang
    Abstract:

    PurposeTo evaluate the technical feasibility and safety of robot-assisted laparoscopic Roux-en-Y hepaticojejunostomy, using the robotic surgical system.MethodsThis is a report of the use of robot-assisted laparoscopic Roux-en-Y hepaticojejunostomy on 2 patients with Recurrent Pyogenic Cholangitis. B

  • A single-centre experience of 40 laparoscopic liver resections.
    Hong Kong medical journal = Xianggang yi xue za zhi, 2006
    Co-Authors: Chung-ngai Tang, K K Tsui, G P Y Yang
    Abstract:

    Objective. To review results of laparoscopic liver resections, particularly in thosepatients with hepatic malignancy and Recurrent Pyogenic Cholangitis.Design. Retrospective analysis.Setting. Minimal access surgery training centre, Hong Kong.Patients. Patients with pathologies located at anterio-inferio-lateral segments(Couinaud segments 2, 3, 4b, 5, 6) for laparoscopic resection were recruitedduring the period 1998 to 2005. Patients were excluded from review if they had:pathologies at central locations and the superior and posterior segments (4a, 7,8), large tumours (>5 cm in diameter), and those close to major vasculature or theliver hilum.Results. During the study period, we attempted 40 such laparoscopic liverresections, excluding marsupialisations and resections for simple liver cysts. Therewere 20 female and 20 male patients, with a mean age of 57 (standard deviation,13; range, 29-81) years. All but one underwent a successful laparoscopic operation.Pathology included hepatocellular carcinoma (n=17), Recurrent PyogenicCholangitis (n=14), colorectal liver metastasis (n=4), benign liver tumour (n=4),and intrahepatic cholangiocarcinoma (n=1). All except four were hand-assistedlaparoscopic liver resections. The mean operating time was 169 (range, 60-290)minutes and mean blood loss amounted to 270 mL (range, 0-1000 mL).Complications occurred in eight (20%) patients, which included six woundinfections, one postoperative bile leak, and two incisional hernias. There was nooperative or hospital mortality. For hepatocellular carcinoma, clear resection(>10 mm) was achieved in all except five patients, and the 1-year and 2-yearsurvival rates were 86% and 59% respectively. Favourable results were alsoobtained for resections in patients with Recurrent Pyogenic Cholangitis; after amean (standard deviation) follow-up of 29 (23) months, only one was readmitted(for Cholangitis).Conclusion. In appropriately selected patients, laparoscopic liver resection isfeasible and safe, and achieves acceptable survival among individuals withhepatic malignancy and very favourable long-term outcomes in thosewith Recurrent Pyogenic Cholangitis undergoing hand-assisted laparoscopicsegmentectomy.

  • Laparoscopy versus open left lateral segmentectomy for Recurrent Pyogenic Cholangitis.
    Surgical endoscopy, 2005
    Co-Authors: Chung-ngai Tang, C. K. Tai, W. T. Siu, Ka-kin Tsui
    Abstract:

    Background: Recurrent Pyogenic Cholangitis (RPC) is a common disease in Southeast Asia. Its classical presentation is repeated attacks of Cholangitis with multiple recurrences of bile duct stones. The stones are commonly located in the left lateral segments (2 and 3) and therefore complete clearance is difficult to achieve by either endoscopic retrograde cholangiopancreatography or surgical exploration of the common bile duct. The definitive treatment usually involves resection of the stone-harboring segments. The recent advent in laparoscopic surgery has shown that hand-assisted laparoscopic segmentectomy is a safe and feasible, alternative. This study aimed to compare hand-assisted laparoscopic segmentectomy with open segmentectomy in patients with Recurrent, RPC.

  • Laparoscopic treatment of Recurrent Pyogenic Cholangitis.
    Journal of hepato-biliary-pancreatic surgery, 2005
    Co-Authors: Chung-ngai Tang, C. K. Tai, W. T. Siu, Ka-kin Tsui
    Abstract:

    Background/Purpose We reviewed the selective use of hand-assisted laparoscopic segmentectomy (HALS) and laparoscopic choledochoduodenostomy (LCD) in the management of Recurrent Pyogenic Cholangitis (RPC).

  • Laparoscopic treatment of Recurrent Pyogenic Cholangitis
    Journal of Hepato-Biliary-Pancreatic Surgery, 2005
    Co-Authors: Chung-ngai Tang, C. K. Tai, W. T. Siu, Ka-kin Tsui
    Abstract:

    Background/Purpose We reviewed the selective use of hand-assisted laparoscopic segmentectomy (HALS) and laparoscopic choledochoduodenostomy (LCD) in the management of Recurrent Pyogenic Cholangitis (RPC). Methods We carried out a retrospective review of a prospectively maintained database of laparoscopic treatment of RPC during the period 1995 to 2004. The perioperative data were analyzed. Results There were 33 laparoscopic procedures performed in 30 patients with RPC during the period 1995–2004. There were 23 female and 7 male patients, with a mean age of 63.2 ± 14.9 years (range, 29–92 years). All these patients had a history of repeated attacks of Cholangitis, and multiple sessions of endoscopic lithotripsy or operative retrieval had previously been attempted. Of these 33 procedures, there were 23 LCDs and 10 HALS. Three patients underwent simultaneous LCD and HALS in the same operation. The mean operative time was 172 ± 63.5 min (range, 75–290 min) and there were three open conversions (10%), due to (1) intraoperative bleeding from the left hepatic vein, (2) lost broken tip of ultrasonic dissector, and (3) significant bleeding during choledochotomy, respectively. Average hospital stay was 11.4 ± 11.1 days (range, 5–60 days). Eight complications (26.6%) were encountered, which included four bile leaks, three wound infections, and one intraabdominal collection. Complete stone clearance was achieved in all but 1 patient (rate, 96.6%), in whom the residual stones were extracted through a postoperative combined endoscopic and percutaneous approach. Long-term results were satisfactory, and only one stone recurrence was detected, upon a mean follow-up of 34.7 months (range, 1–107 months). Conclusions Both LCD and HALS are safe, feasible, and effective treatments for patients with RPC.

Young Jae Kim - One of the best experts on this subject based on the ideXlab platform.

Hyo Won Eun - One of the best experts on this subject based on the ideXlab platform.

  • Malignant versus benign hepatic masses in patients with Recurrent Pyogenic Cholangitis: MR differential diagnosis
    Abdominal Radiology, 2012
    Co-Authors: Hyo Won Eun, Jung Hoon Kim, Seong Sook Hong, Young Jae Kim
    Abstract:

    Purpose To assess MR findings and diagnostic performance for differentiating malignant from benign hepatic masses in Recurrent Pyogenic Cholangitis (RPC). Materials and methods During a recent 6-year period, we performed MRI in 352 patients with RPC. Among them, 58 had confirmed hepatic masses; cholangiocarcinoma ( n  = 15), abscess ( n  = 37), inflammatory pseudotumor ( n  = 3), biloma ( n  = 3). Two radiologists assessed MR findings including enhancement patterns, intratumoral appearance, peritumoral changes, mass location, and multiplicity. They also graded the malignancy using common MR findings. The receiver operating characteristic analysis and Chi-square test were used. The κ statistics was used to determine interobserver agreement. Results The common findings for cholangiocarcinoma were thin and lobulated enhancement at the periphery ( n  = 8, 53%, P  

  • Malignant versus benign hepatic masses in patients with Recurrent Pyogenic Cholangitis: MR differential diagnosis.
    Abdominal imaging, 2011
    Co-Authors: Hyo Won Eun, Jung Hoon Kim, Seong Sook Hong, Young Jae Kim
    Abstract:

    Purpose To assess MR findings and diagnostic performance for differentiating malignant from benign hepatic masses in Recurrent Pyogenic Cholangitis (RPC).

  • CT Findings of Cholangiocarcinoma Associated with Recurrent Pyogenic Cholangitis
    AJR. American journal of roentgenology, 2006
    Co-Authors: Jung Hoon Kim, Tae Kyoung Kim, Hyo Won Eun, Jae Young Byun, Moon-gyu Lee, Yong Ho Auh
    Abstract:

    OBJECTIVE. The purpose of our study was to determine the characteristic CT findings of cholangiocarcinoma associated with Recurrent Pyogenic Cholangitis.CONCLUSION. CT findings of cholangiocarcinoma associated with Recurrent Pyogenic Cholangitis are important in order to improve early diagnosis and proper treatment. Cholangiocarcinoma associated with Recurrent Pyogenic Cholangitis is predominantly located in the atrophic hepatic lobes and in the hepatic lobes of biliary calculi and is associated with the narrowing or obliteration of the portal vein.

Jung Hoon Kim - One of the best experts on this subject based on the ideXlab platform.

  • Malignant versus benign hepatic masses in patients with Recurrent Pyogenic Cholangitis: MR differential diagnosis
    Abdominal Radiology, 2012
    Co-Authors: Hyo Won Eun, Jung Hoon Kim, Seong Sook Hong, Young Jae Kim
    Abstract:

    Purpose To assess MR findings and diagnostic performance for differentiating malignant from benign hepatic masses in Recurrent Pyogenic Cholangitis (RPC). Materials and methods During a recent 6-year period, we performed MRI in 352 patients with RPC. Among them, 58 had confirmed hepatic masses; cholangiocarcinoma ( n  = 15), abscess ( n  = 37), inflammatory pseudotumor ( n  = 3), biloma ( n  = 3). Two radiologists assessed MR findings including enhancement patterns, intratumoral appearance, peritumoral changes, mass location, and multiplicity. They also graded the malignancy using common MR findings. The receiver operating characteristic analysis and Chi-square test were used. The κ statistics was used to determine interobserver agreement. Results The common findings for cholangiocarcinoma were thin and lobulated enhancement at the periphery ( n  = 8, 53%, P  

  • Malignant versus benign hepatic masses in patients with Recurrent Pyogenic Cholangitis: MR differential diagnosis.
    Abdominal imaging, 2011
    Co-Authors: Hyo Won Eun, Jung Hoon Kim, Seong Sook Hong, Young Jae Kim
    Abstract:

    Purpose To assess MR findings and diagnostic performance for differentiating malignant from benign hepatic masses in Recurrent Pyogenic Cholangitis (RPC).

  • CT Findings of Cholangiocarcinoma Associated with Recurrent Pyogenic Cholangitis
    AJR. American journal of roentgenology, 2006
    Co-Authors: Jung Hoon Kim, Tae Kyoung Kim, Hyo Won Eun, Jae Young Byun, Moon-gyu Lee, Yong Ho Auh
    Abstract:

    OBJECTIVE. The purpose of our study was to determine the characteristic CT findings of cholangiocarcinoma associated with Recurrent Pyogenic Cholangitis.CONCLUSION. CT findings of cholangiocarcinoma associated with Recurrent Pyogenic Cholangitis are important in order to improve early diagnosis and proper treatment. Cholangiocarcinoma associated with Recurrent Pyogenic Cholangitis is predominantly located in the atrophic hepatic lobes and in the hepatic lobes of biliary calculi and is associated with the narrowing or obliteration of the portal vein.