At the 37 th congress of Japan biliary association, present status and strategy for complications of laparoscopic cholecystectomy were discussed on October 2001. The discussion was performed based on the data about the cases of each complications in every speaker's institution. Total number of laparoscopic cholecystectomy was 12,199 in twelve hospitals. LC ratio, which is the ratio of LC among total cases of cholecystectomies in each hospital during the same period, was 72 to 98%. Bile duct injury, bowel injury and bleeding occurred in 0.66,0.09 and 0.39% of the patients respectively. Then conversion to laparotomy was required in 2.5% of the cases. Postoperative pulmonary embolism and bile leak were recognized in 0.04 and 0.32%. As a late complication, stone-related visceral abscess, port site recurrence of gallbladder cancer and incisional hernia were seen in 9,5 and 20 cases among this series. The method concerned with repair and reconstruction for bile duct injury was discussed. Late complications, such as abscess and hernia, seemed to need further clinical analysis and evaluation.

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We compared 12 cases of bile duct stone with onset of biliary pancreatitis (=pancreatitis group)and 99 cases of bile duct stones without biliary pancreatitis (=no pancreatitis group). We performed med endoscopic papillary balloon dilatation (=EPBD) inflated gradually following isosorbide dinitrate (ISDN) drip infusion for removal of bile duct stones in both groups. No significant difference was recognized in point of the rate of successful bile duct clearance, early complications, time of procedure and serum amylase levels after EPBD in both groups. Only the function of minor duodenal papilla was significantly worse in pancreatitis group than in no pancreatitis group. EPBD inflated gradually following ISDN drip infusion is effective therapy for bile duct stone removal with onset of biliary pancreatitis.

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Patient 1, a 65-year-old man, was pointed out the stenosis of the hilar bile duct by endoscopic retrograde cholangiography (ERC). He underwent right lobectomy and caudate lobectomy of the liver and extrahepatic bile duct resection. Pathological findings revealed primary sclerosing cholangitis. Patient 2, a 71-year-old man, was pointed out the stenosis of the hilar bile duct by cholangiography when percutaneous transhepatic biliary drainage was undergone for obstructive jaundice. He was diagnosed as having biliary invasion of gallbladder carcinoma, and underwent right lobectomy and caudate lobectomy of the liver, extrahepatic bile duct resection and partial resection of the duodenum and the transverse colon. Pathological examination revealed chronic cholecystitis. Patient 3, a 71-year-old man, was pointed out the stenosis of the common hepatic duct by ERC. Endoscopic ultrasonography revealed a stone of the neck of the gallbladder and Mirizzi's syndrome was suspected. However, we can't deny a malignant tumor completely and we performed open cholecystectomy after portal embolization. Pathological diagnosis was chronic cholecystitis without malignancy. In conclusion, the stenosis of the bile duct that we can't judge whether malignancy or not needs to be performed the therapy as malignancy because biliary malignancies had poor prognosis.

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We report a case of xanthogranulomatous cholecystitis (XGC) in which we observed its formative process by imaging. The patient was a 66-year-old female. She had gall bladder stones and a history of acute cholecystitis. In this case, XGC could be differentiated from carcinoma by the time course of CT and ultrasonographic imaging findings, as the granuloma of XGC developed in a relatively short period of time. This suggests that follow up imaging after the onset of the disease is important in differentiating XGC from gall bladder carcinoma.

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Percutaneous transhepatic biliary drainage (PTBD) is an interventional procedure which is used for decompression of biliary obstruction. Hemobilia is one of a serious complication during PTBD. A 64-year-old Japanese male was referred to us, because of intrahepatic cholangiocarcinoma. Abdominal US and CT revealed a dilatation of the intrahepatic biliary duct and the common bile duct with tumor thrombus. The main tumor was found in S₄ as a low echoic tumor,4 cm in s ize. PTBD was performed by puncturing a peripheral bile duct, B₃. After one month, he showed melena and hemorrhage from the entry site of the catheter. CT revealed a pseudoaneurysm in S₃,3 cm in size. Then, abdominal angiography was performed. The pseudoaneurysm, communicating with bil e duct, was detected in A₃ of the left hepatic artery, which was branched from the left gastric artery. The pseudoaneurysm was successfully embolized using Gelfoam and microcoils and hemorrhage stopped. A peripheral bild duct puncture with color doppler US should be recommended to avoid vascular complications in PTBD.

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A 85-year-old female with hypertention and diabetes, was suffered from abdominal pain at the right upper quadrant. She was referred to our hospital due to swelling of the gallbladder and increasedp ain. The ultrasonographe xaminations howeds wellingo f the gallbladderw ith debris. N o blood flow of the shadow on Doppler device was noted. The computed tomography showed wall thickness, enlargemento f the gallbladderw ithout enhancementA. spitation cytology from the percutaneoust ranshepaticc holecystographro ute showedc lass II. The cholangiographyre vealed no abnormalityo f the bile duct. Tumor marker was high level. S implec holecystectomwy ith mild regional lymphnodesd issectionw as done becauseo f her oldnessa nd diabetic complicationsT. he resected specimen revealed the white papillary mass filled the cavity in the gallbladder without gallbladder stone. Pathlogical findings showed that the tumor was papillary invasive type and partial infiltration to subserosa was noted. She died of liver metastasis after 21 months postoperatively.

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