Jie-Ming Li

Publications (2)3.5 Total impact

• Article: Laparoscopic exploration of common bile duct with primary closure versus T-tube drainage: a randomized clinical trial.

  Wei-Jie Zhang, Gui-Fang Xu, Guo-Zhong Wu, Jie-Ming Li, Zhi-Tao Dong, Xiao-Dong Mo
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  ABSTRACT: Traditionally, the common bile duct (CBD) is closed with T-tube drainage after choledochotomy and removal of CBD stones. However, the insertion of a T-tube is not without complication and the patients have to carry it for several weeks before removal. In the laparoscopic era, surgery is performed with minimally invasive techniques in order to reduce the trauma, hasten recovery, and reduce the hospital stay of patients. T-tube insertion seems to negate these benefits. This randomized study was designed to compare the two methods applied after LCBDE and to determine whether primary closure can be as safe as closure with T-tube drainage. From May 2000 to January 2008, 93 consecutive patients with common bile duct stones (CBDS) and gallbladder in situ were enrolled in this randomized study to undergo laparoscopic cholecystectomy with laparoscopic common bile duct exploration (LCBDE). Intraoperative findings, postoperative complications, postoperative stay, and hospital expenses were recorded and analyzed. There was no mortality in both groups. A T-tube was inserted in 46 patients and the CBD was closed primarily in 47. There were no differences in the demographic characteristics or clinical presentations between the two groups. Compared with the T-tube group, the operative time and postoperative stay were significantly shorter, the hospital expenses were significantly lower, and the incidences of overall postoperative complications and biliary complications were statistically and insignificantly lower in the primary closure group. LCBDE with primary closure without external drainage after laparoscopic choledochotomy is feasible and as safe as T-tube insertion.
  Journal of Surgical Research 05/2009; 157(1):e1-5. · 2.25 Impact Factor
• Article: Risk factors affecting conversion in patients undergoing laparoscopic cholecystectomy.

  Wei-Jie Zhang, Jie-Ming Li, Guo-Zhong Wu, Kun-Lun Luo, Zhi-Tao Dong
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  ABSTRACT: Laparoscopic cholecystectomy is the gold standard in the treatment for cholelithiasis, but there are still some patients requiring conversion to open cholecystectomy for several factors. The objective of this study was to evaluate preoperative risk factors for conversion from laparoscopic to open cholecystectomy. One thousand two hundred and sixty-five laparoscopic cholecystectomies were carried out from January 2005 to January 2006 in our hospital. Preoperative clinical, laboratory and radiographic parameters of these patients were kept prospectively and analysed retrospectively. Conversion to open cholecystectomy was needed in 94 patients (7.4%). The main reason for conversion was inability to safely display and identify anatomical structures of Calot's triangle correctly secondary to severe inflammation or dense adhesions, Multivariate analysis identified male sex, with Murphy's sign positive, gall bladder wall thickness > 4 mm and previous upper abdominal surgery as independent predictors of conversion rate to laparotomy. Preoperative risk factors evaluated by the present study confirm the likelihood of conversion. Recognition of these factors was important for understanding the characteristics of patients at a higher risk of conversion. Identifying risk factors will help the surgeon to plan and counsel the patients and introduce new policies.
  ANZ Journal of Surgery 11/2008; 78(11):973-6. · 1.25 Impact Factor