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Kim DS, Yoon YI, Kim BK, Choudhury A, Kulkarni A, Park JY, Kim J, Sinn DH, Joo DJ, Choi Y, Lee JH, Choi HJ, Yoon KT, Yim SY, Park CS, Kim DG, Lee HW, Choi WM, Chon YE, Kang WH, Rhu J, Lee JG, Cho Y, Sung PS, Lee HA, Kim JH, Bae SH, Yang JM, Suh KS, Al Mahtab M, Tan SS, Abbas Z, Shresta A, Alam S, Arora A, Kumar A, Rathi P, Bhavani R, Panackel C, Lee KC, Li J, Yu ML, George J, Tanwandee T, Hsieh SY, Yong CC, Rela M, Lin HC, Omata M, Sarin SK. Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation. Hepatol Int 2024; 18:299-383. [PMID: 38416312 DOI: 10.1007/s12072-023-10629-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/18/2023] [Indexed: 02/29/2024]
Abstract
Liver transplantation is a highly complex and challenging field of clinical practice. Although it was originally developed in western countries, it has been further advanced in Asian countries through the use of living donor liver transplantation. This method of transplantation is the only available option in many countries in the Asia-Pacific region due to the lack of deceased organ donation. As a result of this clinical situation, there is a growing need for guidelines that are specific to the Asia-Pacific region. These guidelines provide comprehensive recommendations for evidence-based management throughout the entire process of liver transplantation, covering both deceased and living donor liver transplantation. In addition, the development of these guidelines has been a collaborative effort between medical professionals from various countries in the region. This has allowed for the inclusion of diverse perspectives and experiences, leading to a more comprehensive and effective set of guidelines.
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Affiliation(s)
- Dong-Sik Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young-In Yoon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | | | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jongman Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Jin Joo
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Joong Choi
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Tae Yoon
- Department of Internal Medicine, Pusan National University College of Medicine, Yangsan, Republic of Korea
| | - Sun Young Yim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Cheon-Soo Park
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Deok-Gie Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hae Won Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Won-Mook Choi
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Eun Chon
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Woo-Hyoung Kang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Geun Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yuri Cho
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Ilsan, Republic of Korea
| | - Pil Soo Sung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Han Ah Lee
- Department of Internal Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Ji Hoon Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Si Hyun Bae
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Mo Yang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Mamun Al Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Soek Siam Tan
- Department of Medicine, Hospital Selayang, Batu Caves, Selangor, Malaysia
| | - Zaigham Abbas
- Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Ananta Shresta
- Department of Hepatology, Alka Hospital, Lalitpur, Nepal
| | - Shahinul Alam
- Crescent Gastroliver and General Hospital, Dhaka, Bangladesh
| | - Anil Arora
- Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital New Delhi, New Delhi, India
| | - Ashish Kumar
- Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital New Delhi, New Delhi, India
| | - Pravin Rathi
- TN Medical College and BYL Nair Hospital, Mumbai, India
| | - Ruveena Bhavani
- University of Malaya Medical Centre, Petaling Jaya, Selangor, Malaysia
| | | | - Kuei Chuan Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jun Li
- College of Medicine, Zhejiang University, Hangzhou, China
| | - Ming-Lung Yu
- Department of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | | | | | | | | | - H C Lin
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Masao Omata
- Department of Gastroenterology, Yamanashi Central Hospital, Yamanashi, Japan
- University of Tokyo, Bunkyo City, Japan
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2
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Olmedo NB, Dos Santos JS, Junior JE. The Frequency of Anatomical Variants of the Bile Ducts: A Review Based on a Single Classification as Support for Cholangiographic Examinations. Cureus 2024; 16:e58905. [PMID: 38800324 PMCID: PMC11118781 DOI: 10.7759/cureus.58905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Complications arising from hepatobiliary surgery can have adverse effects on both the quality of life and the survival of patients. Magnetic resonance cholangiography (MRC) techniques are highly effective at revealing anatomical variants of the bile ducts and thus play a vital role in minimizing the occurrence of complications. The aims of this review are threefold: to ascertain the classifications utilized for categorizing anatomical variants of the bile ducts, to present the reported results on the prevalence of these anatomical variants, and to explore the diagnostic modalities employed to visualize these anatomical variants and associated complications during surgical procedures. A review of the literature was carried out using the Cochrane Library database and the PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), and Google Scholar platforms. We conducted a comprehensive review of relevant studies to categorize the different anatomical variants according to the Huang classification. According to the Huang classification, our study showed type A1, 60.44%; type A2, 11.76%; type A3, 11.73%; type A4, 5.47%; type A5, 0.26%; and type B, which was identified in insignificant numbers (0.16%) or does not appear; additionally, variants that do not fit into the Huang classification have also been identified (10.18%). The Huang classification serves as an invaluable presurgical guide, aiding in the strategic planning of biliary interventions and effectively reducing the risk of iatrogenic complications, morbidity, mortality, and postoperative length of stay. MRC is still considered the noninvasive gold standard method for evaluating the bile ducts and their anatomical variations.
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Affiliation(s)
- Norman B Olmedo
- Department of Imaging and Radiology, College of Medical Sciences, Central University of Ecuador, Quito, ECU
| | - José Sebastião Dos Santos
- Department of Surgery and Anatomy, Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, BRA
| | - Jorge Elías Junior
- Department of Medical Imaging, Hematology, and Oncology, Ribeirão Medical School, University of São Paulo, Ribeirão Preto, BRA
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3
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Zhu JH, Zhao SL, Kang Q, Zhu Y, Liu LX, Zou H. Classification of anatomical morphology of cystic duct and its association with gallstone. World J Gastrointest Surg 2024; 16:307-317. [PMID: 38463380 PMCID: PMC10921219 DOI: 10.4240/wjgs.v16.i2.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Gallstones are common lesions that often require surgical intervention. Laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstones. Preoperatively, the anatomical morphology of the cystic duct (CD), needs to be accurately recognized, especially when anatomical variations occur in the CD, which is otherwise prone to bile duct injury. However, at present, there is no optimal classification system for CD morphology applicable in clinical practice, and the relationship between anatomical variations in CDs and gallstones remains to be explored. AIM To create a more comprehensive clinically applicable classification of the morphology of CD and to explore the correlations between anatomic variants of CD and gallstones. METHODS A total of 300 patients were retrospectively enrolled from October 2021 to January 2022. The patients were divided into two groups: The gallstone group and the nongallstone group. Relevant clinical data and anatomical data of the CD based on magnetic resonance cholangiopancreatography (MRCP) were collected and analyzed to propose a morphological classification system of the CD and to explore its relationship with gallstones. Multivariate analysis was performed using logistic regression analyses to identify the independent risk factors using variables that were significant in the univariate analysis. RESULTS Of the 300 patients enrolled in this study, 200 (66.7%) had gallstones. The mean age was 48.10 ± 13.30 years, 142 (47.3%) were male, and 158 (52.7%) were female. A total of 55.7% of the patients had a body mass index (BMI) ≥ 24 kg/m2. Based on the MRCP, the CD anatomical typology is divided into four types: Type I: Linear, type II: n-shaped, type III: S-shaped, and type IV: W-shaped. Univariate analysis revealed differences between the gallstone and nongallstone groups in relation to sex, BMI, cholesterol, triglycerides, morphology of CD, site of CD insertion into the extrahepatic bile duct, length of CD, and angle between the common hepatic duct and CD. According to the multivariate analysis, female, BMI (≥ 24 kg/m2), and CD morphology [n-shaped: Odds ratio (OR) = 10.97, 95% confidence interval (95%CI): 5.22-23.07, P < 0.001; S-shaped: OR = 4.43, 95%CI: 1.64-11.95, P = 0.003; W-shaped: OR = 7.74, 95%CI: 1.88-31.78, P = 0.005] were significantly associated with gallstones. CONCLUSION The present study details the morphological variation in the CD and confirms that CD tortuosity is an independent risk factor for gallstones.
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Affiliation(s)
- Jia-Hai Zhu
- Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
| | - Song-Ling Zhao
- Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
| | - Qiang Kang
- Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
| | - Ya Zhu
- Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
| | - Li-Xin Liu
- Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
| | - Hao Zou
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming 650106, Yunnan Province, China
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4
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Mahamid A, Chen M, Sulimani O, Amodeo S, Facciuto L, Kozato A, Bekki Y, Schiano TD, Facciuto ME. The Importance of Segment 4 Anatomy on Outcomes Following Living Donor Left Lateral Segmentectomy. J Surg Res 2023; 285:13-19. [PMID: 36638550 DOI: 10.1016/j.jss.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/10/2022] [Accepted: 12/25/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND During left lateral section (LLS) resection for live liver donation, the vascular inflow and the bile drainage of segment 4 (S4) are compromised. We investigated the long-term changes of S4 after donation and their potential prognostic impact on living liver donors. MATERIALS AND METHODS This was a retrospective analysis of 42 consecutive left lateral (LLS, S2/3) liver resections for living donation. RESULTS There were 25 female and 17 male donors. Median age was 33 y and median body mass index was 26. Median LLS, S2/3, volume was 262 cc, and median sS4 volume was 160 cc. Complications were encountered in three donors (7%). An independent extrahepatic S4 artery (S4A) (with a proximal left heptic artery or a right hepatic artery origin) was identified in 41% of the donors. Ligation of the independent S4A was not associated with the rate of post resection liver dysfunction, complications, or the degree of S4 atrophy. Having a dominant S4 portal triad pedicle feeding the right anterior sectors, segment 5/8, of the liver was associated with increased parenchymal damage as evidenced by a higher peak of alanine aminotransferase but was not associated with postoperative complications. The median degree of atrophy of S4 at 1 y post donation as noted on imaging was 66%. The presence of a dominant S4 portal triad pedicle and the peak alanine aminotransferase early postoperatively were both predictors of the degree of S4 atrophy post donation. CONCLUSIONS The presence of an independent S4A or dominant S4 portal triad pedicle feeding the liver right anterior sectors, segment 5/8, should not be a contraindication for left lateral segment living donation.
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Affiliation(s)
- Ahmad Mahamid
- Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mark Chen
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Omri Sulimani
- Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Salvatore Amodeo
- Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lucas Facciuto
- Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Akio Kozato
- Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yuki Bekki
- Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Thomas D Schiano
- Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marcelo E Facciuto
- Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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5
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Khot R, Morgan MA, Nair RT, Ludwig DR, Arif-Tiwari H, Bhati CS, Itani M. Radiologic findings of biliary complications post liver transplantation. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:166-185. [PMID: 36289069 DOI: 10.1007/s00261-022-03714-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023]
Abstract
Liver transplantation is a potentially curative treatment for patients with acute liver failure, end-stage liver disease, and primary hepatic malignancy. Despite tremendous advancements in surgical techniques and immunosuppressive management, there remains a high rate of post-transplant complications, with one of the main complications being biliary complications. In addition to anastomotic leak and stricture, numerous additional biliary complications are encountered, including ischemic cholangiopathy due to the sole arterial supply of the bile ducts, recurrence of primary biliary disease, infections, biliary obstruction from stones, cast, or hemobilia, and less commonly cystic duct remnant mucocele, vanishing duct syndrome, duct discrepancy and kinking, post-transplant lymphoproliferative disorder, retained stent, and ampullary dysfunction. This article presents an overview of biliary anatomy and surgical techniques in liver transplantation, followed by a detailed review of post-transplant biliary complications with their corresponding imaging findings on multiple modalities with emphasis on magnetic resonance imaging and MR cholangiopancreatography.
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Affiliation(s)
- Rachita Khot
- Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
| | - Matthew A Morgan
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Rashmi T Nair
- Department of Radiology, University of Kentucky, Lexington, KY, USA
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - Hina Arif-Tiwari
- Department of Medical Imaging, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Chandra S Bhati
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
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6
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Shrestha P, Mansur DI, Karki S, Shrestha S, Maskey S, Chaudary R. Atypical Pattern of the Intrahepatic Biliary Duct on Magnetic Resonance Cholangiopancreatography in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:955-958. [PMID: 36705179 PMCID: PMC9795103 DOI: 10.31729/jnma.7658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction The liver possesses different patterns of intrahepatic duct confluences. Even though the typical pattern of the intrahepatic biliary duct is common, atypical variations are also frequently witnessed. The knowledge of the atypical intrahepatic biliary confluences is inevitable during hepato-biliary surgery to reduce post-operative complications. The aim of the study was to find out the prevalence of the atypical pattern of intrahepatic biliary duct pattern on magnetic resonanace cholangiopancreatography in a tertiary care centre. Methods This descriptive cross-sectional study was done in a tertiary care centre after receiveing ethical approval from the Institutional Review Committee [Reference number: KUSMS/IRC (248/2021)]. The branching patterns of the atypical intrahepatic biliary pattern were observed in Magnetic resonance cholangiopancreatography images and were classified. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated. Results Among 199 magnetic resonance cholangiopancreatography images, the atypical intrahepatic biliary duct was observed in 48 (24.12%) (18.18-30.06, 95% Confidence Interval) of the images. Conclusions The prevalence of the atypical intrahepatic biliary duct pattern is lower as compared to other studies done in similar settings. Keywords bile ducts; liver; magnetic resonance cholangiopancreatography.
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Affiliation(s)
- Pragya Shrestha
- Department of Anatomy, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Dil Islam Mansur
- Department of Anatomy, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Subindra Karki
- Department of Radiodiagnosis, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Sheprala Shrestha
- Department of Anatomy, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal,Correspondence: Dr Pragya Shrestha, Department of Anatomy, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. , Phone: +977-9841658315
| | - Sunima Maskey
- Department of Anatomy, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Roshan Chaudary
- Department of Radiodiagnosis, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
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7
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Kajiwara M, Ishii F, Sasaki T, Nakashima R, Hasegawa S. Crucial Roles of the Assistant Surgeon During Laparoscopic Left Hemihepatectomy. Cureus 2022; 14:e24050. [PMID: 35573504 PMCID: PMC9095429 DOI: 10.7759/cureus.24050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 11/05/2022] Open
Abstract
Background Although left hemihepatectomy has been widely performed via the laparoscopic approach, the roles of the assistant surgeon have not been well-documented so far. We herein present our standardized procedures of laparoscopic left hemihepatectomy without Spiegel’s lobe resection, focusing on the crucial roles of the assistant surgeon. Methods During laparoscopic left hemihepatectomy without Spiegel’s lobe resection, countertraction by the assistant surgeon is quite important especially during isolating the left Glissonean pedicle and transecting liver parenchyma. When securing the left hepatic pedicle using the Glissonean approach, the assistant surgeon pushes Segment 4 of the liver cranially and pulls the tape encircling the hepatoduodenal ligament caudally in the opposite way, orthogonal to the direction of the laparoscopic forceps toward the left portal triad. During liver parenchymal transection, the assistant surgeon pulls the hanging tape across the left lobe of the liver in order to provide a wide and stable liver transection plane. With this standardized technique, nine cases of laparoscopic left hemihepatectomy were performed over the last two years in our department, and the perioperative data were retrospectively analyzed. Results The median age of the nine patients was 70 years (range: 58 - 84 years). Most of the patients were males (77.8%). Five of nine patients were diagnosed with colorectal liver metastasis, two with hepatocellular carcinoma (HCC), one with inflammatory pseudotumor, and the other one with hepaticolithiasis. There were no conversions to open surgery. The median operative time and estimated blood loss were 337 minutes (range: 219 - 478 minutes) and 100 ml (range: 41 - 375 ml), respectively. The median length of postoperative hospital stay was nine days (range: 7 - 16 days). Major complications (Clavien-Dindo classification grade III or more) were not encountered in our cohort postoperatively. Conclusion We presented here our standardized assistant roles during laparoscopic left hemihepatectomy without Spiegel’s lobe resection, which was revealed to be safe and feasible in our cohort.
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8
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Bao-Qiang W, Jun H, Wen-Song L, Yong J, Xue-Min C, Dong-Lin S. Laparoscopic repair of transected right hepatic artery during cholecystectomy: A report of two cases. Ann Hepatol 2021; 21:100161. [PMID: 31836423 DOI: 10.1016/j.aohep.2019.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 02/04/2023]
Abstract
In laparoscopic cholecystectomy (LC), the treatment of iatrogenic biliary tract injury has been given much attention. However, most accidental right hepatic artery (RHA) injuries are treated with simple clipping. The reason is that the RHA has difficulty in revascularization, and it is generally considered that RHA injury does not cause serious consequences. However, some studies suggest that some cases of RHA ligation can cause a series of pathological changes correlated to arterial ischemia, such as liver abscess, bile tumor, liver atrophy and anastomotic stenosis. Theoretically, RHA blood flow should be restored when possible, in order to avoid the complications of right hepatic ischemia. The present study involved two patients, including one male and one female patient. Both patients were admitted to the hospital with the diagnosis of chronic cholecystitis and gallbladder stone, and developed ischemia of the right half hepatic after accidental transection of the RHA. Both patients underwent continuous end-end anastomosis of the RHA with 6-0 Prolene suture. After the blood vessel anastomosis, the right half liver quickly recovered to its original bright red. No adverse complications were observed in follow-ups at three and six months after the operation. Laparoscopic repair of the RHA is technically feasible. Reconstruction of the RHA can prevent complications associated with right hepatic ischemia.
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Affiliation(s)
- Wu Bao-Qiang
- Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Suzhou University, The First People's Hospital of Changzhou, Changzhou 213003, China
| | - Hu Jun
- Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Suzhou University, The First People's Hospital of Changzhou, Changzhou 213003, China
| | - Liu Wen-Song
- Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Suzhou University, The First People's Hospital of Changzhou, Changzhou 213003, China
| | - Jiang Yong
- Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Suzhou University, The First People's Hospital of Changzhou, Changzhou 213003, China
| | - Chen Xue-Min
- Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Suzhou University, The First People's Hospital of Changzhou, Changzhou 213003, China.
| | - Sun Dong-Lin
- Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Suzhou University, The First People's Hospital of Changzhou, Changzhou 213003, China
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9
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Borhani AA, Elsayes KM, Catania R, Kambadakone A, Furlan A, Kierans AS, Kamath A, Harmath C, Horvat N, Humar A, Kielar AZ. Imaging Evaluation of Living Liver Donor Candidates: Techniques, Protocols, and Anatomy. Radiographics 2021; 41:1572-1591. [PMID: 34597229 PMCID: PMC9478886 DOI: 10.1148/rg.2021210012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/05/2021] [Accepted: 04/13/2021] [Indexed: 12/17/2022]
Abstract
The need for liver transplants is increasing because the prevalence of liver diseases and the indications for transplants are growing. In response to the shortage of grafts from deceased donors, more transplants are being performed worldwide with grafts from living donors. Radiologic evaluation is an integral component in the assessment of donor candidates to ensure their eligibility and to choose the most appropriate surgical approach. MRI is the preferred modality for evaluation of the liver parenchyma and biliary tree. In most centers, a combination of MRI and CT is used to take advantage of the higher spatial resolution of CT for evaluation of arteries. However, MRI-only assessment is feasible. In addition to assessment of the liver parenchyma for abnormalities such as steatosis, a detailed evaluation of the hepatic vascular and biliary system for pertinent anatomic variants is crucial, because these variants can affect surgical techniques and outcomes in both recipients and donors. In this pictorial article, after a brief review of the most common surgical techniques and postsurgical liver anatomy, the biliary and vascular anatomy are discussed, with specific attention paid to the variants that are pertinent to this surgical procedure. The roles of liver segmentation and volumetric assessment and current imaging techniques and protocols are also discussed. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Amir A. Borhani
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Khaled M. Elsayes
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Roberta Catania
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Avinash Kambadakone
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Alessandro Furlan
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Andrea S. Kierans
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Amita Kamath
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Carla Harmath
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Natally Horvat
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Abhinav Humar
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Ania Z. Kielar
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
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10
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Reddy S, Lopes Vendrami C, Mittal P, Borhani AA, Moreno CC, Miller FH. MRI evaluation of bile duct injuries and other post-cholecystectomy complications. Abdom Radiol (NY) 2021; 46:3086-3104. [PMID: 33576868 DOI: 10.1007/s00261-020-02947-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 12/14/2022]
Abstract
Laparoscopic cholecystectomy is one of the most common procedures performed each year and can be associated with various post-operative complications. Imaging is integral to diagnosis and management of patients with suspected cholecystectomy complications, and a thorough understanding of normal and abnormal biliary anatomy, risk factors for biliary injury, and the spectrum of adverse events is crucial for interpretation of imaging studies. Magnetic resonance cholangiography (MRC) enhanced with hepatobiliary contrast agent is useful in delineating biliary anatomy and pathology following cholecystectomy. In this article, we provide a protocol for contrast-enhanced MR imaging of the biliary tree. We also review the classification and imaging manifestations of post-cholecystectomy bile duct injuries in addition to other complications such as bilomas, retained/dropped gallstones, and vascular injuries.
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Affiliation(s)
- Shilpa Reddy
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Camila Lopes Vendrami
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Pardeep Mittal
- Department of Radiology, Medical College of Georgia, Augusta, GA, 30912, USA
| | - Amir A Borhani
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Courtney C Moreno
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA.
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11
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Aljiffry M, Abbas M, Wazzan MAM, Abduljabbar AH, Aloufi S, Aljahdli E. Biliary anatomy and pancreatic duct variations: A cross-sectional study. Saudi J Gastroenterol 2020; 26:285019. [PMID: 32461381 PMCID: PMC7580731 DOI: 10.4103/sjg.sjg_573_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/22/2020] [Accepted: 03/09/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND/AIM Biliary tree and pancreatic duct can appear in different variations whose proper understanding is obligatory for surgeons. Magnetic resonance cholangiopancreatography (MRCP) is considered a safe and accurate tool for evaluating biliary tree and pancreatic duct. Typical anatomy for right hepatic duct (RHD) and left hepatic duct (LHD) is reported as 57% and 63%, respectively. The most common (4-10%) pancreatic anomaly is divisum. In the present study, we evaluated and determined the prevalence of biliary tree and pancreatic duct variations among patients at a university hospital. MATERIALS AND METHODS The MRCP records of 370 patients from 2015 to 2017 were obtained for cross-sectional study. Images were retrospectively reviewed for variations by two independent senior radiologists. Demographic data were obtained for all the patients. Huang et al. classification was used for RHD and LHD variations. The cystic duct was reported based on its course and insertion pattern. The pancreatic duct was observed for the presence of divisum, its course, and configuration. RESULTS Three hundred and twenty-five patients were included in the final study. Most commonly observed variant for RHD were A1 (34.2%) and A2 (32.2%). For LHD, B1 (71.4%) was the most common variant. Cystic duct insertion was commonly seen as right lateral insertion (27.7%). Pancreatic divisum was observed in 0.6% of cases. Nationality, origin, and gender-specific variations were obtained. CONCLUSION Variations in biliary anatomy and pancreatic duct are very diverse and extend from the intrahepatic biliary system down to the pancreas. Performing a similar study on a larger population is mandatory to illustrate the range of variations present within the community.
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Affiliation(s)
- Murad Aljiffry
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammad Abbas
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammad A. M. Wazzan
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed H. Abduljabbar
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Safiyah Aloufi
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Emad Aljahdli
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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12
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Kurahashi S, Komatsu S, Matsumura T, Fukami Y, Arikawa T, Saito T, Osawa T, Uchino T, Kato S, Suzuki K, Toda Y, Kaneko K, Sano T. A novel classification of aberrant right hepatic ducts ensures a critical view of safety in laparoscopic cholecystectomy. Surg Endosc 2020; 34:2904-2910. [PMID: 32377838 DOI: 10.1007/s00464-020-07610-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/28/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Based on the spatial relationship of an aberrant right hepatic duct (ARHD) with the cystic duct and gallbladder neck, we propose a practical classification to evaluate the specific form predisposing to injury in laparoscopic cholecystectomy (LC). METHODS We retrospectively investigated the preoperative images (mostly magnetic resonance cholangiopancreatography) and clinical outcomes of 721 consecutive patients who underwent LC at our institute from 2015 to 2018. We defined the high-risk ARHD as follows: Type A: communicating with the cystic duct and Type B: running along the gallbladder neck or adjacent to the infundibulum (the minimal distance from the ARHD < 5 mm), regardless of the confluence pattern in the biliary tree. Other ARHDs were considered to be of low risk. RESULTS A high-risk ARHD was identified in 16 cases (2.2%): four (0.6%) with Type A anatomy and 12 (1.7%) with Type B. The remaining ARHD cases (n = 34, 4.7%) were categorized as low risk. There were no significant differences in the operative outcomes (operative time, blood loss, hospital stay) between the high- and low- risk groups. Subtotal cholecystectomy was applied in four cases (25%) in the high-risk group, a significantly higher percentage than the low-risk group (n = 1, 2.9%). In all patients with high-risk ARHD, LC was completed safely without bile duct injury or conversion to laparotomy. CONCLUSIONS Our simple classification of high-risk ARHD can highlight the variants located close to the dissecting site to achieve a critical view of safety and may contribute to avoiding inadvertent damage of an ARHD in LC.
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Affiliation(s)
- Shintaro Kurahashi
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shunichiro Komatsu
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Tatsuki Matsumura
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yasuyuki Fukami
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takashi Arikawa
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takuya Saito
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takaaki Osawa
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tairin Uchino
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shoko Kato
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kenta Suzuki
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yoko Toda
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kenitiro Kaneko
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tsuyoshi Sano
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
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13
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Rahmani B, Gandhi J, Joshi G, Smith NL, Reid I, Khan SA. The Role of Diabetes Mellitus in Diseases of the Gallbladder and Biliary Tract. Curr Diabetes Rev 2020; 16:931-948. [PMID: 32133965 DOI: 10.2174/1573399816666200305094727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The increasing prevalence of diabetes mellitus worldwide continues to pose a heavy burden. Though its gastrointestinal impact is appropriately recognized, the lesser known associations may be overlooked. OBJECTIVE We aim to review the negative implications of diabetes on the gallbladder and the biliary tract. METHODS A MEDLINE® database search of literature was conducted with emphasis on the previous five years, combining keywords such as "diabetes," "gallbladder," and "biliary". RESULTS The association of diabetes to the formation of gallstones, gallbladder cancer, and cancer of the biliary tract are discussed along with diagnosis and treatment. CONCLUSION Though we uncover the role of diabetic neuropathy in gallbladder and biliary complications, the specific individual diabetic risk factors behind these developments is unclear. Also, in addition to diabetes control and surgical gallbladder management, the treatment approach also requires further focus.
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Affiliation(s)
- Benjamin Rahmani
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook,
NY, USA
| | - Jason Gandhi
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook,
NY, USA
- Medical Student Research Institute, St. George’s University School of Medicine, Grenada, West Indies
| | - Gunjan Joshi
- Department of Internal Medicine, Stony Brook Southampton Hospital, Southampton, NY, USA
| | | | - Inefta Reid
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook,
NY, USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook,
NY, USA
- Department of Urology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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14
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Quijano Y. Características anatómicas de las vías biliares en una muestra de cadáveres de población colombiana. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.15446/revfacmed.v68n1.70880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. En comparación con otros países, los estudios sobre características anatómicas de vías biliares en población colombiana son escasos.Objetivo. Analizar las características anatómicas de las vías biliares en una muestra de 60 tractos gastrointestinales de población colombiana.Materiales y métodos. Se realizó un estudio descriptivo analítico transversal donde se emplearon y disecaron las vías biliares de 60 tractos gastrointestinales humanos.Resultados. Según la clasificación de Blumgart de las variaciones anatómicas del tracto biliar, se encontraron las siguientes variaciones: Tipo A (78.3%), Tipo B (5%), Tipo C2 (3.3%), Tipo D2 (1.7%), Tipo E1 (1.7%), Tipo E2 (8.3%) y Tipo F (1.7%). En cuanto a las dimensiones promedio de las vías biliares extrahepáticas, se encontraron los siguientes diámetros y longitudes: conducto hepático derecho, 3.62mm y 10.64mm; conducto hepático izquierdo, 3.66mm y 10.74mm; conducto hepático común, 4.97mm y 25.59mm, y conducto colédoco, 4.90mm y 39.58mm. En general, las características anatómicas observadas en la mayoría de la muestra fueron similares a las reportadas en la literatura.Conclusiones. En el 78.3% de los casos se observaron características anatómicas usuales, mientras que las variantes anatómicas estuvieron presentes en el 21.7%. La longitud y el diámetro de las vías biliares están dentro del promedio reportado en la literatura.
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15
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Rhaiem R, Piardi T, Renard Y, Chetboun M, Aghaei A, Hoeffel C, Sommacale D, Kianmanesh R. Preoperative magnetic resonance cholangiopancreatography before planned laparoscopic cholecystectomy: is it necessary? JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2019; 24:107. [PMID: 31949458 PMCID: PMC6950362 DOI: 10.4103/jrms.jrms_281_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/01/2019] [Accepted: 10/07/2019] [Indexed: 12/24/2022]
Abstract
Background: The most feared complication of laparoscopic cholecystectomy (LC) is biliary tract injuries (BTI). We conducted a prospective study to evaluate the role of preoperative magnetic resonance cholangiopancreatography (MRCP) in describing the biliary tract anatomy and to investigate its potential benefit to prevent BTI. Materials and Methods: From January 2012 to December 2016, 402 patients who underwent LC with preoperative MRCP were prospectively included. Routine intraoperative cholangiography was not performed. Patients' characteristics, preoperative diagnosis, biliary anatomy, conversion to laparotomy, and the incidence of BTI were analyzed. Results: Preoperative MRCP was performed prospectively in 402 patients. LC was indicated for cholecystitis and pancreatitis, respectively, in 119 (29.6%) and 53 (13.2%) patients. One hundred and five (26%) patients had anatomical variations of biliary tract. Three BTI (0.75%) occurred with a major BTI (Strasberg E) and two bile leakage from the cystic stump (Strasberg A). For these 3 patients, biliary anatomy was modal on MRCP. No BTI occurred in patients presenting “dangerous” biliary anatomical variations. Conclusion: MRCP could be a valuable tool to study preoperatively the biliary anatomy and to recognize “dangerous” anatomical variations. Subsequent BTI might be avoided. Further randomized trials should be designed to assess its real value as a routine investigation before LC.
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Affiliation(s)
- Rami Rhaiem
- Department of Digestive and Hepatobiliary Surgery, Robert Debré University-Hospital, University Champagne-Ardennes, Reims, France
| | - Tullio Piardi
- Department of Digestive and Hepatobiliary Surgery, Robert Debré University-Hospital, University Champagne-Ardennes, Reims, France
| | - Yohann Renard
- Department of Digestive and Hepatobiliary Surgery, Robert Debré University-Hospital, University Champagne-Ardennes, Reims, France
| | - Mikael Chetboun
- Department of Digestive and Hepatobiliary Surgery, Robert Debré University-Hospital, University Champagne-Ardennes, Reims, France
| | - Arman Aghaei
- Department of Digestive and Hepatobiliary Surgery, Robert Debré University-Hospital, University Champagne-Ardennes, Reims, France
| | - Christine Hoeffel
- Department of Radiology, Robert Debré University-Hospital, University Champagne-Ardennes Reims, France
| | - Daniele Sommacale
- Department of Digestive and Hepatobiliary Surgery, Robert Debré University-Hospital, University Champagne-Ardennes, Reims, France
| | - Reza Kianmanesh
- Department of Digestive and Hepatobiliary Surgery, Robert Debré University-Hospital, University Champagne-Ardennes, Reims, France
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16
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Lubikowski J, Piotuch B, Stadnik A, Przedniczek M, Remiszewski P, Milkiewicz P, Silva MA, Wojcicki M. Difficult iatrogenic bile duct injuries following different types of upper abdominal surgery: report of three cases and review of literature. BMC Surg 2019; 19:162. [PMID: 31694627 PMCID: PMC6833182 DOI: 10.1186/s12893-019-0619-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/10/2019] [Indexed: 12/14/2022] Open
Abstract
Background Iatrogenic bile duct injuries (BDIs) are mostly associated with laparoscopic cholecystectomy but may also occur following gastroduodenal surgery or liver resection. Delayed diagnosis of type of injury with an ongoing biliary leak as well as the management in a non-specialized general surgical units are still the main factors affecting the outcome. Case presentation Herein we present three types of BDIs (Bismuth type I, IV and V) following three different types of upper abdominal surgery, ie. Billroth II gastric resection, laparoscopic cholecystectomy and left hepatectomy. All of them were complex injuries with complete bile duct transections necessitating surgical treatment. All were also very difficult to treat mainly because of a delayed diagnosis of type of injury, associated biliary leak and as a consequence severe inflammatory changes within the liver hilum. The treatment was carried out in our specialist hepatobiliary unit and first focused on infection and inflammation control with adequate biliary drainage. This was followed by a delayed surgical repair with the technique which had to be tailored to the type of injury in each case. Conclusion We emphasize that staged and individualized treatment strategy is often necessary in case of a delayed diagnosis of complex BDIs presenting with a biliary leak, inflammatory intraabdominal changes and infection. Referral of such patients to expert hepatobiliary centres is crucial for the outcome.
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Affiliation(s)
- Jerzy Lubikowski
- Department of General and Oncological Surgery, Pomeranian Medical University, Szczecin, Poland.,Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, M. Curie Hospital, Szczecin, Poland
| | - Bernard Piotuch
- Department of Surgery, Ministry of the Interior and Administration Hospital, Szczecin, Poland.,Department of General and Hand Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Anna Stadnik
- Department of Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Marta Przedniczek
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097, Warsaw, Poland
| | - Piotr Remiszewski
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097, Warsaw, Poland
| | - Piotr Milkiewicz
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097, Warsaw, Poland.,Translational Medicine Group, Pomeranian Medical University, Szczecin, Poland
| | - Michael A Silva
- Department of Hepatobiliary and Pancreatic Surgery, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Maciej Wojcicki
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, ul. Banacha 1a, 02-097, Warsaw, Poland.
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17
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Sommariva C, Lauro A, Pagano N, Vaccari S, D'Andrea V, Marino IR, Cervellera M, Tonini V. Subcapsular Hepatic Hematoma Post-ERCP: Case Report and Review of the Literature. Dig Dis Sci 2019; 64:2114-2119. [PMID: 31197631 DOI: 10.1007/s10620-019-05679-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Hepatic hematoma is a rare but possible complication of ERCP. We describe the case of a 75-year old man with a large, 8 × 12 cm, sub-capsular and intra-parenchymal hematoma post ERCP, affecting the right liver segments and treated conservatively. AREAS COVERED A review of literature has been performed, highlighting two possible mechanisms: hematoma may occur as the result of accidental laceration of a small intrahepatic vessel by the guidewire, whereas the other hypothesis posits that the hepatic damage is secondary to traction on the biliary system exerted by the balloon. We speculate that in case of anomalies of the biliary tree, the incidence of this complication is higher than expected. EXPERT COMMENTARY In case of hepatic hematoma post ERCP, a conservative approach should always be considered before proceeding to interventional radiologic procedures or to surgical therapy.
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Affiliation(s)
- C Sommariva
- Surgery Emergency and GI Department, St. Orsola University Hospital, Bologna, Italy
| | - A Lauro
- Surgery Emergency and GI Department, St. Orsola University Hospital, Bologna, Italy.
| | - N Pagano
- Surgery Emergency and GI Department, St. Orsola University Hospital, Bologna, Italy
| | - S Vaccari
- Surgery Emergency and GI Department, St. Orsola University Hospital, Bologna, Italy
| | - V D'Andrea
- Department of Surgical Sciences, La Sapienza University, Umberto I Hospital, Rome, Italy
| | - I R Marino
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - M Cervellera
- Surgery Emergency and GI Department, St. Orsola University Hospital, Bologna, Italy
| | - V Tonini
- Surgery Emergency and GI Department, St. Orsola University Hospital, Bologna, Italy
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18
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Battula NR, Anbarasan R, Thumma V, Perera MTPR, Muiesan P, Isaac JR, Sharif K, Mirza DF. Utility of a routine bench cholangiogram for ex situ split liver procedure. Clin Transplant 2019; 33:e13614. [DOI: 10.1111/ctr.13614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/10/2019] [Accepted: 05/19/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Narendra R. Battula
- Division of Transplant & Hepatobiliary Surgery University of Florida Gainesville Florida
| | | | | | - M. Thamara P. R. Perera
- Liver Unit Queen Elizabeth University Hospital Birmingham UK
- Liver Unit Birmingham Children's Hospital Birmingham UK
| | - Paolo Muiesan
- Liver Unit Queen Elizabeth University Hospital Birmingham UK
- Liver Unit Birmingham Children's Hospital Birmingham UK
| | - John R. Isaac
- Liver Unit Queen Elizabeth University Hospital Birmingham UK
| | - Khalid Sharif
- Liver Unit Birmingham Children's Hospital Birmingham UK
| | - Darius F. Mirza
- Liver Unit Queen Elizabeth University Hospital Birmingham UK
- Liver Unit Birmingham Children's Hospital Birmingham UK
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19
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Bauschke A, Altendorf-Hofmann A, Malessa C, Rohland O, Settmacher U. [Influence of bile duct anatomy on biliary complications in hepatic right lobe living donors]. Chirurg 2019; 89:222-228. [PMID: 28940029 DOI: 10.1007/s00104-017-0514-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Perioperative morbidity in the living donation of partial livers is mainly due to infections and biliary complications. Bile duct anatomy variants, in particular of the right system, are suspected to be causative. We investigated the influence of bile duct variants on the incidence of biliary donor complications in donations of the right liver lobe. We analyzed 103 donors. Twelve patients had a bile leak that required treatment. All of these were treated endoscopically without any residual defect. We did not see a central extrahepatic bile duct lesion Nagano type C. The anatomic variant Huang A3 is a challenge with respect to the surgical technique. Three of 17 patients with biliary anatomy Huang A3 developed leaks. The bile duct anatomy can be carefully evaluated by magnetic resonance cholangiopancreatography (MRCP) and intraoperative cholangiography. The anatomic variant Huang A3 warrants particular attention for the closure of the bile duct orifice.
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Affiliation(s)
- A Bauschke
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland.
| | - A Altendorf-Hofmann
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland
| | - C Malessa
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland
| | - O Rohland
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland
| | - U Settmacher
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland
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20
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Magnetic resonance and retrograde endoscopic cholangiopancreatography-based identification of biliary tree variants: are there type-related variabilities among the Saudi population? Surg Radiol Anat 2019; 41:869-877. [DOI: 10.1007/s00276-019-02249-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 04/25/2019] [Indexed: 12/17/2022]
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21
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Pessanha I, Alexandrino H, Piedade C, Cunha C, Gonçalves I, Lopes MF, Furtado E. Successful liver transplantation using a whole liver graft with gallbladder agenesis: First report in pediatric liver transplantation. Pediatr Transplant 2019; 23:e13342. [PMID: 30575232 DOI: 10.1111/petr.13342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/14/2018] [Accepted: 11/27/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Gallbladder agenesis (GA) is a rare congenital condition, occurring in approximately 40/100.000. It is likely due to an embryologic mishap in the development of the gallbladder bud and can be associated with other congenital variations in biliary anatomy. However, the liver likely suffers no functional impairment and can be safely used for transplantation. To the best of our knowledge, this is the first case report describing a pediatric liver transplantation (PLT) using a graft with GA. CASE REPORT A 10-year-old boy with methylmalonic aciduria underwent isolated liver transplant with a deceased graft from a donor with no relevant medical or surgical history and normal laboratory tests. During the back-table liver preparation procedure, no evidence of gallbladder was found, raising the possibility of a GA, confirmed by intraoperative cholangiography. The liver transplantation procedure was uneventful despite the particularly rare combination of biliary tree anatomic distribution found in the cholangiography. At 1 year of follow-up, there were no clinical, laboratory, or imagological signs of bile leaks or anastomotic site stricture. DISCUSSION The present report highlights the importance of the accurate knowledge of the vasculobiliary anatomic variation, particularly in extremely rare cases, such as GA, and in complex hepatobiliary procedures, such as PLT. In our opinion, grafts with GA should not be discarded for transplantation.
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Affiliation(s)
- Inês Pessanha
- Department of Paediatric Surgery, Paediatric Hospital, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Henrique Alexandrino
- Department of General Surgery, Centro Hospitalar e Universitário de Coimbra, University Hospitals of Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Cláudia Piedade
- Department of Paediatric Surgery, Paediatric Hospital, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Paediatric and Adult Liver Transplantation Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Catarina Cunha
- Department of Paediatric Surgery, Paediatric Hospital, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Paediatric and Adult Liver Transplantation Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Isabel Gonçalves
- Paediatric and Adult Liver Transplantation Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Maria Francelina Lopes
- Department of Paediatric Surgery, Paediatric Hospital, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Paediatric and Adult Liver Transplantation Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Emanuel Furtado
- Paediatric and Adult Liver Transplantation Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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22
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Abstract
RATIONALE The clinical manifestations of VACTERL association include vertebral anomalies, anal atresia, congenital heart diseases, tracheoesophageal fistula, renal dysplasia, and limb abnormalities. The association of intrahepatic anomalies and VACTERL syndrome is a rare coincidence. VACTER syndrome and intrahepatic bile drainage anomalies might be genetically related. PATIENT CONCERNS A 12-year-old girl presented with episodic colicky abdominal pain, nausea, and vomiting for several years. The individual episodes resolved spontaneously within a few days. She had a history of VACTERL syndrome, including a butterfly shape of the L3 vertebra, anal atresia, and an atrial septal defect. DIAGNOSES On laboratory findings, abnormal liver function tests included elevated total bilirubin, alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyltransferase. There was no significant abnormal finding in hepatobiliary system sonography except mild gallbladder wall thickening. We performed magnetic resonance cholangiopancreatography and demonstrated an abnormal intrahepatic bile duct confluence, which showed 3 bile ducts draining directly into the neck of the gallbladder. INTERVENTION Her symptoms related to bile reflux during gallbladder contraction. Cholecystectomy with choledochojejunostomy was undertaken because segments of the bile drainage were intertwined. OUTCOMES After surgery, her symptoms decreased, but abdominal discomfort remained due to uncorrected left intrahepatic anomalies. LESSONS Although hepatobiliary anomalies are not included in VACTERL association diagnostic criteria, detailed hepatobiliary work up is needed when gastrointestinal symptoms are present in VACTERL association patients.
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Affiliation(s)
| | | | - Suk Keu Yeom
- Department of Radiology, College of Medicine, Korea University, Seoul
- Department of Radiology
| | - JeeHyun Lee
- Department of Pediatrics
- Department of Pediatrics, Korea University Medical Center Ansan Hospital, Korea
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23
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Rassam F, Roos E, van Lienden KP, van Hooft JE, Klümpen HJ, van Tienhoven G, Bennink RJ, Engelbrecht MR, Schoorlemmer A, Beuers UHW, Verheij J, Besselink MG, Busch OR, van Gulik TM. Modern work-up and extended resection in perihilar cholangiocarcinoma: the AMC experience. Langenbecks Arch Surg 2018; 403:289-307. [PMID: 29350267 PMCID: PMC5986829 DOI: 10.1007/s00423-018-1649-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/15/2017] [Indexed: 12/12/2022]
Abstract
AIM Perihilar cholangiocarcinoma (PHC) is a challenging disease and requires aggressive surgical treatment in order to achieve curation. The assessment and work-up of patients with presumed PHC is multidisciplinary, complex and requires extensive experience. The aim of this paper is to review current aspects of diagnosis, preoperative work-up and extended resection in patients with PHC from the perspective of our own institutional experience with this complex tumor. METHODS We provided a review of applied modalities in the diagnosis and work-up of PHC according to current literature. All patients with presumed PHC in our center between 2000 and 2016 were identified and described. The types of resection, surgical techniques and outcomes were analyzed. RESULTS AND CONCLUSION Upcoming diagnostic modalities such as Spyglass and combinations of serum biomarkers and molecular markers have potential to decrease the rate of misdiagnosis of benign, inflammatory disease. Assessment of liver function with hepatobiliary scintigraphy provides better information on the future remnant liver (FRL) than volume alone. The selective use of staging laparoscopy is advisable to avoid futile laparotomies. In patients requiring extended resection, selective preoperative biliary drainage is mandatory in cholangitis and when FRL is small (< 50%). Preoperative portal vein embolization (PVE) is used when FRL volume is less than 40% and optionally includes the left portal vein branches to segment 4. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) as alternative to PVE is not recommended in PHC. N2 positive lymph nodes preclude long-term survival. The benefit of unconditional en bloc resection of the portal vein bifurcation is uncertain. Along these lines, an aggressive surgical approach encompassing extended liver resection including segment 1, regional lymphadenectomy and conditional portal venous resection translates into favorable long-term survival.
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Affiliation(s)
- F Rassam
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
| | - E Roos
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - K P van Lienden
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - J E van Hooft
- Department of Gastroenterology & Hepatology and Tytgat Institute for Liver and Intestinal Research, Academic Medical Center, Amsterdam, The Netherlands
| | - H J Klümpen
- Department of Medical Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - G van Tienhoven
- Department of Radiotherapy, Academic Medical Center, Amsterdam, The Netherlands
| | - R J Bennink
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - M R Engelbrecht
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - A Schoorlemmer
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - U H W Beuers
- Department of Gastroenterology & Hepatology and Tytgat Institute for Liver and Intestinal Research, Academic Medical Center, Amsterdam, The Netherlands
| | - J Verheij
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - M G Besselink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - O R Busch
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - T M van Gulik
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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24
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Kleinubing DR, Riera R, Matos D, Linhares MM. Selective versus routine intraoperative cholangiography for cholecystectomy. Hippokratia 2018. [DOI: 10.1002/14651858.cd012971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Diego R Kleinubing
- Universidade Federal do Pampa; Department of Surgery, Faculty of Medicine; Uruguaiana Rio Grande do Sul Brazil
| | - Rachel Riera
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde; Cochrane Brazil; Rua Borges Lagoa, 564 cj 63 São Paulo SP Brazil 04038-000
| | - Delcio Matos
- Escola Paulista de Medicina, Universidade Federal de São Paulo; Department of Gastroenterological Surgery; Rua Edison 278, Apto 61 Campo Belo São Paulo São Paulo Brazil 04618-031
| | - Marcelo Moura Linhares
- Universidade Federal de São Paulo; Department of Surgery; Rua Leandro Dupre, 334. Ap-21 Sao Paulo SP Brazil 04025011
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25
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Liu X, Min X, Ma Z, He X, Du Z. Laparoscopic hepatectomy produces better outcomes for hepatolithiasis than open hepatectomy: An updated systematic review and meta-analysis. Int J Surg 2018; 51:151-163. [PMID: 29367038 DOI: 10.1016/j.ijsu.2018.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 01/13/2018] [Accepted: 01/16/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The present meta-analysis focused on comparing the efficacy and safety of laparoscopic hepatectomy (LH) versus open hepatectomy (OH) for hepatolithiasis. In detail, short-term outcomes including operative time, intraoperative blood loss, intraoperative blood transfusion, postoperative time to oral intake, length of hospital stay, overall postoperative complication rate, initial residual stone, and stone recurrence were analyzed systematically. METHODS PubMed, Embase, Web of Science and Cochrane Library were comprehensively searched for eligible studies up to Jun. 30. 2017. Bibliographic citation management software (EndNoteX7) was applied to literature management. Quality assessment was carried out according to the modification of the Newcastle-Ottawa Scale (NOS). The data were analyzed by Stata SE12.0 (StataCorp, College Station, TX). Sensitivity analysis was conducted by deleting single study step by step. Odds ratio (OR) were calculated for dichotomous data, and standard mean difference (SMD) with 95% confidence intervals (CI) was calculated continuous data. RESULTS = 0%; P = 0.22). In addition, our stratified analysis according to types of LH indicated that the laparoscopic approach still produced more favorable outcomes whatever patients underwent left lateral sectionectomy (LLS) or left hemihepatectomy (LHH). CONCLUSION The laparoscopic hepatectomy is a better alternative to open approach in patients with hepatolithiasis, providing less overall complication rate, shorter postoperative stay of hospital stay, less blood loss, and shorter time to oral intake. However, high-quality randomized controlled trials (RCTs) are badly needed to provide higher-level evidence due to unavoidable bias from non-randomized trials.
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Affiliation(s)
- Xiaohong Liu
- Department of General Surgery, The Second Hospital of Lanzhou University, Lanzhou 730030, China
| | - Xiaocui Min
- Department of Hepatology, The Second Hospital of Lanzhou University, 82 Cuiyingmen, Lanzhou 730030, China
| | - Zhen Ma
- Department of Hepatology, The Second Hospital of Lanzhou University, 82 Cuiyingmen, Lanzhou 730030, China
| | - Xiaodong He
- Lanzhou University, 199 West Donggang Road, Lanzhou, Gansu 730000, China
| | - Zhixing Du
- Department of General Surgery, The Second Hospital of Lanzhou University, Lanzhou 730030, China.
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26
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Imamura H, Eguchi S, Shapiro AMJ, Kin T. A case of double common bile duct in a deceased donor for transplantation. Surg Radiol Anat 2017; 39:1409-1411. [PMID: 28523346 PMCID: PMC5681599 DOI: 10.1007/s00276-017-1874-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/15/2017] [Indexed: 02/07/2023]
Abstract
A double common bile duct is extremely rare among the anatomical variations in the biliary tract system. We report an incidentally encountered case of the double common bile duct and discuss the novel anatomical findings of the accessory common bile duct from the viewpoint of embryology. A unique point of our case is that the accessory common bile duct bifurcated at the level of the intrapancreatic bile duct. There is no similar case in the previous literature among type II double common bile duct in the viewpoint of anatomical findings of the accessory common bile duct. We assume that this asymptomatic anatomical variation may be present more commonly, but not diagnosed.
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Affiliation(s)
- Hajime Imamura
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Clinical Islet Transplantation Program, University of Alberta, Edmonton, AB, Canada
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - A M James Shapiro
- Clinical Islet Transplantation Program, University of Alberta, Edmonton, AB, Canada
| | - Tatsuya Kin
- Clinical Islet Transplantation Program, University of Alberta, Edmonton, AB, Canada.
- Clinical Islet Laboratory, University of Alberta, 210 College Plaza, 8215-112th St, Edmonton, AB, T6G 2C8, Canada.
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27
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Kostakis ID, Feretis T, Stamopoulos P, Garoufalia Z, Dimitroulis D, Kykalos S, Kouraklis G, Tsourouflis G. A rare anatomical variation of the biliary tree. J Surg Case Rep 2017; 2017:rjx087. [PMID: 28584622 PMCID: PMC5451662 DOI: 10.1093/jscr/rjx087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 03/19/2017] [Accepted: 05/05/2017] [Indexed: 12/13/2022] Open
Abstract
A 31-year-old woman was admitted to our department in order to undergo a laparoscopic cholecystectomy. The operation was converted to open due to cholorrhea during the dissection in the hepatocystic triangle. The cholorrhea came from a transected bile duct, which was 2 mm in diameter, came out of the hepatoduodenal ligament, ran along the common hepatic duct and drained into the cystic duct, in proximity to the neck of the gallbladder. The gallbladder was removed and an intraoperative cholangiography revealed that the aberrant bile duct was originated from the right posterior sectoral duct (RPSD). The RPSD continued its typical course up to its confluence with the right anterior sectoral duct and the formation of the right hepatic duct. This is a rare type of aberrant bile duct, which is added to the long catalogue of the anatomical variations of the biliary tree.
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Affiliation(s)
- Ioannis D Kostakis
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
| | - Themistoklis Feretis
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
| | - Paraskevas Stamopoulos
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
| | - Zoe Garoufalia
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
| | - Dimitrios Dimitroulis
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
| | - Stylianos Kykalos
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
| | - Gregory Kouraklis
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
| | - Gerasimos Tsourouflis
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
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28
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Ji GW, Zhu FP, Wang K, Jiao CY, Shao ZC, Li XC. Clinical Implications of Biliary Confluence Pattern for Bismuth-Corlette Type IV Hilar Cholangiocarcinoma Applied to Hemihepatectomy. J Gastrointest Surg 2017; 21:666-675. [PMID: 28168674 DOI: 10.1007/s11605-017-3377-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/23/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Since biliary variations are commonly seen, our aims are to clarify these insidious variations and discuss their surgicopathologic implications for Bismuth-Corlette (BC) type IV hilar cholangiocarcinoma (HC) applied to hemihepatectomy. METHODS Three-dimensional images of patients with distal bile duct obstruction (n = 97) and advanced HC (n = 79) were reconstructed and analyzed retrospectively. Normal biliary confluence pattern was defined as the peripheral segment IV duct (B4) joining the common trunk of segment II (B2) and segment III (B3) ducts to form the left hepatic duct (LHD) that then joined the right hepatic duct (RHD). The lengths from left and right secondary biliary ramifications to the right side of the umbilical portion of the left portal vein (Rl-L) and the cranio-ventral side of the right portal vein (Rr-R) were measured, respectively, and compared with the resectable bile duct length in HCs. Surgicopathologic findings were compared between different BC types. RESULTS The resectable bile duct length in right hemihepatectomy for eradication of type IV tumors was significantly longer than the Rl-L length in normal biliary configuration (17.4 ± 1.8 and 10.3 ± 3.4 mm, respectively, p < 0.001), and type III variation (B2 joining the common trunk of B3 and B4) was the predominant configuration (53.8%). The resectable length in left hemihepatectomy for eradication of type IV tumors was comparable with the Rr-R length in RHD absent cases (15.2 ± 2.5 and 16.4 ± 2.6 mm, respectively, p = 0.177) but significantly longer than that in normal configuration (p < 0.001). The estimated length was 8.5 ± 2.0 mm in unresectable cases. There was no significant difference between type III and IV tumors, except for the rate of nodal metastasis (29.7 and 76.0%, respectively, p < 0.001). CONCLUSION Hemihepatectomy might be selected for curative-intent resection of BC type IV tumors considering the advantageous biliary variations, whereas anatomical trisegmentectomy is recommended for the resectable bile duct length less than 10 mm. Biliary variations might result in excessive classification of BC type IV but require validation on further study.
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Affiliation(s)
- Gu-Wei Ji
- Key Laboratory on Living Donor Liver Transplantation, Ministry of Health, Department of Liver Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China
| | - Fei-Peng Zhu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Ke Wang
- Key Laboratory on Living Donor Liver Transplantation, Ministry of Health, Department of Liver Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China
| | - Chen-Yu Jiao
- Key Laboratory on Living Donor Liver Transplantation, Ministry of Health, Department of Liver Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China
| | - Zi-Cheng Shao
- Key Laboratory on Living Donor Liver Transplantation, Ministry of Health, Department of Liver Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China
| | - Xiang-Cheng Li
- Key Laboratory on Living Donor Liver Transplantation, Ministry of Health, Department of Liver Surgery, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People's Republic of China.
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