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The clinical effect of primary duct closure and T-tube drainage: A propensity score matched study. Asian J Surg 2022:S1015-9584(22)01411-7. [PMID: 36283872 DOI: 10.1016/j.asjsur.2022.09.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/16/2022] [Accepted: 09/28/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although laparoscopic common bile duct exploration (LCBDE) is considered a safe and effective method for the removal of bile duct stones, selecting primary duct closure (PDC) or T-tube drainage (TTD) following choledochotomy remains controversial. This study aims to explore the clinical effects of PDC and TTD after LCBDE. METHODS We retrospectively analyzed clinical data of 348 patients with choledocholithiasis treated with LCBDE from January 2016 to October 2020. All patients were divided into PDC (225 cases) and TTD (123 cases) groups. Propensity score matching (PSM) was performed. We compared operative parameters and outcomes. RESULTS After matching (n = 116/group), no significant difference was observed between the two groups (P > 0.05) regarding intra-abdominal infection, incision infection, bile leakage, and retained stones. In terms of operation time, intraoperative blood loss, postoperative hospital stay, postoperative exhaust time, postoperative antibiotic use time, and postoperative abdominal drainage time, PDC group was obviously superior to TTD group (P < 0.05). CONCLUSION Primary closure following LCBDE is considered a safe and effective alternative to T-tube drainage.
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Gigola F, Grimaldi C, Bici K, Ghionzoli M, Spinelli C, Muiesan P, Morabito A. Epidemiology and Surgical Management of Foreign Bodies in the Liver in the Pediatric Population: A Systematic Review of the Literature. CHILDREN 2022; 9:children9020120. [PMID: 35204841 PMCID: PMC8870636 DOI: 10.3390/children9020120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/28/2021] [Accepted: 01/11/2022] [Indexed: 11/16/2022]
Abstract
Retention of foreign bodies (FB) in the liver parenchyma is a rare event in children but it can bring a heavy burden in terms of immediate and long-term complications. Multiple materials can migrate inside the liver. Clinical manifestations may vary, depending on the nature of the foreign body, its route of penetration and timing after the initial event. Moreover, the location of the FB inside the liver parenchyma may pose specific issues related to the possible complications of a challenging surgical extraction. Different clinical settings and the need for highly specialized surgical skills may influence the overall management of these children. Given the rarity of this event, a systematic review of the literature on this topic was conducted and confirmed the pivotal role of surgery in the pediatric population.
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Affiliation(s)
- Francesca Gigola
- Department of Pediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (F.G.); (K.B.); (M.G.); (A.M.)
| | - Chiara Grimaldi
- Department of Pediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (F.G.); (K.B.); (M.G.); (A.M.)
- Correspondence:
| | - Kejd Bici
- Department of Pediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (F.G.); (K.B.); (M.G.); (A.M.)
| | - Marco Ghionzoli
- Department of Pediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (F.G.); (K.B.); (M.G.); (A.M.)
| | - Claudio Spinelli
- Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, 56100 Pisa, Italy;
| | - Paolo Muiesan
- Department of Hepatobiliary Surgery, Careggi University Hospital, 50134 Florence, Italy;
| | - Antonino Morabito
- Department of Pediatric Surgery, Meyer Children’s Hospital, 50139 Florence, Italy; (F.G.); (K.B.); (M.G.); (A.M.)
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Rajput D, Patnaik I, Shasheendran S, Kumar BKP, Gupta A. Fractured T Tube Fragment in Common Bile Duct during Retrieval: An Unforeseen Mishap. Surg J (N Y) 2021; 7:e251-e254. [PMID: 34541317 PMCID: PMC8440054 DOI: 10.1055/s-0041-1735643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 07/12/2021] [Indexed: 11/05/2022] Open
Abstract
Common bile duct (CBD) exploration by surgical method—open or laparoscopic, traditionally involved using a T tube to take care of postoperative intraluminal pressure and edema. The complications of T tube include bile leak after removal, formation of biliary fistula, excoriation of the skin, dehydration, saline depletion, retained T tube fragment, CBD obstruction, cholangitis, pancreatitis, and duodenal erosion. Here, we report a case of retained T tube fragment after an attempted removal in an operated case of choledocholithiasis, which was managed by endoscopic retrograde cholangiopancreatography and balloon catheter removal of the remnant.
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Affiliation(s)
- Deepak Rajput
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, Dehradun, India
| | - Itish Patnaik
- Department of Medical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Dehradun, India
| | - Sruthi Shasheendran
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, Dehradun, India
| | - Beeram K Prasanna Kumar
- Department of Medical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Dehradun, India
| | - Amit Gupta
- Department of General Surgery, All India Institute of Medical Sciences, Rishikesh, Dehradun, India
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Aggarwal D, Jain V. Horseshoe kidney leading to ERCP failure; innovative use of guide wire during laparoscopic CBD exploration: A case report. Int J Surg Case Rep 2021; 82:105927. [PMID: 33962263 PMCID: PMC8113847 DOI: 10.1016/j.ijscr.2021.105927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Horseshoe kidneys are the most common fusion defect of the kidneys, which amounts to about 0.25% of the population. They are usually asymptomatic and are often identified incidentally. The horseshoe kidney can push the second and third part of the duodenum anteriorly, leading to an altered CBD course. Choledocholithiasis is seen in approximately 10-15% of patients with cholelithiasis. Presently, the most preferred approach for managing CBD stones is ERCP. However, in ERCP failure cases, Laparoscopic CBD exploration is the primary treatment modality, with or without T-tube use, with all the advantages of minimally invasive surgery. CASE PRESENTATION AND DISCUSSION A 65-year-old female presented with complaints of pain in the right hypochondriac region for three months associated with nausea, jaundice, and loss of appetite and weight. Her USG abdomen showed cholelithiasis with dilated CBD with horseshoe kidney with severe hydronephrosis of the left kidney. They are usually asymptomatic and are often identified incidentally. In this patient, it was believed that the horseshoe kidney had pushed the second and third part of the duodenum anteriorly, leading to an altered CBD course leading to ERCP failure. MRCP confirmed cholelithiasis with choledocholithiasis with dilated CBD of 11.3 mm with horseshoe kidney. ERCP was attempted but was unsuccessful due to non-visualization of the papilla due to overcrowding of duodenal folds. For patients with ERCP failure, laparoscopic CBD exploration is mandatory. For this patient, the CBD was cannulated with a guidewire, if needed, for repeat ERCP and was closed with T-tube in situ. CONCLUSION There are no particular preoperative indicators that can predict the failure of ERCP. However, in ERCP failure cases, laparoscopic CBD exploration (with or without T-tube use) is the primary treatment modality.
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Affiliation(s)
- Deepika Aggarwal
- Department of General Surgery, Mata Chanan Devi Hospital, New Delhi, India.
| | - Vimal Jain
- Department of General Surgery, Mata Chanan Devi Hospital, New Delhi, India
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5
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Yu M, Huang B, Lin Y, Nie Y, Zhou Z, Liu S, Hou B. Acute obstructive cholangitis due to fishbone in the common bile duct: a case report and review of the literature. BMC Gastroenterol 2019; 19:177. [PMID: 31699035 PMCID: PMC6839197 DOI: 10.1186/s12876-019-1088-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 10/02/2019] [Indexed: 12/17/2022] Open
Abstract
Background Choledocholithiasis is an endemic condition in the world. Although rare, foreign body migration with biliary complications needs to be considered in the differential diagnosis for patients presenting with typical symptoms even many years after cholecystectomy, EPCP, war-wound, foreign body ingestion or any other particular history before. It is of great clinical value as the present review may offer some help when dealing with choledocholithiasis caused by foreign bodies. Case presentation We reported a case of choledocholithiasis caused by fishbone from choledochoduodenal anastomosis regurgitation. Moreover, we showed up all the instances of choledocholithiasis caused by foreign bodies published until June 2018 and wrote the world’s first literature review of foreign bodies in the bile duct of 144 cases. The findings from this case suggest that the migration of fishbone can cause various consequences, one of these, as we reported here, is as a core of gallstone and a cause of choledocholithiasis. Conclusion The literature review declared the choledocholithiasis caused by foreign bodies prefer the wrinkly and mainly comes from three parts: postoperative complications, foreign body ingestion, and post-war complications such as bullet injury and shrapnel wound. The Jonckheere-Terpstra test indicated the ERCP was currently the treatment of choice. It is a very singular case of choledocholithiasis caused by fishbone, and the present review is the first one concerning choledocholithiasis caused by foreign bodies all over the world.
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Affiliation(s)
- Min Yu
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Bowen Huang
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, Guangdong, China
| | - Ye Lin
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Yuxue Nie
- Department of Internal Medicine, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Zixuan Zhou
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China
| | - Shanshan Liu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, Guangdong, China
| | - Baohua Hou
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong, China. .,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, Guangdong, China.
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Wang L, Dong P, Zhang Y, Liu X, Tian B. Iatrogenic bile duct Injury with a retained T-tube in common bile duct for 10 years: A case report. Medicine (Baltimore) 2019; 98:e15127. [PMID: 30985676 PMCID: PMC6485887 DOI: 10.1097/md.0000000000015127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Bile duct injury (BDI), a major complication of cholecystectomy, usually needs hepaticojejunostomy or primary repair over T-tube in severe cases. There were few cases about retained fragments of T-tube. Whereas, intact T-tube retained in common bile duct (CBD) for years after BDI was very rare. PATIENT CONCERNS A 55-year-old female complaining of a retained T-tube in the right upper quadrant for 10 years with bilious exudation for 3 months. DIAGNOSIS Based on the medical history of reoperation after the initial laparoscopic cholecystectomy (LC), the retained T-tube, the bilious exudation, and the feature of image modalities, she was diagnosed with retained biliary T-tube, biliary leak, hepatolithiasis, and BDI. INTERVENTIONS After nonsurgical management at local hospitals, the patient had her indwelling T-tube removal during laparotomy in our center finally. During this procedure, bile duct exploration, hilar bile ducts reconstruction, and primary Roux-en-Y hepaticojejunostomy were performed. OUTCOMES Unfortunately, bile leakage occurred postoperatively. After drainage of the peritoneal bilious fluid, the patient recovered gradually without further complication. LESSONS T-tube in CBD could act as nidus for stone formation after long-time placement. As a result of gradual stone formation on T-tube, severe hepatic ducts dilatation may occur without the presence of jaundice. Timely follow-up and proper surgical intervention should be suggested for patients with T-tube placement or iatrogenic BDI to avoid further impacts.
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Affiliation(s)
- Li Wang
- Department of Pancreatic Surgery
| | - Ping Dong
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Yi Zhang
- Department of Pancreatic Surgery
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Laparoendoscopic single-site cholecystectomy and common bile duct exploration using conventional instruments. Int J Surg 2016; 33 Pt A:140-5. [DOI: 10.1016/j.ijsu.2016.07.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/30/2016] [Accepted: 07/16/2016] [Indexed: 11/20/2022]
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Xu J, Wang H, Song ZW, Shen MD, Shi SH, Zhang W, Zhang M, Zheng SS. Foreign body retained in liver long after gauze packing. World J Gastroenterol 2013; 19:3364-3368. [PMID: 23745042 PMCID: PMC3671092 DOI: 10.3748/wjg.v19.i21.3364] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 05/05/2013] [Accepted: 05/17/2013] [Indexed: 02/06/2023] Open
Abstract
This case report describes a foreign body retained in the liver long after perihepatic gauze packing. A 64-year-old female patient had suffered a rib fracture and liver rupture during a traffic accident in 1973. She discovered a mass in her right hypochondrium. Her hepatic ultrasonography showed a round mass (20.3 cm × 17.3 cm × 16.0 cm in size) with fluid echogenicity in the right lobe of her liver, and a hepatic cystic-solid mass (19.7 cm × 18.5 cm × 15.6 cm in size) was identified in an abdominal computerized tomography scan. Several pieces of gauze were extracted, and brown pus from the hepatic mass was suctioned during her exploratory laparotomy. Histology documented gauze remnants with necrotic material inclusions and fibrotic capsules. To our knowledge, this patient’s case represents the longest time for which a foreign body has been retained in the liver. In addition, we conducted a comprehensive literature review of foreign bodies retained in the liver. Foreign bodies may be introduced into the liver via penetrating trauma, surgical procedures or the ingestion of foreign bodies (which then migrate from the gut). Thus, they can be classified into the following three categories: penetrating, medical and migrated foreign bodies. The details of the case are thoroughly described.
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Rai SS, Grubnik VV, Kovalchuk OL, Grubnik OV. Comparison of long-term results of laparoscopic and endoscopic exploration of common bile duct. J Minim Access Surg 2011; 2:16-22. [PMID: 21170222 PMCID: PMC2997216 DOI: 10.4103/0972-9941.25672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Accepted: 04/04/2006] [Indexed: 02/07/2023] Open
Abstract
Background: To compare long term results of laparoscopic and endoscopic exploration of common bile duct, to assess post-procedure quality of life. Materials and Methods: From September 1992 to August 2003, we performed 4058 cholecystectomies, out of which 479 (11.80%) patients had choledocholithiasis. There were 163 males and 316 females. Mean age was 63.65 ± 5.5 years. These patients were put in two groups. In the first group of 240 patients, a majority of patients underwent two-stage procedures. ERCP/ES was performed in 210 (87.50%) cases. In the second group of 239 patients, a majority of patients underwent single-stage procedures. ERCP/ES was done in 32 (13.38%) cases. Results: Mortality was zero in both groups. Morbidity was 15.1% in first group and 7.5% in second group. Mean hospital stay was 11.7 ± 3.2 days in first group and 6.2 ± 2.1 days in second group. Average operative time was 95.6 ± 20 minutes in first group and 128.4 ± 32 minutes in second group. Completed questionnaires received from 400 (83.50%) patients revealed better long-term results in the second group. Clinical features of low-grade cholangitis were seen in 20% of patients who underwent ES. Hence the post-procedure quality of life in patients who underwent single-stage procedures was definitely much better, because of minimal damage of sphincter of Oddi. Conclusions: Single-stage laparoscopic operations provide better results and shorter hospital stay. Damage to sphincter of Oddi should be minimal, to avoid long-term low-grade cholangitis. In young patients, the operation of choice should be single-stage laparoscopic procedure with absolutely no damage to sphincter of Oddi.
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Affiliation(s)
- S S Rai
- Department of Surgical Diseases and Post-Graduate Education, Odessa State Medical University, Odessa Regional Hospital, Street Zabalotnaya 26, Katovskawa, Odessa 65025, Ukraine - CIS
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Chen CC, Wu SD, Tian Y, Zeng XT, Siwo EA, Xian GZ. The fading role of T-tube in laparoscopic choledochotomy: primary choledochorrhaphy and over pigtail j and endonasobiliary drainage tubes. J Laparoendosc Adv Surg Tech A 2010; 20:807-11. [PMID: 21029026 DOI: 10.1089/lap.2010.0075] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND AIM The traditional management of open/laparoscopic choledochotomy after common bile duct (CBD) exploration is accomplished by placement of a T-tube, a procedure historically associated with complications and discomfort. In this study, we share in humble our laparoscopic experience of the use of primary closure of CBD, primary closure over pigtail J, and endonasobiliary drainage (ENBD) tubes as easy and effective alternatives to T-tubes. METHODS From April 2006 to March 2009, 27 (16 women) patients with CBD stones underwent laparoscopic choledochotomy at our institute and were engaged in this study by means of T-tube-free approach after bile duct exploration: primary closure, pigtail J tube, and ENBD tube groups. On admission, routine laboratory and imaging workups were performed to confirm choledocholithiasis diagnosis. RESULTS The mean operative time for primary closure, pigtail J tube, and ENBD tube groups were 95, 100, and 97.5 minutes, respectively. There was no conversion to open surgery nor was intraoperative complication experienced in all the groups. No major biliary complications such as bile leakage or bile peritonitis were seen; however, 1 patient from the pigtail J group experienced premature tube dislodgement and 1 patient from the ENBD tube group was found with a singular CBD retained stone. CONCLUSIONS Laparoscopic primary closure of the CBD and over pigtail J and ENBD tubes are easy and effective alternatives to T-tube placements; these procedures are safe and with great feasibility, they offer faster recovery time for patients and early discharge with lower hospital charge.
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Affiliation(s)
- Chun-Chih Chen
- Department of Biliary and Vascular Surgery, Shengjing Hospital of China Medical University, Shenyang, China
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Naraynsingh V, Hariharan S, Ramdass MJ, Dan D, Shukla P, Maharaj R. Open common bile duct exploration without T-tube insertion- two decade experience from a limited resource setting in the Caribbean. Indian J Surg 2010; 72:185-8. [PMID: 23133244 PMCID: PMC3452659 DOI: 10.1007/s12262-010-0060-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2009] [Accepted: 05/18/2009] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Despite advancements in gallbladder surgery with the introduction of endoscopic and laparoscopic techniques, many surgeons, especially in the developing world, still perform open cholecystectomy with common bile duct (CBD) exploration for choledocholithiasis. The purpose of the study is to report the outcomes of a case series of open CBD exploration without the use of T-tubes. MATERIALS AND METHODS A retrospective chart review of all consecutive open CBD exploration done by the first author over a period of 23 years was conducted. Demographic data, preoperative investigations, the surgical techniques and perioperative outcomes were recorded. RESULTS Of 690 open cholecystectomies performed during the study period, 108 had common bile duct exploration. In 94 cases this was done via a supraduodenal choledochotomy, in 10 cases via a transduodenal sphincteroplasty and in 4 cases via the cystic duct. In 90 cases, a simple choledochotomy and primary closure was done while in 4 cases choledocho-duodenostomy was required. Eighty-seven percent of surgeries were done on elective basis and 13% on an emergency basis and no T-tubes were used in any patients. The mean hospital length of stay was 3.2 days and the perioperative morbidity was negligible. CONCLUSIONS In a limited resource setting, there is still a role for open CBD exploration and primary closure without the necessity of T-tubes and stents as evidenced by a good perioperative patient outcome.
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Affiliation(s)
- Vijay Naraynsingh
- Department of Clinical Surgical Sciences, The University of the West Indies, Trinidad, West Indies
| | - Seetharaman Hariharan
- Department of Clinical Surgical Sciences, The University of the West Indies, Trinidad, West Indies
| | - Michael J. Ramdass
- Department of Clinical Surgical Sciences, The University of the West Indies, Trinidad, West Indies
| | - Dilip Dan
- Department of Clinical Surgical Sciences, The University of the West Indies, Trinidad, West Indies
| | - Parul Shukla
- Tata Memorial Hospital, Mumbai, Maharashtra India
| | - Ravi Maharaj
- Tata Memorial Hospital, Mumbai, Maharashtra India
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Abstract
The use of a T-tube to drain the biliary tree after choledochotomy has been a common surgical practice. Inadvertent fracture of the T-tube limb during removal is a rare occurrence which can lead to several complications. We report a case of cholangitis caused by a T-tube fragment retained in the common bile duct 36 years after cholecystectomy.
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Affiliation(s)
- Tarun Sharma
- Division of Gastroenterology, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15121, USA
| | - Katie F Farah
- Division of Gastroenterology, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15121, USA
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Chandrasekar TS, Murugesh M, Radhakrishnan S, Sadagopan T, Hussain ACMH. Endoscopic removal of retained T- tube fragment. BMJ Case Rep 2009; 2009:bcr07.2008.0356. [PMID: 21686845 DOI: 10.1136/bcr.07.2008.0356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
T-tube usage is common following common bile duct exploration for calculi and other complex biliary surgeries to ensure proper biliary diversion and healing. A 25-year-old woman was referred from a surgical unit with a history of open cholecystectomy and common bile duct exploration for cholelithiasis and choledocholithiasis with T-tube placement in the common bile duct for postoperative biliary diversion. While retrieving the T-tube, it got fractured and the fragment remained in the bile duct. We report a rare case of retained T-tube fragment after T-tube removal that was retrieved endoscopically.
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Abstract
BACKGROUND T-tube drainage used to be standard practice after surgical choledocholithotomy, but there is now a tendency in some centers to close the common bile duct (CBD) primarily. This study was designed to review the complications associated with T-tube drainage after CBD exploration and to determine whether primary closure of the bile duct reduces postoperative morbidity. METHODS A retrospective audit was performed on patients undergoing CBD exploration between July 1997 and March 2007, who were identified from the theatre database of one teaching hospital. Intraoperative findings and postoperative complications were recorded from the clinical notes. RESULTS During the study period, 158 patients (97 women; median age 65 (range, 25-90) years) underwent CBD exploration. A T-tube was inserted in 91 patients (group I) and the CBD was closed primarily in 67 (group II). One or more biliary complications occurred in 26 patients (16.5%): 20 (22.0%) in group I and 6 (8.9%) in group II (p = 0.03). In group I, 15 had a biliary leak (3 needed reoperation), 2 had accidental slippage of the tube, 2 an entrapped T-tube, and 1 a retained stone. In group II, six patients had biliary leakage, two of whom were re-explored. Six patients in group I also had peritubal infection, necessitating the use of antibiotics. There were three deaths: two in group I (1 T-tube-related) and 1 in group II (p = 1, not significant). CONCLUSION There is a lower biliary complication rate associated with primary closure of the CBD than after T-tube drainage.
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Abstract
BACKGROUND T-tube drainage used to be standard practice after surgical choledocholithotomy, but there is now a tendency in some centers to close the common bile duct (CBD) primarily. This study was designed to review the complications associated with T-tube drainage after CBD exploration and to determine whether primary closure of the bile duct reduces postoperative morbidity. METHODS A retrospective audit was performed on patients undergoing CBD exploration between July 1997 and March 2007, who were identified from the theatre database of one teaching hospital. Intraoperative findings and postoperative complications were recorded from the clinical notes. RESULTS During the study period, 158 patients (97 women; median age 65 (range, 25-90) years) underwent CBD exploration. A T-tube was inserted in 91 patients (group I) and the CBD was closed primarily in 67 (group II). One or more biliary complications occurred in 26 patients (16.5%): 20 (22.0%) in group I and 6 (8.9%) in group II (p = 0.03). In group I, 15 had a biliary leak (3 needed reoperation), 2 had accidental slippage of the tube, 2 an entrapped T-tube, and 1 a retained stone. In group II, six patients had biliary leakage, two of whom were re-explored. Six patients in group I also had peritubal infection, necessitating the use of antibiotics. There were three deaths: two in group I (1 T-tube-related) and 1 in group II (p = 1, not significant). CONCLUSION There is a lower biliary complication rate associated with primary closure of the CBD than after T-tube drainage.
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16
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Alkhatib AA, Mieles L, Merhav H, Saggi B, Adler DG. Endoscopic dislodgement of retained, intact T-tubes after liver transplantation via ERCP after failed traction removal. Dig Dis Sci 2006; 51:2023-5. [PMID: 17053954 DOI: 10.1007/s10620-006-9470-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2006] [Accepted: 05/31/2006] [Indexed: 12/09/2022]
Affiliation(s)
- Amer A Alkhatib
- Department of Internal Medicine, University of Texas-Houston Medical School, Houston, Texas 77030, USA
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17
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Cimsit B, Keskin M, Ozden I, Alper A. Obstructive jaundice due to a textiloma mimicking a common bile duct stone. ACTA ACUST UNITED AC 2006; 13:172-3. [PMID: 16547681 DOI: 10.1007/s00534-005-1022-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2005] [Accepted: 08/02/2005] [Indexed: 01/27/2023]
Abstract
A foreign body is a rare cause of obstructive jaundice. We report a 19-year-old woman with jaundice caused by a surgical gauze in the common bile duct (CBD). Four yours earlier, she had undergone a cholecystectomy and drainage for hydatid disease of the liver. Her postoperative course was complicated by a biliary fistula that healed after 50 days. She now presented with obstructive jaundice of 2 weeks' duration. Magnetic resonance cholangiopancreatography (MRCP) showed a signal-void mass, consistent with a CBD stone. Surgical exploration of the CBD revealed a surgical gauze as the cause of the obstruction. To the best of our knowledge, this is the first case of a surgical gauze obstructing the CBD requiring surgical removal.
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Affiliation(s)
- Bayindir Cimsit
- Department of General Surgery, Hepatopancreatobiliary Unit, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Ojanguren A, Doenz F, Qanadli SD, Madoff DC, Halkic N, Bessoud B, Denys A. Percutaneous Extraction of Retained Biliary T-tubes: a New Technique. J Vasc Interv Radiol 2005; 16:1033-6. [PMID: 16002514 DOI: 10.1097/01.rvi.0000161143.12677.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Retained T-tubes are rare complications after biliary surgery. The authors present three cases of retained T-tubes in patients with transplanted liver that could not be removed by a standard manual traction. The authors describe a new simple percutaneous method that allows removal of these T-tubes without complication.
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Affiliation(s)
- Andrea Ojanguren
- Department of Radiology and Interventional Radiology, Division of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
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