Endoscopic management of laparoscopic cholecystectomy-associated bile duct injuries

Clinical utility of 0.025-inch guidewire VisiGlide2TM in the endoscopic retrograde cholangiopancreatography-related procedures

AIM

To examine the result of the use of 0.025-inch guidewire (GW) VisiGlide2^TM as the first choice in the endoscopic retrograde cholangiopancreatography (ERCP)-related procedures without selecting the patient in a multicenter prospective study.

METHODS

ERCP using 0.025-inch GW VisiGlide2^TM as the first choice was conducted in patients who have needed ERCP, and its accomplishment rate of procedure, procedural time, incidence of accidental symptoms were compared with those of ERCP using 0.025-inch GW VisiGlide^TM.

RESULTS

The accomplishment rate of procedure was 97.5% (197/202), and procedural time was 23.930 ± 16.207 min. The accomplishment rate of procedure using 0.025-inch GW VisiGlide^TM was 92.3% (183/195), and procedural time was 31.285 ± 19.122 min, thus the accomplishment rate of procedure was significantly improved and procedural time was significantly shortened (P < 0.05). Accidental symptoms by ERCP-related procedures were observed in 3.0% (6/202), and all were conservatively alleviated.

CONCLUSION

When 0.025-inch GW VisiGlide2^TM was used for ERCP-related procedure as the first choice, it showed high accomplishment rate of procedure and low incidence of accidental symptoms, suggesting it can be used as the universal GW. Clinical Trial Registry (UMIN0000016042).

Predicting prolonged hospital stay after laparoscopic cholecystectomy

INTRODUCTION

Widespread application of laparoscopic cholecystectomy (LC) has resulted in a high complication rate and leads to prolonged hospital stays. This study aimed to investigate the preoperative and intraoperative clinical factors that relate to prolongation of hospital stay.

METHODS

We studied 370 patients who underwent LC for gallbladder disease between 2008 and 2012. Clinical risk factors were retrospectively collected. The clinical pathway for LC was indicated for all patients, and they were divided into two groups according to postoperative length of stay (LOS): the normal duration group (LOS ≤5 days) and the long duration (LD) group (LOS ≥6 days). Multiple regression analysis was used to predict risk factors that identified hospital prolongation to create a LOS prediction score.

RESULTS

The normal duration group was 236 patients and the LD group was 134. Seventeen patients (4.6%) required conversion from laparoscopic to open surgery. LOS was 4.82 days in the normal duration group and 12.08 days in the LD group. In the LD group, 18.7% of the patients stayed more than 14 days, but no patients were readmitted. Thirteen clinical factors were statistically different between the two groups. ASA score and LC difficulty were the most predictive risk factors for LOS prolongation. LOS prediction score consisted of eight variables selected from 13 factors; it helped determine the likelihood of whether a patients' hospital stay was prolonged (sensitivity, 82.1%; specificity, 75.0%).

CONCLUSION

Thirteen factors closely related to hospital stay duration and LOS prediction score could predict the prolongation of a patient's hospital stay.

Endoscopic management of biliary complications after partial liver resection in children

BACKGROUND

Biliary complications after liver surgery are difficult to manage. Endoscopic retrograde cholangiopancreatography (ERCP) with stenting of the common bile duct is not commonly practiced in children for this purpose. The aim of this retrospective review is to evaluate the role of ERCP as both a diagnostic and a therapeutic tool in the management of biliary complications after liver resection in children.

PATIENTS AND METHODS

The charts of all patients from 0 to 18 years old who underwent partial liver resection in a tertiary children's hospital in Amsterdam, the Netherlands, between 2000 and 2010 were retrospectively reviewed.

RESULTS

Forty-five children (median age: 3.6 years, range: 2 months-17 years) underwent partial liver resection. Post-operative biliary complications occurred in 13 children. Ten patients were suffering from bile leakage. Eight of them underwent ERCP with stent placement after which leakage stopped in 5 patients. Three patients presented with a post-operative biliary tract stricture. ERCP with dilation and stent placement was performed in 2 of them, which solved the problem in one patient. ERCP demonstrated the nature (bile leak and/or biliary tract stricture(s)), extent, and location of the lesion in 8 of 10 children. There were no serious procedure related complications. Rescue procedures in the other patients included hepaticojejunostomy and liver transplant.

CONCLUSION

ERCP with stenting of the common bile duct has a diagnostic and therapeutic role in the management of bile leaks after partial liver resection in children. The value of ERCP in the management of a stricture of the biliary tract is less conclusive.

Duodenoscopic diagnosis and treatment of bile leakage after laparoscopic cholecystectomy

AIM: To investigate the value of duodenoscopy in the diagnosis and treatment of bile leakage after laparoscopic cholecystectomy (LC).

METHODS: The clinical data for 32 patients who had bile leakage after LC and were treated at Tianjin Nankai Hospital from June 2004 to January 2010 were retrospectively analyzed.

RESULTS: All 32 patients received endoscopic retrograde cholangiopancreatography (ERCP), and the nature of bile leakage in all of them was elucidated. Of all patients, 20 had cystic duct stump leakage, 7 had common bile duct leakage, 3 had hepatic duct leakage, 2 had aberrant bile duct leakage; 28 were cured by endoscopic nasobiliary drainage (ENBD), and 4 by plastic biliary stent implantation.The overall cure rate was 100%. The length of hospitalization stay ranged from 1 to 6 wk, with an average length of 24 d. No recurrence occurred in all patients during 3 to 72 months of follow-up.

CONCLUSION: Duodenoscopy is a feasible and effective approach for the diagnosis and treatment of bile leakage after LC.