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Cadili L, Streith L, Segedi M, Hayashi AH. Management of complex acute biliary disease for the general surgeon: A narrative review. Am J Surg 2024; 231:46-54. [PMID: 36990834 DOI: 10.1016/j.amjsurg.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/26/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023]
Abstract
Acute gallbladder diseases are a common surgical emergency faced by General Surgeons that can sometimes be quite challenging. These complex biliary diseases require multifaceted and expeditious care, optimized based on hospital facility and operating room (OR) resources and the expertise of the surgical team. Effective management of biliary emergencies requires two foundational principles: achieving source control while mitigating the risk of injury to the biliary tree and its blood supply. This review article highlights salient literature on seven complex biliary diseases: acute cholecystitis, cholangitis, Mirizzi syndrome, gallstone ileus with cholecystoenteric fistula, gallstone pancreatitis, gall bladder cancer, and post-cholecystectomy bile leak.
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Affiliation(s)
- Lina Cadili
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Lucas Streith
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maja Segedi
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada; Hepatopancreatobiliary and Liver Transplant Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Allen H Hayashi
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada; Division of General Surgery, Island Health Authority, Victoria, British Columbia, Canada
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Meira-Júnior JD, Ramos-Aranda J, Carrillo-Vidales J, Velásquez-Coria ER, Mercado MA, Dominguez-Rosado I. BILE DUCT INJURY REPAIR IN A PATIENT WITH SITUS INVERSUS TOTALIS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2024; 37:e1795. [PMID: 38511812 PMCID: PMC10949928 DOI: 10.1590/0102-672020240002e1795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 11/30/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND Bile duct injury (BDI) causes significant sequelae for the patient in terms of morbidity, mortality, and long-term quality of life, and should be managed in centers with expertise. Anatomical variants may contribute to a higher risk of BDI during cholecystectomy. AIMS To report a case of bile duct injury in a patient with situs inversus totalis. METHODS A 42-year-old female patient with a previous history of situs inversus totalis and a BDI was initially operated on simultaneously to the lesion ten years ago by a non-specialized surgeon. She was referred to a specialized center due to recurrent episodes of cholangitis and a cholestatic laboratory pattern. Cholangioresonance revealed a severe anastomotic stricture. Due to her young age and recurrent cholangitis, she was submitted to a redo hepaticojejunostomy with the Hepp-Couinaud technique. To the best of our knowledge, this is the first report of BDI repair in a patient with situs inversus totalis. RESULTS The previous hepaticojejunostomy was undone and remade with the Hepp-Couinaud technique high in the hilar plate with a wide opening in the hepatic confluence of the bile ducts towards the left hepatic duct. The previous Roux limb was maintained. Postoperative recovery was uneventful, the drain was removed on the seventh post-operative day, and the patient is now asymptomatic, with normal bilirubin and canalicular enzymes, and no further episodes of cholestasis or cholangitis. CONCLUSIONS Anatomical variants may increase the difficulty of both cholecystectomy and BDI repair. BDI repair should be performed in a specialized center by formal hepato-pancreato-biliary surgeons to assure a safe perioperative management and a good long-term outcome.
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Affiliation(s)
- José Donizeti Meira-Júnior
- Universidade de São Paulo, Digestive Surgery Division, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Javier Ramos-Aranda
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Hepatopancreatobiliary Surgery Division, Mexico City, Mexico
| | - Javier Carrillo-Vidales
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Hepatopancreatobiliary Surgery Division, Mexico City, Mexico
| | - Erik Rodrigo Velásquez-Coria
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Hepatopancreatobiliary Surgery Division, Mexico City, Mexico
| | - Miguel Angel Mercado
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Hepatopancreatobiliary Surgery Division, Mexico City, Mexico
| | - Ismael Dominguez-Rosado
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Hepatopancreatobiliary Surgery Division, Mexico City, Mexico
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Marichez A, Fernandez B, Belaroussi Y, Mauriac P, Julien C, Subtil C, Lapuyade B, Adam JP, Laurent C, Chiche L. Waiting for bile duct dilation before repair of bile duct injury: a worthwhile strategy? Langenbecks Arch Surg 2023; 408:409. [PMID: 37848704 DOI: 10.1007/s00423-023-03139-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Hepaticojejunostomy (HJ) is the gold standard procedure for repairing major bile duct injury (BDI). Dilation status of the BD before repair has not been assessed as a risk factor for anastomotic stricture. METHOD This retrospective single-centre study was performed on a population of 87 patients with BDI repaired by HJ between 2007 and 2021. Dilation status was assessed preoperatively, and dilation was defined as the presence of visible peripheral intrahepatic BDs with remaining BD diameter > 8 mm. The short- and long-term outcomes of HJ were assessed according to preoperative dilation status. RESULTS Before final repair, the BDs were dilated (dBD) in 56.3% of patients and not dilated (ND) in 43.7%. Patients with ND at the time of repair had more severe BDI injury than those with dBD (94.7% vs. 77.6%, p = 0.026). The rate of preoperative cholangitis was lower in patients with ND than in those with dBD (10.5% vs. 44.9%, p = 0.001). The rate of short-term morbidity after HJ was 33.3% (ND vs. dBD: 38.8% vs. 26.3%, p = 0.32). Long-term anastomotic stricture rate was 5.7% with a mean follow-up period of 61.3 months. There were no differences in long-term biliary complications according to dilation status (ND vs. dBD: 12.2% vs. 10.5%, p = 1). CONCLUSION Dilation status of the BD before HJ for BDI seemed to have no impact on short- or long-term outcomes. Both surgical and radiological external biliary drainages after BDI appear to be acceptable options to reduce cholangitis before repair without increasing risk for long-term anastomotic stricture.
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Affiliation(s)
- Arthur Marichez
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France.
- Inserm UMR 1312 - Team 3 "Liver Cancers and Tumoral Invasion", Bordeaux Institute of Oncology, University of Bordeaux, Bordeaux, France.
| | - Benjamin Fernandez
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France
| | - Yaniss Belaroussi
- Inserm, Bordeaux Population Health Research Center, ISPED, Bordeaux, France
| | - Paul Mauriac
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France
| | - Céline Julien
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France
| | - Clément Subtil
- Digestive Endoscopy Unit, Haut Lévêque Hospital, CHU de Bordeaux, Bordeaux, France
| | - Bruno Lapuyade
- Department of Digestive Interventional Radiology, Haut Lévêque Hospital, CHU de Bordeaux, Bordeaux, France
| | - Jean-Philippe Adam
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France
| | - Christophe Laurent
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France
| | - Laurence Chiche
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France
- Inserm UMR 1312 - Team 3 "Liver Cancers and Tumoral Invasion", Bordeaux Institute of Oncology, University of Bordeaux, Bordeaux, France
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Marchegiani F, Conticchio M, Zadoroznyj A, Inchingolo R, Memeo R, De'angelis N. Detection and management of bile duct injury during cholecystectomy. Minerva Surg 2023; 78:545-557. [PMID: 36883937 DOI: 10.23736/s2724-5691.23.09866-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Cholecystectomy represents one of the most performed surgical procedures. Bile duct injuries (BDIs) are a dangerous complication of this intervention. With the advent of the laparoscopy, the rate of BDIs showed a growing trend that was partially justified by the learning curve of this technique. EVIDENCE ACQUISITION A literature search was conducted on Embase, Medline, and Cochrane databases to identify studies published up to October 2022 that analyzed the intraoperative detection and management of BDIs diagnosed during cholecystectomy. EVIDENCE SYNTHESIS According to the literature, approximately 25% of BDIs is diagnosed during the laparoscopic cholecystectomy. In the clinical suspicion of BDI, an intraoperative cholangiography is performed to confirm it. Complimentary technology, such as near-infrared cholangiography, can be also adopted. Intraoperative ultrasound represents a useful tool to furtherly define the biliary and the vascular anatomy. The proper classification of the type of BDI allows to identify the correct treatment. When a good expertise in hepato-pancreato-biliary surgery is available, a direct repair is performed with good outcomes both in case of simple and complex lesions. When the local resources are limited or there is a lack of dedicated surgical experience, patient referral to a reference center shows better outcomes. In particular, complex vasculo-biliary injuries require a highly specialized treatment. The key elements to transfer the patients are a good documentation of the injury, a proper drainage of the abdomen, and an antibiotic therapy. CONCLUSIONS BDI management requires a proper diagnostic process and prompt treatment to reduce the morbidity and mortality of this feared complication occurring during cholecystectomy.
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Affiliation(s)
- Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France
| | - Maria Conticchio
- Unit of Hepato-Pancreato-Biliary Surgery, F. Miulli General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Alizée Zadoroznyj
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France
| | - Riccardo Inchingolo
- Unit of Interventional Radiology, F. Miulli General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreato-Biliary Surgery, F. Miulli General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Nicola De'angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France -
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Giuliante F, Panettieri E, De Rose AM, Murazio M, Vellone M, Mele C, Clemente G, Giovannini I, Nuzzo G, Ardito F. Bile duct injury after cholecystectomy: timing of surgical repair should be based on clinical presentation. The experience of a tertiary referral center with Hepp-Couinaud hepatico-jejunostomy. Updates Surg 2023; 75:1509-1517. [PMID: 37580549 PMCID: PMC10435431 DOI: 10.1007/s13304-023-01611-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/21/2023] [Indexed: 08/16/2023]
Abstract
Impact of timing of repair on outcomes of patients repaired with Hepp-Couinaud hepatico-jejunostomy (HC-HJ) after bile duct injury (BDI) during cholecystectomy remains debated. This is an observational retrospective study at a tertiary referral hepato-biliary center. HC-HJ was always performed in patients without sepsis or bile leak and with dilated bile ducts. Timing of repair was classified as: early (≤ 2 weeks), intermediate (> 2 weeks, ≤ 6 weeks), and delayed (> 6 weeks). 114 patients underwent HC-HJ between 1994 and 2022: 42.1% underwent previous attempts of repair at referring institutions (Group A) and 57.9% were referred without any attempt of repair before referral (Group B). Overall, a delayed HC-HJ was performed in 78% of patients; intermediate and early repair were performed in 17% and 6%, respectively. In Group B, 10.6% of patients underwent an early, 27.3% an intermediate, and 62.1% a delayed repair. Postoperative mortality was nil. Median follow-up was 106.7 months. Overall primary patency (PP) attainment rate was 94.7%, with a 5- and 10-year actuarial primary patency (APP) of 84.6% and 84%, respectively. Post-repair bile leak was associated with PP loss in the entire population (odds ratio [OR] 9.75, 95% confidence interval [CI] 1.64-57.87, p = 0.012); no correlation of PP loss with timing of repair was noted. Treatment of anastomotic stricture (occurred in 15.3% of patients) was performed with percutaneous treatment, achieving absence of biliary symptoms in 93% and 91% of cases at 5 and 10 years, respectively. BDI can be successfully repaired by HC-HJ regardless of timing when surgery is performed in stable patients with dilated bile ducts and without bile leak.
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Affiliation(s)
- Felice Giuliante
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 00168, Rome, Italy.
| | - Elena Panettieri
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Agostino M De Rose
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Marino Murazio
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Maria Vellone
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Caterina Mele
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Gennaro Clemente
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Ivo Giovannini
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Gennaro Nuzzo
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Francesco Ardito
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 1, 00168, Rome, Italy
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Symeonidis D, Tepetes K, Tzovaras G, Samara AA, Zacharoulis D. BILE: A Literature Review Based Novel Clinical Classification and Treatment Algorithm of Iatrogenic Bile Duct Injuries. J Clin Med 2023; 12:3786. [PMID: 37297981 PMCID: PMC10253433 DOI: 10.3390/jcm12113786] [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: 03/31/2023] [Revised: 05/18/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSES The management of patients with iatrogenic bile duct injuries (IBDI) is a challenging field, often with dismal medico legal projections. Attempts to classify IBDI have been made repeatedly and the final results were either analytical and extensive but not useful in everyday clinical practice systems, or simple and user friendly but with limited clinical correspondence approaches. The purpose of the present review is to propose a novel, clinical classification system of IBDI by reviewing the relevant literature. METHODS A systematic literature review was conducted by performing bibliographic searches in the available electronic databases, including PubMed, Scopus, and the Cochrane Library. RESULTS Based on the literature results, we propose a five (5) stage (A, B, C, D and E) classification system for IBDI (BILE Classification). Each stage is correlated with the recommended and most appropriate treatment. Although the proposed classification scheme is clinically oriented, the anatomical correspondence of each IBDI stage has been incorporated as well, using the Strasberg classification. CONCLUSIONS BILE classification represents a novel, simple, and dynamic in nature classification system of IBDI. The proposed classification focuses on the clinical consequences of IBDI and provides an action map that can appropriately guide the treatment plan.
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Affiliation(s)
| | | | | | - Athina A. Samara
- Department of Surgery, University Hospital of Larisa, Mezourlo, 41221 Larisa, Greece
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Omar MA, Kamal A, Redwan AA, Alansary MN, Ahmed EA. Post-cholecystectomy major bile duct injury: ideal time to repair based on a multicentre randomized controlled trial with promising results. Int J Surg 2023; 109:1208-1221. [PMID: 37072143 PMCID: PMC10389623 DOI: 10.1097/js9.0000000000000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/06/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Bile duct injury (BDI) is one of the serious complications of cholecystectomy procedures, which has a disastrous impact on long-term survival, health-related quality of life (QoL), healthcare costs as well as high rates of litigation. The standard treatment of major BDI is hepaticojejunostomy (HJ). Surgical outcomes depend on many factors, including the severity of the injury, the surgeons' experiences, the patient's condition, and the reconstruction time. The authors aimed to assess the impact of reconstruction time and abdominal sepsis control on the reconstruction success rate. METHODS This is a multicenter, multi-arm, parallel-group, randomized trial that included all consecutive patients treated with HJ for major post-cholecystectomy BDI from February 2014 to January 2022. Patients were randomized according to the time of reconstruction by HJ and abdominal sepsis control into group A (early reconstruction without sepsis control), group B (early reconstruction with sepsis control), and group C (delayed reconstruction). The primary outcome was successful reconstruction rate, while blood loss, HJ diameter, operative time, drainage amount, drain and stent duration, postoperative liver function tests, morbidity and mortality, number of admissions and interventions, hospital stay, total cost, and patient QoL were considered secondary outcomes. RESULTS Three hundred twenty one patients from three centres were randomized into three groups. Forty-four patients were excluded from the analysis, leaving 277 patients for intention to treat analysis. With univariate analysis, older age, male gender, laparoscopic cholecystectomy, conversion to open cholecystectomy, failure of intraoperative BDI recognition, Strasberg E4 classification, uncontrolled abdominal sepsis, secondary repair, end-to-side anastomosis, diameter of HJ (< 8 mm), non-stented anastomosis, and major complications were risk factors for successful reconstruction. With multivariate analysis, conversion to open cholecystectomy, uncontrolled sepsis, secondary repair, the small diameter of HJ, and non-stented anastomosis were the independent risk factors for the successful reconstruction. Also, group B patients showed decreased admission and intervention rates, decreased hospital stay, decreased total cost, and early improved patient QoL. CONCLUSION Early reconstruction after abdominal sepsis control can be done safely at any time with comparable results for delayed reconstruction in addition to decreased total cost and improved patient QoL.
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Affiliation(s)
| | - Ayman Kamal
- Anesthesia and Intensive Care, South Valley University, Qena
| | - Alaa A. Redwan
- Department of General Surgery, Helwan University, Helwan
| | | | - Emad Ali Ahmed
- Department of General Surgery, Helwan University, Helwan
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Sucandy I, Durrani H, Giovannetti A, Spence J, Ross S, Rosemurgy A. Robotic Roux-en-Y Hepaticojejunostomy With Arterial Repair for Biliovascular Injury Following Laparoscopic Cholecystectomy. Am Surg 2023; 89:1034-1035. [PMID: 33291944 DOI: 10.1177/0003134820956336] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Affiliation(s)
| | - Hamza Durrani
- Digestive Health Institute of AdventHealth, Tampa, USA
| | | | | | - Sharona Ross
- Digestive Health Institute of AdventHealth, Tampa, USA
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Klabukov I, Tenchurin T, Shepelev A, Baranovskii D, Mamagulashvili V, Dyuzheva T, Krasilnikova O, Balyasin M, Lyundup A, Krasheninnikov M, Sulina Y, Gomzyak V, Krasheninnikov S, Buzin A, Zayratyants G, Yakimova A, Demchenko A, Ivanov S, Shegay P, Kaprin A, Chvalun S. Biomechanical Behaviors and Degradation Properties of Multilayered Polymer Scaffolds: The Phase Space Method for Bile Duct Design and Bioengineering. Biomedicines 2023; 11:biomedicines11030745. [PMID: 36979723 PMCID: PMC10044742 DOI: 10.3390/biomedicines11030745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
This article reports the electrospinning technique for the manufacturing of multilayered scaffolds for bile duct tissue engineering based on an inner layer of polycaprolactone (PCL) and an outer layer either of a copolymer of D,L-lactide and glycolide (PLGA) or a copolymer of L-lactide and ε-caprolactone (PLCL). A study of the degradation properties of separate polymers showed that flat PCL samples exhibited the highest resistance to hydrolysis in comparison with PLGA and PLCL. Irrespective of the liquid-phase nature, no significant mass loss of PCL samples was found in 140 days of incubation. The PLCL- and PLGA-based flat samples were more prone to hydrolysis within the same period of time, which was confirmed by the increased loss of mass and a significant reduction of weight-average molecular mass. The study of the mechanical properties of developed multi-layered tubular scaffolds revealed that their strength in the longitudinal and transverse directions was comparable with the values measured for a decellularized bile duct. The strength of three-layered scaffolds declined significantly because of the active degradation of the outer layer made of PLGA. The strength of scaffolds with the PLCL outer layer deteriorated much less with time, both in the axial (p-value = 0.0016) and radial (p-value = 0.0022) directions. A novel method for assessment of the physiological relevance of synthetic scaffolds was developed and named the phase space approach for assessment of physiological relevance. Two-dimensional phase space (elongation modulus and tensile strength) was used for the assessment and visualization of the physiological relevance of scaffolds for bile duct bioengineering. In conclusion, the design of scaffolds for the creation of physiologically relevant tissue-engineered bile ducts should be based not only on biodegradation properties but also on the biomechanical time-related behavior of various compositions of polymers and copolymers.
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Affiliation(s)
- Ilya Klabukov
- Department of Regenerative Medicine, National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 249031 Obninsk, Russia
- Department of Urology and Operative Nephrology, Peoples Friendship University of Russia (RUDN University), 117198 Moscow, Russia
- Obninsk Institute for Nuclear Power Engineering, National Research Nuclear University MEPhI, 115409 Obninsk, Russia
- Correspondence:
| | - Timur Tenchurin
- National Research Centre “Kurchatov Institute”, 1, Akademika Kurchatova pl., 123182 Moscow, Russia
| | - Alexey Shepelev
- National Research Centre “Kurchatov Institute”, 1, Akademika Kurchatova pl., 123182 Moscow, Russia
| | - Denis Baranovskii
- Department of Regenerative Medicine, National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 249031 Obninsk, Russia
- Department of Urology and Operative Nephrology, Peoples Friendship University of Russia (RUDN University), 117198 Moscow, Russia
| | - Vissarion Mamagulashvili
- National Research Centre “Kurchatov Institute”, 1, Akademika Kurchatova pl., 123182 Moscow, Russia
| | - Tatiana Dyuzheva
- Department of Hospital Surgery, Sklifosovsky Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Olga Krasilnikova
- Department of Regenerative Medicine, National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 249031 Obninsk, Russia
| | - Maksim Balyasin
- Research and Educational Resource Center for Cellular Technologies, Peoples Friendship University of Russia (RUDN University), 117198 Moscow, Russia
| | - Alexey Lyundup
- Research and Educational Resource Center for Cellular Technologies, Peoples Friendship University of Russia (RUDN University), 117198 Moscow, Russia
- N.P. Bochkov Research Centre for Medical Genetics, 115478 Moscow, Russia
| | - Mikhail Krasheninnikov
- Research and Educational Resource Center for Cellular Technologies, Peoples Friendship University of Russia (RUDN University), 117198 Moscow, Russia
- Lomonosov Institute of Fine Chemical Technologies, Russian Technological University MIREA, 119454 Moscow, Russia
| | - Yana Sulina
- Department of Obstetrics and Gynecology, Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Vitaly Gomzyak
- National Research Centre “Kurchatov Institute”, 1, Akademika Kurchatova pl., 123182 Moscow, Russia
| | - Sergey Krasheninnikov
- National Research Centre “Kurchatov Institute”, 1, Akademika Kurchatova pl., 123182 Moscow, Russia
| | - Alexander Buzin
- National Research Centre “Kurchatov Institute”, 1, Akademika Kurchatova pl., 123182 Moscow, Russia
- Laboratory of the Structure of Polymer Materials, Enikolopov Institute of Synthetic Polymer Materials RAS, 117393 Moscow, Russia
| | - Georgiy Zayratyants
- Department of Pathology, Moscow State University of Medicine and Dentistry, Delegatskaya st., 20, p. 1, 127473 Moscow, Russia
| | - Anna Yakimova
- Department of Regenerative Medicine, National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 249031 Obninsk, Russia
| | - Anna Demchenko
- N.P. Bochkov Research Centre for Medical Genetics, 115478 Moscow, Russia
| | - Sergey Ivanov
- Department of Regenerative Medicine, National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 249031 Obninsk, Russia
| | - Peter Shegay
- Department of Regenerative Medicine, National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 249031 Obninsk, Russia
- Department of Urology and Operative Nephrology, Peoples Friendship University of Russia (RUDN University), 117198 Moscow, Russia
| | - Andrey Kaprin
- Department of Regenerative Medicine, National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 249031 Obninsk, Russia
- Department of Urology and Operative Nephrology, Peoples Friendship University of Russia (RUDN University), 117198 Moscow, Russia
| | - Sergei Chvalun
- National Research Centre “Kurchatov Institute”, 1, Akademika Kurchatova pl., 123182 Moscow, Russia
- Laboratory of the Structure of Polymer Materials, Enikolopov Institute of Synthetic Polymer Materials RAS, 117393 Moscow, Russia
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10
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Marichez A, Adam JP, Laurent C, Chiche L. Hepaticojejunostomy for bile duct injury: state of the art. Langenbecks Arch Surg 2023; 408:107. [PMID: 36843190 DOI: 10.1007/s00423-023-02818-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/18/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Hepaticojejunostomy (HJ) is the gold standard procedure for the reconstruction of the bile duct in many benign and malignant situations. One of the major situation is the bile duct injury (BDI) after cholecystectomy, either for early or late repair. This procedure presents some specificities associated to a debated management of BDI. PURPOSE This article provides a state-of-the-art of the hepaticojejunostomy procedure focusing on bile duct injury including its indications and outcomes CONCLUSION: Performed at the right moment and respecting the technical rules, HJ provides a restoration of the biliary patency in the long term of 80 to 90%. It is the main surgical technique to repair BDI. Complications and failure of this procedure can be difficult to manage. That is why the primary repair requires an appropriate multidisciplinary approach associated with an expert high quality surgical technique.
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Affiliation(s)
- A Marichez
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, Bordeaux, France.,Inserm UMR 1312 - Team 3 "Liver Cancers and Tumoral Invasion". Bordeaux Institute of Oncology, University of Bordeaux, Bordeaux, France
| | - J-P Adam
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, Bordeaux, France
| | - C Laurent
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, Bordeaux, France
| | - L Chiche
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, Bordeaux, France. .,Inserm UMR 1312 - Team 3 "Liver Cancers and Tumoral Invasion". Bordeaux Institute of Oncology, University of Bordeaux, Bordeaux, France.
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11
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Cubisino A, Dreifuss NH, Cassese G, Bianco FM, Panaro F. Minimally invasive biliary anastomosis after iatrogenic bile duct injury: a systematic review. Updates Surg 2023; 75:31-39. [PMID: 36205829 DOI: 10.1007/s13304-022-01392-5] [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: 06/30/2022] [Accepted: 09/27/2022] [Indexed: 01/14/2023]
Abstract
Major bile duct injuries (BDIs) may require complex surgical repairs that are usually performed with a conventional open approach. This study aims to analyze current evidence concerning the safety and the outcomes of the minimally invasive (MI) approach for biliary anastomosis in post-cholecystectomy BDIs. A systematic search of MEDLINE, Embase, and Web-Of-Science indexed studies involving MI (laparoscopic or robotic) biliary anastomosis in patients with iatrogenic BDIs was performed. The quality of the studies was assessed using the MINORS criteria. A total of 13 studies involving 198 patients were included. One hundred and twenty-five patients (63.1%) underwent a laparoscopic biliary anastomosis, while 73 (36.1%) received an analogue robotic procedure. All the included BDIs were types D and E (E1-E5). The mean OT varied between 190 and 330 (mean = 227) minutes. Ten studies reported the mean intraoperative blood loss that ranged between 50 and 252 (mean = 135.9) mL. No conversions occurred in the robotic series, while four patients required conversion to open surgery among the laparoscopic ones. The mean length of postoperative hospital stay was 6.3 days. The reported overall morbidity was similar among the robotic and laparoscopic series. During the follow-up period, no surgery-related mortality occurred. A growing number of referral centers are showing the safety and feasibility of the MI approach for biliary anastomosis in patients with major BDIs. Further prospective comparative studies are needed to draw more definitive conclusions.
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Affiliation(s)
- Antonio Cubisino
- Division of General, Minimally Invasive and Robotic Surgery Unit, Department of Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA.
| | - Nicolas H Dreifuss
- Division of General, Minimally Invasive and Robotic Surgery Unit, Department of Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA
| | - Gianluca Cassese
- Department of Clinical Medicine and Surgery, Minimally Invasive and Robotic HPB Surgery Unit, Federico II University, Naples, Italy
| | - Francesco M Bianco
- Division of General, Minimally Invasive and Robotic Surgery Unit, Department of Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA
| | - Fabrizio Panaro
- Division of HBP Surgery and Transplantation, Department of Surgery, Hôpital Saint Eloi, CHU-Montpellier, 80 Av. Augustin Fliche, 34295, Montpellier, France
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12
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Ödemiş B, Başpınar B, Tola M, Torun S. Magnetic Compression Anastomosis Is a Good Treatment Option for Patients with Completely Obstructed Benign Biliary Strictures: A Case Series Study. Dig Dis Sci 2022; 67:4906-4918. [PMID: 35050430 DOI: 10.1007/s10620-022-07381-3] [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: 06/21/2021] [Accepted: 01/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Completely obstructed benign biliary strictures (BBS) is a difficult-to-treat condition. Surgery is the main treatment modality with high morbidity and mortality. Recently, the magnetic compression anastomosis (MCA) technique was employed in such cases with low complication rates. AIMS To evaluate the effectiveness of the MCA in completely obstructed BBS. METHODS 21 MCA procedures were performed in 19 patients with completely obstructed BBS. All patients had percutaneous biliary access. Magnets were located to the proximal side of the obstruction via percutaneous biliary sheath and the distal side endoscopically. The procedure was terminated as the magnets attracted. Either self-expandable fully covered metallic stent and/or a growing number of plastic stents were introduced after recanalization was achieved. RESULT A total number of 19 patients with completely obstructed BBS resulting from cholecystectomy or liver transplant underwent 21 MCA procedures. Among those, 19 (90.5%) interventions were successful. The median stricture length that had been measured after magnet attraction was 4 mm (range 1-10 mm). The median magnet coupling time in successful cases was 9 days (range 4-27 days). No correlation was found between magnet coupling time and stricture length (p = 0.27). Complications were observed in 6 (cholangitis:1, magnet migration:2, magnet entrapment:3) of 19 successful MCA procedures. Fifteen of the 19 successful procedures had at least a period of stent-free follow-up. Recurrence of stenosis occurred in 7 procedures, of which 4 remained stent-free with retreatment. Eventually, 12 procedures had stent-free last status. CONCLUSIONS MCA is an effective and safe treatment option in completely obstructed BBS. Further studies are required for procedural standardization.
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Affiliation(s)
- Bülent Ödemiş
- Department of Gastroenterology and Hepatology, Ankara City Hospital, Bilkent Avenue Çankaya, 06800, Ankara, Turkey.
| | - Batuhan Başpınar
- Department of Gastroenterology and Hepatology, Ankara City Hospital, Bilkent Avenue Çankaya, 06800, Ankara, Turkey
| | - Muharrem Tola
- Department of Radiology, Division of Interventional Radiology, Ankara City Hospital, Bilkent Avenue Çankaya, 06800, Ankara, Turkey
| | - Serkan Torun
- Faculty of Medicine, Department of Gastroenterology, Düzce University, Konuralp Campus, Beçiyörükler District, 81010, Merkez, Düzce, Turkey
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13
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Lopez-Lopez V, Kuemmerli C, Cutillas J, Maupoey J, López-Andujar R, Ramos E, Mils K, Valdivieso A, Valero AP, Martinez PA, Paterna S, Serrablo A, Reese T, Oldhafer K, Brusadin R, Conesa AL, Valladares LD, Loinaz C, Garcés-Albir M, Sabater L, Mocchegiani F, Vivarelli M, Pérez SA, Flores B, Lucena JL, Sánchez-Cabús S, Calero A, Minguillon A, Ramia JM, Alcazar C, Aguilo J, Ruiperez-Valiente JA, Grochola LF, Clavien PA, Petrowsky H, Robles-Campos R. Vascular injury during cholecystectomy: A multicenter critical analysis behind the drama. Surgery 2022; 172:1067-1075. [PMID: 35965144 DOI: 10.1016/j.surg.2022.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/27/2022] [Accepted: 06/27/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The management of a vascular injury during cholecystectomy is still very complicated, especially in centers not specialized in complex hepatobiliary surgery. METHODS This was a multi-institutional retrospective study in patients with vascular injuries during cholecystectomy from 18 centers in 4 countries. The aim of the study was to analyze the management of vascular injuries focusing on referral, time to perform the repair, and different treatments options outcomes. RESULTS A total of 104 patients were included. Twenty-nine patients underwent vascular repair (27.9%), 13 (12.5%) liver resection, and 1 liver transplant as a first treatment. Eighty-four (80.4%) vascular and biliary injuries occurred in nonspecialized centers and 45 (53.6%) were immediately transferred. Intraoperative diagnosed injuries were rare in referred patients (18% vs 84%, P = .001). The patients managed at the hospital where the injury occurred had a higher number of reoperations (64% vs 20%, P ˂ .001). The need for vascular reconstruction was associated with higher mortality (P = .04). Two of the 4 patients transplanted died. CONCLUSION Vascular lesions during cholecystectomy are a potentially life-threatening complication. Management of referral to specialized centers to perform multiple complex multidisciplinary procedures should be mandatory. Late vascular repair has not shown to be associated with worse results.
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Affiliation(s)
- Victor Lopez-Lopez
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain.
| | - Christoph Kuemmerli
- Department of Surgery and Transplantation, University Hospital Zurich, Switzerland; Department of Surgery, Clarunis - University Center for Gastrointestinal and Liver Diseases Basel, Switzerland. https://twitter.com/ChristophKuemme
| | - Jose Cutillas
- Department of General Surgery, Hospital Francesc de Borja, Gandía, Valencia, Spain
| | - Javier Maupoey
- Department of Hepatobiliary Surgery and Transplants, Hospital Universitario La Fe, Valencia, Spain
| | - Rafael López-Andujar
- Department of Hepatobiliary Surgery and Transplants, Hospital Universitario La Fe, Valencia, Spain
| | - Emilio Ramos
- Department of Hepatobiliary Surgery and Liver Transplant Unit, Hospital Universitari Bellvitge, University of Barcelona, Barcelona, Spain
| | - Kristel Mils
- Department of Hepatobiliary Surgery and Liver Transplant Unit, Hospital Universitari Bellvitge, University of Barcelona, Barcelona, Spain
| | - Andres Valdivieso
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, Bilbao, Spain
| | | | | | - Sandra Paterna
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - Alejando Serrablo
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - Tim Reese
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Germany
| | - Karl Oldhafer
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Germany
| | - Roberto Brusadin
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
| | - Asunción López Conesa
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
| | - Luis Díez Valladares
- Department of Surgery, Hepatopancreatobiliary Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Carmelo Loinaz
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Marina Garcés-Albir
- Department of Surgery, Hospital Clinico Valencia, University of Valencia, Biomedical Research Institute (INCLIVA), Spain
| | - Luis Sabater
- Department of Surgery, Hospital Clinico Valencia, University of Valencia, Biomedical Research Institute (INCLIVA), Spain
| | - Federico Mocchegiani
- Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Marco Vivarelli
- Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | | | - Benito Flores
- Department of Surgery, Morales University Hospital, Madrid, Spain
| | - Jose Luis Lucena
- Department of Surgery, Puerta del Hierro University Hospital, Madrid, Spain
| | - Santiago Sánchez-Cabús
- Hepatobiliopancreatic Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | - Alicia Calero
- Department of General Surgery, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain
| | | | - Jose Manuel Ramia
- Department of Surgery, University Hospital of Alicante, Spain; Universidad Miguel Hernandez, Alicante, Spain
| | - Cándido Alcazar
- Department of Surgery, University Hospital of Alicante, Spain; Universidad Miguel Hernandez, Alicante, Spain
| | - Javier Aguilo
- Department of General Surgery, Hospital Lluís Alcanyís Hospital, Xàtiva, Valencia, Spain
| | | | - Lukasz Filip Grochola
- Clinic for Visceral and Thoracic Surgery, Cantonal Hospital of Winterthur, Switzerland
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Switzerland
| | - Henrik Petrowsky
- Department of Surgery and Transplantation, University Hospital Zurich, Switzerland
| | - Ricardo Robles-Campos
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
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14
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Liver Transplantation as Definitive Treatment of Post-cholecystectomy Bile Duct Injury: Experience in a High-volume Repair Center. Ann Surg 2022; 275:e729-e732. [PMID: 35084146 DOI: 10.1097/sla.0000000000005245] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the perioperative and long-term outcomes of patients undergoing LT due to BDI in a tertiary care center. BACKGROUND BDI is associated with significant morbidity and long-term impact on quality of life. LT represents the only possibility of a cure in patients with BDI who develop SBC. METHODS Retrospective cohort study from a prospective LT database. Between 2008 and 2019, patients with SBC due to BDI after cholecystectomy and requiring LT were identified. Perioperative and long-term outcomes were analyzed. RESULTS Among 354 LT, 12 patients underwent LT to treat post-cholecystectomy BDI and accounted for 3.4% of all LT. The median time from BDI to SBC diagnosis was 9.3 years (2.4-14). The mean time from SBC to inclusion on the waitlist was 2.4years (± 2.2). Postoperative complications occurred in 11 patients (91.6%); mainly infectious (9/12 patients, 75%), followed by renal complications (4/12 patients, 33.3%). Only 2 patients developed major complications, which were the patients who died, resulting in a 90-day mortality of 16.7%. After a mean follow-up of 40.3 months (± 42.2) survival at 1, 3, and 5 years was 83%. CONCLUSIONS Although BDI is an unusual indication for LT worldwide, it accounted for 3.4% of all LT in our center. Although postoperative mortality remains high, LT is the only possibility of a cure, with acceptable long-term outcomes. Early referral to a tertiary care center is essential to avoid long-term complications of BDI, such as SBC.
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15
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Postoperative liver function tests can predict anastomotic dysfunction after bile duct injury repair. Updates Surg 2022; 74:937-944. [PMID: 35415799 DOI: 10.1007/s13304-022-01275-9] [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: 10/19/2021] [Accepted: 03/07/2022] [Indexed: 12/07/2022]
Abstract
Liver function tests help in the follow-up of postoperative patients with iatrogenic bile duct injury. There is not clear evidence regarding their predictive role on anastomosis dysfunction. We describe our experience with postoperative liver function tests and a predictive model of long-term patency after repair. This is retrospective cohort study of patients with bilioenteric anastomosis for bile duct injury and their long-term follow-up. A binomial logistic regression model was performed to ascertain the effects of the grade of bile duct injury and liver function test in the postoperative period. A total of 329 patients were considered for the analysis. In the logistic regression model two predictor variables were statistically significant for anastomosis stenosis: type of bilioenteric anastomosis and alkaline phosphatase levels. A ROC curve analysis was made for alkaline phosphatase with an area under the curve of 0.758 (95% CI 0.67-0.84). A threshold of 323 mg/dL was established (OR 6.0, 95% CI 2.60-13.83) with a sensitivity of 75%, specificity of 67%, PPV of 20%, NPV of 96%, PLR of 2.27 and NLR of 0.37. Increased alkaline phosphatase (above 323 mg/dL) after the fourth operative week was found to be a predictor of long-term dysfunction.
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16
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Yin T, Chen S, Li L, Diao M, Huang T, Li Q, Xie X. One- versus two-stage single-incision laparoscopic cyst excision and hepaticojejunostomy in patients with completely perforated choledochal cysts and good medical conditions. Pediatr Surg Int 2022; 38:541-545. [PMID: 35157126 DOI: 10.1007/s00383-022-05073-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of the current study was to evaluate the efficacy of one- and two-stage single-incision laparoscopic hepaticojejunostomy (SILH) for perforated CDCs with good medical conditions. METHODS Between June 2015 and December 2020, 57 patients were reviewed: Group 1: patients who underwent one-stage SILH (n = 16); Group 2: patients who underwent two-stage SILH (n = 41). The demographic characteristics, operational details, postoperative outcomes and postoperative complications were evaluated. RESULTS The mean follow-up durations of group 1 and 2 were 39.3 and 38.6 months, respectively. One patient (6.3%) in group 1, and 4 patients (9.8%) in group 2 were converted to laparotomy (p = 0.67). No statistical significance was found in operative time, blood transfusion, time to resume full diet, duration of drainage after definitive surgery and postoperative hospital stays between the two groups. Four patients in group 2 developed bile leakage, which was higher than that in group 1 (9.8% vs 0, p = 0.20). None suffered incidental injury, bleeding, anastomotic stenosis, cholangitis, cholelithiasis, pancreatic leakage, pancreatitis, Roux-loop obstruction, adhesive intestinal obstruction or wound infection. Liver function normalized within 1 year postoperatively in both groups. CONCLUSIONS In experienced hands, one-stage single-incision laparoscopic hepaticojejunostomy is safe and effective for patients with complete perforations and good medical conditions.
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Affiliation(s)
- Tong Yin
- Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Suyun Chen
- Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Long Li
- Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China.
| | - Mei Diao
- Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China.
| | - Ting Huang
- Children's Hospital Capital Institute of Pediatrics, Graduate School of Peking Union Medical College, Beijing, China
| | - Qianqing Li
- Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - XiangHui Xie
- Beijing Children's Hospital, Capital Medical University, Beijing, China
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Kambakamba P, Cremen S, Möckli B, Linecker M. Timing of surgical repair of bile duct injuries after laparoscopic cholecystectomy: A systematic review. World J Hepatol 2022; 14:442-455. [PMID: 35317176 PMCID: PMC8891678 DOI: 10.4254/wjh.v14.i2.442] [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: 06/19/2021] [Revised: 10/02/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The surgical management of bile duct injuries (BDIs) after laparoscopic cholecystectomy (LC) is challenging and the optimal timing of surgery remains unclear. The primary aim of this study was to systematically evaluate the evidence behind the timing of BDI repair after LC in the literature.
AIM To assess timing of surgical repair of BDI and postoperative complications.
METHODS The MEDLINE, EMBASE, and The Cochrane Library databases were systematically screened up to August 2021. Risk of bias was assessed via the Newcastle Ottawa scale. The primary outcomes of this review included the timing of BDI repair and postoperative complications.
RESULTS A total of 439 abstracts were screened, and 24 studies were included with 15609 patients included in this review. Of the 5229 BDIs reported, 4934 (94%) were classified as major injury. Timing of bile duct repair was immediate (14%, n = 705), early (28%, n = 1367), delayed (28%, n = 1367), or late (26%, n = 1286). Standardization of definition for timing of repair was remarkably poor among studies. Definitions for immediate repair ranged from < 24 h to 6 wk after LC while early repair ranged from < 24 h to 12 wk. Likewise, delayed (> 24 h to > 12 wk after LC) and late repair (> 6 wk after LC) showed a broad overlap.
CONCLUSION The lack of standardization among studies precludes any conclusive recommendation on optimal timing of BDI repair after LC. This finding indicates an urgent need for a standardized reporting system of BDI repair.
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Affiliation(s)
- Patryk Kambakamba
- Department of HPB and Transplant Surgery, St. Vincent’s University Hospital Dublin, Dublin d04 T6F4, Ireland
- Department of Surgery, Cantonal Hospital Glarus, Glarus 8750, Switzerland
| | - Sinead Cremen
- Department of HPB and Transplant Surgery, St. Vincent’s University Hospital Dublin, Dublin d04 T6F4, Ireland
| | - Beat Möckli
- Department of Visceral and Transplantation Surgery, University of Geneva Hospitals, Geneva 1205, Switzerland
| | - Michael Linecker
- Department of Surgery and Transplantation, University Medical Center Schleswig Holstein, Kiel 24105, Germany
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18
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Zendel A, Kumar A, Serrano P, de Oliveira GC, Button J, Gebre B, Gerber DA, Desai CS. Management of Major Injuries to the Bile Duct at a Hepatobiliary Specialty Referral Center. Am Surg 2022:31348211063553. [PMID: 35172613 DOI: 10.1177/00031348211063553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Aim is to evaluate geographical and demographic factors influencing management of bile duct injuries occurring during cholecystectomy in a tertiary hepato-pancreato-biliary center in Southeast US. METHODS All referrals for biliary injuries during cholecystectomy, between Jan 2017 and December 2020 were included. RESULTS 19 patients were identified with a median age of 59 (47-65), average BMI of 30.3 (18-49), and the prevalence of diabetes mellitus, hypertension and cardiovascular disease of 11%, 47% and 16%, respectively. The average transfer distance was 76 miles (8-102) and median transfer time was 3 days (1-12). 16 (84%) had Strasberg E injury, with 4 (21%) having a concomitant vascular injury (3 - right hepatic artery, 1 - right portal vein). Two (10.5%) were managed non-operatively, immediate surgical repair was performed in 2 (10.5%) and 15 (78.9%) patients underwent a delayed repair with a median of 87 days (69-118) from injury to repair. Median operative time was 5 hours (4-7), blood loss was 150 mL (100-200) and hospital stay was 8 days (6-12). DISCUSSION Factors including distance between hospitals, delays in patient transfer due to bed availability and transportation, play a role in the decision-making towards delayed repair. The delayed repair has the benefit of medical optimization of our high-risk patients' population.
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Affiliation(s)
- Alex Zendel
- Abdominal Transplant Surgery, RinggoldID:6797University of North Carlina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Aman Kumar
- Abdominal Transplant Surgery, RinggoldID:6797University of North Carlina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Pablo Serrano
- Abdominal Transplant Surgery, RinggoldID:6797University of North Carlina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Guilherme C de Oliveira
- Abdominal Transplant Surgery, RinggoldID:6797University of North Carlina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Julia Button
- Abdominal Transplant Surgery, RinggoldID:6797University of North Carlina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Betelhme Gebre
- Abdominal Transplant Surgery, RinggoldID:6797University of North Carlina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - David A Gerber
- Abdominal Transplant Surgery, RinggoldID:6797University of North Carlina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Chirag S Desai
- Abdominal Transplant Surgery, RinggoldID:6797University of North Carlina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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19
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Julian D, Martín DS, Martín P, Rodrigo SC, Guillermo A, Oscar M, Juan P. Role of laparoscopy in the immediate, intermediate, and long-term management of iatrogenic bile duct injuries during laparoscopic cholecystectomy. Langenbecks Arch Surg 2022; 407:663-673. [DOI: 10.1007/s00423-022-02452-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 01/20/2022] [Indexed: 12/17/2022]
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20
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Machine Learning-Based Analysis in the Management of Iatrogenic Bile Duct Injury During Cholecystectomy: a Nationwide Multicenter Study. J Gastrointest Surg 2022; 26:1713-1723. [PMID: 35790677 PMCID: PMC9439981 DOI: 10.1007/s11605-022-05398-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/17/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Iatrogenic bile duct injury (IBDI) is a challenging surgical complication. IBDI management can be guided by artificial intelligence models. Our study identified the factors associated with successful initial repair of IBDI and predicted the success of definitive repair based on patient risk levels. METHODS This is a retrospective multi-institution cohort of patients with IBDI after cholecystectomy conducted between 1990 and 2020. We implemented a decision tree analysis to determine the factors that contribute to successful initial repair and developed a risk-scoring model based on the Comprehensive Complication Index. RESULTS We analyzed 748 patients across 22 hospitals. Our decision tree model was 82.8% accurate in predicting the success of the initial repair. Non-type E (p < 0.01), treatment in specialized centers (p < 0.01), and surgical repair (p < 0.001) were associated with better prognosis. The risk-scoring model was 82.3% (79.0-85.3%, 95% confidence interval [CI]) and 71.7% (63.8-78.7%, 95% CI) accurate in predicting success in the development and validation cohorts, respectively. Surgical repair, successful initial repair, and repair between 2 and 6 weeks were associated with better outcomes. DISCUSSION Machine learning algorithms for IBDI are a novel tool may help to improve the decision-making process and guide management of these patients.
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Iatrogenic Bile Duct Injury: Call for Help, Refer Early, Reduce Infection. Invited Commentary: Liver Transplantation as Definitive Treatment of Postcholecystectomy Bile Duct Injury: Experience in a High-volume Repair Center. Ann Surg 2021; 275:e733-e734. [PMID: 34913898 DOI: 10.1097/sla.0000000000005342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Comment on "Early Versus Delayed Surgical Repair and Referral for Patients With Bile Duct Injury: A Systematic Review and Meta-Analysis". Ann Surg 2021; 274:e756. [PMID: 32502077 DOI: 10.1097/sla.0000000000003954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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de Benito Sanz M, Carbajo AY, Sanchez-Ocana R, Chavarría C, de la Serna-Higuera C, Perez-Miranda M. Combined endoscopic retrograde and endosonography-guided (CERES) cholangiography for interventional repair of transected bile ducts after cholecystectomy: treatment approaches and outcomes. Surg Endosc 2021; 36:2197-2207. [PMID: 34816304 DOI: 10.1007/s00464-021-08809-z] [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: 03/31/2021] [Accepted: 10/17/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Post-cholecystectomy transected bile ducts (TBDs) are not amenable to standard endoscopic management. Combined ERCP and endosonography (CERES) including EUS-guided hepaticoenterostomy enhance therapeutic biliary endoscopy. CERES treatment of post-cholecystectomy TBDs is evaluated. METHODS Among 165 consecutive patients who underwent ERCP for post-cholecystectomy bile duct injury (Amsterdam A/B/C/D grades [%] = 47/30/7/16) between January 2009-November 2020 at a tertiary-care center, 10/26 (38%) with TBDs (6 female; 32-92 years old) underwent CERES before attempted endoscopic repair (staged CERES, n = 7) or surgical repair (preoperative CERES, n = 1), or as destination therapy (definitive CERES, n = 2). Short-term clinical success rate, final clinical success rate and comprehensive complication index (CCI) were retrospectively determined. Additionally, number of follow-up procedures, adverse events, recurrences, final patency grades and definitive cure rate were determined in patients with staged CERES. RESULTS Index CERES (hepaticogastrostomy, 60%; hepaticoduodenostomy, 40%) achieved bile leak and jaundice resolution in 10 patients (100% short-term clinical success rate). Overall, 9/10 patients maintained good/excellent biliary drainage over a median 3.2 years without any unplanned percutaneous/surgical procedures (90% final clinical success rate; median CCI = 8.7). Staged CERES using recanalization (n = 6) or diversion (n = 1) strategies achieved Grade A patency in 5/7 (71%) patients after a median of 2 follow-up procedures over a median 12-month treatment period; 2 failed recanalization patients were salvaged by indefinite hepaticoenterostomy stent or elective surgery, respectively. Among staged CERES, 2 treatment-related cholangitis occurred (29%) and 2 recurring strictures (29%) developed over a median 8.4 year follow-up; recurring strictures were endoscopically remodeled (n = 1) or indefinitely stented (n = 1); final Grade A/B biliary patency was achieved in 5/7 (71%) and definitive cure in 4/7 (57%). CONCLUSIONS CERES controls acute symptoms in selected post-cholecystectomy TBD patients allowing subsequent staged endoscopic therapy. Definitive cure or long-term biliary drainage is possible in most cases and elective surgery can be facilitated in the remainder.
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Affiliation(s)
- Marina de Benito Sanz
- Department Head and Associate Professor of Medicine, Gastroenterology Department, Hospital Universitario Rio Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
| | - Ana Y Carbajo
- Department Head and Associate Professor of Medicine, Gastroenterology Department, Hospital Universitario Rio Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
| | - Ramon Sanchez-Ocana
- Department Head and Associate Professor of Medicine, Gastroenterology Department, Hospital Universitario Rio Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
| | - Carlos Chavarría
- Department Head and Associate Professor of Medicine, Gastroenterology Department, Hospital Universitario Rio Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
| | - Carlos de la Serna-Higuera
- Department Head and Associate Professor of Medicine, Gastroenterology Department, Hospital Universitario Rio Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain
| | - Manuel Perez-Miranda
- Department Head and Associate Professor of Medicine, Gastroenterology Department, Hospital Universitario Rio Hortega, Calle Dulzaina 2, 47012, Valladolid, Spain.
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Ma D, Liu P, Lan J, Chen B, Gu Y, Li Y, Yue P, Liu Z, Guo D. A Novel End-to-End Biliary-to-Biliary Anastomosis Technique for Iatrogenic Bile Duct Injury of Strasberg-Bismuth E1-4 Treatment: A Retrospective Study and in vivo Assessment. Front Surg 2021; 8:747304. [PMID: 34778361 PMCID: PMC8580848 DOI: 10.3389/fsurg.2021.747304] [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: 07/26/2021] [Accepted: 09/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background: An iatrogenic bile duct injury (IBDI) is a severe complication that has a great impact on the physical and mental quality of life of the patients, especially for patients with postoperative benign biliary stricture. The effective measures for end-to-end biliary-to-biliary anastomosis intraoperative are essential to prevent the postoperative bile duct stricture, but also a challenge even to the most skilled biliary tract surgeon. Objective: A postoperative benign biliary stricture is an extremely intractable complication that occurs following IBDI. This study aimed to introduce a novel end-to-end biliary-to-biliary anastomosis technique named fish-mouth-shaped (FMS) end-to-end biliary-to-biliary reconstruction and determine the safety and effectiveness for preventing the postoperative benign biliary stricture in both rats and humans. Methods: In this study, 18 patients with biliary injury who underwent an FMS reconstruction procedure were retrospectively analyzed. Their general information, disease of the first hospitalization, operation method, and classification of bile duct injury (BDI) were collected. The postoperative complications were evaluated immediately perioperatively and the long-term complications were followed up at the later period of at least 5 years. An IBDI animal model using 18 male rats was developed for animal-based evaluations. A bile duct diathermy injury model was used to mimic BDI. The FMS group underwent an FMS reconstruction procedure while the control group underwent common end-to-end biliary-to-biliary anastomosis, a sham operation group was also established. The blood samples, liver, spleen, and common bile duct tissues were harvested for further assessments. Results: In the retrospective study, there was no postoperative mortality and no patient developed cholangitis during the 5-years postoperation follow-up. In the study of IBDI animal models, compared with the control group, the FMS reconstruction procedure reduced the occurrence of benign biliary stenosis, liver function damage, and jaundice. The blood tests as well as morphological and pathological observations revealed that rats in the FMS reconstruction group had a better recovery than those in the control group. Conclusions: An FMS reconstruction procedure is a safe and efficient BDI treatment method.
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Affiliation(s)
- Dong Ma
- Department of Hepatobiliary Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Pengpeng Liu
- Department of Hepatobiliary Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jianwei Lan
- Department of Hepatobiliary Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Baiyang Chen
- Department of Hepatobiliary Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yang Gu
- Department of Hepatobiliary Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yun Li
- Department of Hepatobiliary Surgery, Affiliated Jingmen First People's Hospital of Hubei University for Nationalities, Jingmen, China
| | - Pengpeng Yue
- Department of Hepatobiliary Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhisu Liu
- Department of Hepatobiliary Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Deliang Guo
- Department of Hepatobiliary Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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25
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Standardizing Diagnostic and Surgical Approach to Management of Bile Duct Injuries After Cholecystectomy: Long-Term Outcomes of Patients Treated at a High-Volume HPB Center. J Gastrointest Surg 2021; 25:2796-2805. [PMID: 33532980 DOI: 10.1007/s11605-021-04916-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/10/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Optimal diagnostic and surgical approaches for patients with bile duct injuries (BDI) remain debated. This study reviews results from a standardized approach to management of high-grade BDIs at a North American center. DESIGN Patients undergoing surgical repair for BDIs over a 15-year period were included. Post-operative outcomes and biliary patency rates were calculated using imaging, laboratory values, and patient interviews. RESULTS A total of 107 consecutive patients underwent repair for BDIs. Bismuth grade I/II injuries were identified in 46 patients (41%), grade III/IV in 41 (38%), grade V in 11 patients (10%), and 9 (10%) were unclassified. BDI anatomy was commonly identified using magnetic resonance imaging (MRI) (75%). Concomitant arterial injuries were identified in 30 (28 with formal angiography). Fifteen had early repairs (within 4 days) and remainder interval repairs (median: 65 days). Hepp-Couinaud repair was method of choice (83%). Estimated primary biliary patency was 100% at 30 days and 87% at 5 years. CONCLUSION With appropriate referral to a specialist, surgical reconstruction of BDIs can have excellent outcomes, even with accompanying arterial injuries. Based on our experience, MR as first imaging modality and supplemental angiography served as the optimal diagnostic strategy. Delayed repair, using Hepp-Couinaud technique, with selective liver resection results in high long-term patency rates.
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Sirichindakul P, Ieamsuwan D, Wattanakul T, Taesombat W, Sutherasan M, Vorasittha A, Nonthasoot B. Partial segments 4/5 liver resection facilitates the repair of complicated bile duct injuries: a technical challenge and long-term outcomes. Updates Surg 2021; 73:1709-1716. [PMID: 34347275 DOI: 10.1007/s13304-021-01146-9] [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: 04/22/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
Adequate exposure with optimal anteroposterior view of the hilar plate is challenging and crucial in a surgical repair of complicated hilar bile duct injuries. A high-quality anastomosis depends on the ability to identify non-scarred, non-inflamed, non-ischemic bile ducts. This study provides operative details of the Partial Segments 4/5 Liver Resection with a Roux-en-Y hepaticojejunostomy (PS4/5LRHJ) and presents its long-term outcomes. 36 patients with the Strasberg type E bile duct injuries (BDIs) who underwent the PS4/5LRHJ from 2003 to 2019 were retrospectively reviewed. Outcomes of the surgical treatments were analyzed. The mean age of the patients was 46.3 years. 22 patients underwent BDI repair as index operations and 14 patients as re-repair operations. Operative times between the index operation group and the re-repair group (396.6 min vs 391.3 min, respectively, p = 0.876) and blood loss (590.6 ml vs 640 ml, respectively, p = 0.587) were not statistically different. The mean length of hospital stay was 23 days. The median follow-up duration was 73 months. Major complications developed in 10 patients (27.8%), of which intra-abdominal collection was the most common (eight patients, 22.2%). Anastomotic stricture developed in one patient (2.8%). The mortality rate was zero. The overall 10-year patency rate was 95.2%. PS4/5LRHJ offered long-term patency with acceptable morbidity in the hilar bile duct injuries and re-repair operations.
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Affiliation(s)
- Pongserath Sirichindakul
- Department of Surgery, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, 1873 Rama 4 Rd, Pathumwan, Bangkok, 10330, Thailand.
| | - Dungfun Ieamsuwan
- Department of Surgery, Nakhon Pathom Hospital, 196 Tesa Rd, Mueng, Nakhon Pathom District, Nakhon Pathom, 73000, Thailand
| | - Thitipat Wattanakul
- Department of Surgery, Sawanpracharak Hospital, 43 Attakavee Rd, Takhian Luean, Amphoe Mueang, Nakhon Sawan, 60000, Thailand
| | - Wipusit Taesombat
- Department of Surgery, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, 1873 Rama 4 Rd, Pathumwan, Bangkok, 10330, Thailand
| | - Methee Sutherasan
- Department of Surgery, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, 1873 Rama 4 Rd, Pathumwan, Bangkok, 10330, Thailand
| | - Athaya Vorasittha
- Department of Surgery, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, 1873 Rama 4 Rd, Pathumwan, Bangkok, 10330, Thailand
| | - Bunthoon Nonthasoot
- Department of Surgery, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, 1873 Rama 4 Rd, Pathumwan, Bangkok, 10330, Thailand
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27
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Kurdia KC, Irrinki S, Siddharth B, Gupta V, Lal A, Yadav TD. Percutaneous transhepatic cholangiography in the era of magnetic resonance cholangiopancreatography: A prospective comparative analysis in preoperative evaluation of benign biliary stricture. JGH OPEN 2021; 5:820-824. [PMID: 34263078 PMCID: PMC8264248 DOI: 10.1002/jgh3.12594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/08/2021] [Indexed: 11/22/2022]
Abstract
Background and Aim Accurate anatomical delineation is the key before definitive repair for benign biliary stricture (BBS). The role of percutaneous transhepatic cholangiography (PTC) as a road map is less studied in the era of magnetic resonance cholangiopancreatography (MRCP). Methods A prospective observational study, performed between July 2012 and December 2013. All patients of post‐cholecystectomy BBS were evaluated with MRCP and PTC prior to definitive repair. Findings of MRCP and PTC were compared with intraoperative details. Results Thirty patients with BBS were included in the study. MRCP was performed in all but PTC was amenable in 28 of 30 (93.3%) patients. PTC was comparable to MRCP in diagnosing stricture type (96.4% vs 89.3%), intrahepatic stones (75% vs 75%), and biliary anomalies (95.6% vs 100%). Additionally, PTC revealed internal biliary fistula in 4 (85.7% vs 61.4%; P value 0.04). PTC‐related minor complications were noted in 2 (7.1%) patients. Conclusion PTC is comparable to MRCP in diagnosing the stricture type, intrahepatic biliary stones, and biliary anomalies. Though comparable to MRCP, the authors could not reveal any additional information that could change the course of management in BBS.
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Affiliation(s)
- Kailash C Kurdia
- Department of General Surgery Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Santhosh Irrinki
- Department of General Surgery Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Bharath Siddharth
- Department of General Surgery Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Vikas Gupta
- Department of General Surgery Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Anupam Lal
- Department of Radiodiagnosis Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh India
| | - Thakur D Yadav
- Department of General Surgery Post Graduate Institute of Medical Education and Research (PGIMER) Chandigarh India
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28
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de'Angelis N, Catena F, Memeo R, Coccolini F, Martínez-Pérez A, Romeo OM, De Simone B, Di Saverio S, Brustia R, Rhaiem R, Piardi T, Conticchio M, Marchegiani F, Beghdadi N, Abu-Zidan FM, Alikhanov R, Allard MA, Allievi N, Amaddeo G, Ansaloni L, Andersson R, Andolfi E, Azfar M, Bala M, Benkabbou A, Ben-Ishay O, Bianchi G, Biffl WL, Brunetti F, Carra MC, Casanova D, Celentano V, Ceresoli M, Chiara O, Cimbanassi S, Bini R, Coimbra R, Luigi de'Angelis G, Decembrino F, De Palma A, de Reuver PR, Domingo C, Cotsoglou C, Ferrero A, Fraga GP, Gaiani F, Gheza F, Gurrado A, Harrison E, Henriquez A, Hofmeyr S, Iadarola R, Kashuk JL, Kianmanesh R, Kirkpatrick AW, Kluger Y, Landi F, Langella S, Lapointe R, Le Roy B, Luciani A, Machado F, Maggi U, Maier RV, Mefire AC, Hiramatsu K, Ordoñez C, Patrizi F, Planells M, Peitzman AB, Pekolj J, Perdigao F, Pereira BM, Pessaux P, Pisano M, Puyana JC, Rizoli S, Portigliotti L, Romito R, Sakakushev B, Sanei B, Scatton O, Serradilla-Martin M, Schneck AS, Sissoko ML, Sobhani I, Ten Broek RP, Testini M, Valinas R, Veloudis G, Vitali GC, Weber D, Zorcolo L, Giuliante F, Gavriilidis P, Fuks D, Sommacale D. 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy. World J Emerg Surg 2021; 16:30. [PMID: 34112197 PMCID: PMC8190978 DOI: 10.1186/s13017-021-00369-w] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/18/2021] [Indexed: 12/16/2022] Open
Abstract
Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4-1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.
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Affiliation(s)
- Nicola de'Angelis
- Unit of Minimally Invasive and Robotic Digestive Surgery, General Regional Hospital "F. Miulli", Strada Prov. 127 Acquaviva - Santeramo Km. 4, 70021 Acquaviva delle Fonti BA, Bari, Italy. .,Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France.
| | - Fausto Catena
- Department of Emergency and Trauma Surgery of the University Hospital of Parma, Parma, Italy
| | - Riccardo Memeo
- Department of Hepato-Pancreatic-Biliary Surgery, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Aleix Martínez-Pérez
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Oreste M Romeo
- Trauma, Burn, and Surgical Care Program, Bronson Methodist Hospital, Kalamazoo, Michigan, USA
| | - Belinda De Simone
- Service de Chirurgie Générale, Digestive, et Métabolique, Centre hospitalier de Poissy/Saint Germain en Laye, Saint Germain en Laye, France
| | - Salomone Di Saverio
- Department of Surgery, Cambridge University Hospital, NHS Foundation Trust, Cambridge, UK
| | - Raffaele Brustia
- Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Rami Rhaiem
- Department of HBP and Digestive Oncologic Surgery, Robert Debré University Hospital, Reims, France
| | - Tullio Piardi
- Department of HBP and Digestive Oncologic Surgery, Robert Debré University Hospital, Reims, France.,Department of Surgery, HPB Unit, Troyes Hospital, Troyes, France
| | - Maria Conticchio
- Department of Hepato-Pancreatic-Biliary Surgery, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Francesco Marchegiani
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Nassiba Beghdadi
- Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Ruslan Alikhanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Shosse Enthusiastov, 86, 111123, Moscow, Russia
| | | | - Niccolò Allievi
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Giuliana Amaddeo
- Service d'Hepatologie, APHP, Henri Mondor University Hospital, Creteil, and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Luca Ansaloni
- General Surgery, San Matteo University Hospital, Pavia, Italy
| | | | - Enrico Andolfi
- Department of Surgery, Division of General Surgery, San Donato Hospital, 52100, Arezzo, Italy
| | - Mohammad Azfar
- Department of Surgery, Al Rahba Hospital, Abu Dhabi, UAE
| | - Miklosh Bala
- Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Offir Ben-Ishay
- Department of General Surgery, Rambam Healthcare Campus, Haifa, Israel
| | - Giorgio Bianchi
- Unit of Minimally Invasive and Robotic Digestive Surgery, General Regional Hospital "F. Miulli", Strada Prov. 127 Acquaviva - Santeramo Km. 4, 70021 Acquaviva delle Fonti BA, Bari, Italy
| | - Walter L Biffl
- Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
| | - Francesco Brunetti
- Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | | | - Daniel Casanova
- Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | - Valerio Celentano
- Colorectal Unit, Chelsea and Westminster Hospital, NHS Foundation Trust, London, UK
| | - Marco Ceresoli
- Emergency and General Surgery Department, University of Milan Bicocca, Milan, Italy
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Roberto Bini
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC and Loma Linda University School of Medicine, Loma Linda, USA
| | - Gian Luigi de'Angelis
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Decembrino
- Gastroenterology and Endoscopy Unit, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Andrea De Palma
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Philip R de Reuver
- Department of Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Carlos Domingo
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | | | - Alessandro Ferrero
- Department of General and Oncological Surgery, Azienda Ospedaliera Ordine Mauriziano "Umberto I", Turin, Italy
| | - Gustavo P Fraga
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Federica Gaiani
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Federico Gheza
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Angela Gurrado
- Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Ewen Harrison
- Department of Clinical Surgery and Centre for Medical Informatics, Usher Institute, University of Edinburgh, Little France Crescent, Edinburgh, UK
| | | | - Stefan Hofmeyr
- Division of Surgery, Surgical Gastroenterology Unit, Tygerberg Academic Hospital, University of Stellenbosch Faculty of Medicine and Health Sciences, Stellenbosch, South Africa
| | - Roberta Iadarola
- Department of Emergency and Trauma Surgery of the University Hospital of Parma, Parma, Italy
| | - Jeffry L Kashuk
- Department of Surgery, Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
| | - Reza Kianmanesh
- Department of HBP and Digestive Oncologic Surgery, Robert Debré University Hospital, Reims, France
| | - Andrew W Kirkpatrick
- Department of Surgery, Critical Care Medicine and the Regional Trauma Service, Foothills Medical Center, Calgari, Alberta, Canada
| | - Yoram Kluger
- Department of General Surgery, Rambam Healthcare Campus, Haifa, Israel
| | - Filippo Landi
- Department of HPB and Transplant Surgery, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
| | - Serena Langella
- Department of General and Oncological Surgery, Azienda Ospedaliera Ordine Mauriziano "Umberto I", Turin, Italy
| | - Real Lapointe
- Department of HBP Surgery and Liver Transplantation, Department of Surgery, Centre Hospitalier de l'Université de Montreal, Montreal, QC, Canada
| | - Bertrand Le Roy
- Department of Digestive Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Alain Luciani
- Unit of Radiology, Henri Mondor University Hospital (AP-HP), Creteil, and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Fernando Machado
- Department of Emergency Surgery, Hospital de Clínicas, School of Medicine UDELAR, Montevideo, Uruguay
| | - Umberto Maggi
- General Surgery and Liver Transplantation Unit, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Ronald V Maier
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Alain Chichom Mefire
- Department of Surgery and Obstetrics/Gynecologic, Regional Hospital, Limbe, Cameroon
| | - Kazuhiro Hiramatsu
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan
| | - Carlos Ordoñez
- Division of Trauma and Acute Care Surgery, Department of Surgery, Fundacion Valle del Lili, Universidad del Valle Cali, Cali, Colombia
| | - Franca Patrizi
- Unit of Gastroenterology and Endoscopy, Maggiore Hospital, Bologna, Italy
| | - Manuel Planells
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Andrew B Peitzman
- Department of Surgery, UPMC, University of Pittsburg, School of Medicine, Pittsburg, USA
| | - Juan Pekolj
- General Surgery, Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Fabiano Perdigao
- Liver Transplant Unit, APHP, Unité de Chirurgie Hépatobiliaire et Transplantation hépatique, Hôpital Pitié Salpêtrière, Paris, France
| | - Bruno M Pereira
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Patrick Pessaux
- Hepatobiliary and Pancreatic Surgical Unit, Visceral and Digestive Surgery, IHU mix-surg, Institute for Minimally Invasive Image-Guided Surgery, University of Strasbourg, Strasbourg, France
| | - Michele Pisano
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Juan Carlos Puyana
- Trauma & Acute Care Surgery - Global Health, University of Pittsburgh, Pittsburgh, USA
| | - Sandro Rizoli
- Trauma and Acute Care Service, St Michael's Hospital, Toronto, ON, Canada
| | - Luca Portigliotti
- Chirurgia Epato-Gastro-Pancreatica, Azienda Ospedaliera-Universitaria Maggiore della Carità, Novara, Italy
| | - Raffaele Romito
- Chirurgia Epato-Gastro-Pancreatica, Azienda Ospedaliera-Universitaria Maggiore della Carità, Novara, Italy
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Behnam Sanei
- Department of Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Olivier Scatton
- Liver Transplant Unit, APHP, Unité de Chirurgie Hépatobiliaire et Transplantation hépatique, Hôpital Pitié Salpêtrière, Paris, France
| | - Mario Serradilla-Martin
- Instituto de Investigación Sanitaria Aragón, Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Anne-Sophie Schneck
- Digestive Surgery Unit, Centre Hospitalier Universitaire de Guadeloupe, Pointe-À-Pitre, Les Avymes, Guadeloupe, France
| | - Mohammed Lamine Sissoko
- Service de Chirurgie, Hôpital National Blaise Compaoré de Ouagadougou, Ouagadougou, Burkina Faso
| | - Iradj Sobhani
- Department of Gastroenterology and Digestive Endoscopy, Henri Mondor Hospital, AP-HP, Creteil, and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Richard P Ten Broek
- Department of Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Mario Testini
- Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Roberto Valinas
- Department of Surgery "F", Faculty of Medicine, Clinic Hospital "Dr. Manuel Quintela", Montevideo, Uruguay
| | | | - Giulio Cesare Vitali
- Division of Transplantation, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Luigi Zorcolo
- Department of Surgery, Colorectal Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Foundation "Policlinico Universitario A. Gemelli", IRCCS, Rome, Italy
| | - Paschalis Gavriilidis
- Division of Gastrointestinal and HBP Surgery, Imperial College HealthCare, NHS Trust, Hammersmith Hospital, London, UK
| | - David Fuks
- Institut Mutualiste Montsouris, Paris, France
| | - Daniele Sommacale
- Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
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Zhang K, Wu L, Gao K, Yan C, Zheng C, Guo C. Strict Surgical Repair for Bile Leakage Following the Roux-en-Y Hepaticojejunostomy. Front Surg 2021; 8:641127. [PMID: 34017852 PMCID: PMC8130580 DOI: 10.3389/fsurg.2021.641127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The optimal bile leakage management strategy in the pediatric population following the initial Roux-en-Y hepaticojejunostomy is still a matter of discussion today. Here, we assessed the roles of bile leakage management and surgical implementation on outcomes for patients with bile leakage. Materials and Methods: A revised protocol for bile leakage management with restricted surgical intervention was implemented at Chongqing Children’s Hospital on March 15, 2013 and Sanxia Hospital on April 20, 2013. We performed a retrospective, historical control analysis for the protocol implementation to compare the short- and long-term outcomes using the corresponding statistical methods. Results: There was a total of 84 patients included in the analysis, including 46 patients in the pre-protocol group and 38 patients in the post-protocol group. No statistical differences for the demographic features were found between the two groups. There was a decrease in redo surgeries in the post-protocol cohort compared to those in the pre-protocol cohort (odds ratio [OR] = 4.48 [95% CI, 1.57–12.77]; p = 0.003). Furthermore, patients in the post-protocol group were less likely to be associated with intensive care unit (ICU) admission (OR = 3.72 [95% CI, 1.11–12.49]; p = 0.024) compared to patients in the pre-protocol group, respectively. There was no mortality between the two groups. Conclusions: A restrictive surgical intervention strategy can effectively reduce the rate of redo surgery and exhibited promising outcomes for bile leakage in terms of postoperative recovery and hospitalization costs.
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Affiliation(s)
- Keying Zhang
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Linfeng Wu
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Kai Gao
- Department of Pediatric General and Neonatal Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chengwei Yan
- Department of Pediatric General Surgery, Sanxia Hospital, Chongqing University, Chongqing, China
| | - Chao Zheng
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China.,Department of Traumatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chunbao Guo
- Department of Pediatric General and Neonatal Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Department of Orthopaedics, Children's Hospital of Chongqing Medical University, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China
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30
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Yang HC, Huang SY, Wu CC, Chou CM. Delayed repair of post-hepatectomy bile duct injury by ducto-jejunostomy directly through a percutaneous transhepatic cholangial drainage tract: An easy alternative. Asian J Surg 2021; 44:926-927. [PMID: 33895053 DOI: 10.1016/j.asjsur.2021.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Han-Chung Yang
- Department of Surgery, Taichung Veterans General Hospital, Taiwan, ROC.
| | - Sheng-Yang Huang
- Department of Surgery, Taichung Veterans General Hospital, Taiwan, ROC; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
| | - Cheng-Chung Wu
- Department of Surgery, Taichung Veterans General Hospital, Taiwan, ROC.
| | - Chia-Man Chou
- Department of Surgery, Taichung Veterans General Hospital, Taiwan, ROC; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
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31
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Rao PP, Singh A, Singh KJ. Bile Duct Injuries: Outcome of Early and Delayed Repair at a Tertiary Care Centre. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02393-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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32
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Wang X, Gao K, Yan C, Guo C. Short- and intermediate-term evaluation of the initial definitive operation for perforated choledochal cysts compared to two-stage management. Eur J Trauma Emerg Surg 2020; 48:1129-1135. [PMID: 33245366 DOI: 10.1007/s00068-020-01553-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/10/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Recently, single definitive hepaticojejunostomy has been proposed to replace two-stage procedures, including initial urgent biliary drainage and final biliary reconstruction, with a reduced hospitalization time and corresponding overall hospitalization cost. We aimed to investigate the safety and efficacy of the initial definitive operation compared with the two-stage approach. METHODS The medical records of patients with perforated CDCs managed between 2010 and 2017 were retrospectively reviewed. The qualified samples were divided according to a single definitive operation or two-stage approach. We conducted a comparison of the clinical characteristics, including surgical parameters, length of stay, and short- and intermediate-term complications. RESULTS A total of 117 patients with perforated CDCs were reviewed, with 48 cases of single-stage management and 69 cases of two-stage management. No differences in the baseline characteristics between the two groups were found, such as age, sex distribution, ultrasound presentation, or laboratory findings. The initial definitive operation was associated with a lower total duration of drainage, including abdominal drainage and biliary drainage (p < 0.001), and rate of unplanned readmission (OR, 0.056; 95% CI 0.007-0.435; p < 0.001) than those who underwent two-stage management. Furthermore, the initial definitive operation significantly reduced the postoperative hospital stay (p < 0.001), and the overall hospitalization cost was accordingly reduced compared with two-stage management (p < 0.001). CONCLUSIONS The initial single definitive operation was safe and effective for most of the patients with perforated CDCs when expertise was available. Therefore, a single definitive operation should be considered the treatment of choice for perforated CDCs.
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Affiliation(s)
- Xu Wang
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Kai Gao
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Chengwei Yan
- Department of Pediatric General Surgery, Chongqing Three Gorges Central Hospital, Chongqing, 400014, People's Republic of China
| | - Chunbao Guo
- Department of Ultrasound, The Affiliated Hospital of Medical College, Qingdao University, Qingdao, Chongqing, People's Republic of China. .,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China. .,Department of Pediatric General Surgery and Liver Transplantation, Children's Hospital of Chongqing Medical University, 136 Zhongshan 2nd Rd., Chongqing, 400014, People's Republic of China.
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