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Cullen JM, Conzen KD, Pomfret EA. Living Donor Liver Transplantation: Left Lobe or Right Lobe. Surg Clin North Am 2024; 104:89-102. [PMID: 37953043 DOI: 10.1016/j.suc.2023.07.003] [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] [Indexed: 11/14/2023]
Abstract
Living Donor Liver Transplantation (LDLT) has seen great advancements since its inception in 1988. Herein, the nuances of LDLT are discussed spanning from donor evaluation to the recipient operation. Special attention is given to donor anatomy and graft optimization techniques in the recipient.
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Affiliation(s)
- J Michael Cullen
- Colorado Center for Transplantation Care, Research and Education (CCTCARE), University of Colorado Anschutz, University of Colorado Anschutz Medical Campus, 1635 Aurora Ct, AOP 7th Fl, C-318, Aurora, CO 80045, USA
| | - Kendra D Conzen
- Colorado Center for Transplantation Care, Research and Education (CCTCARE), University of Colorado Anschutz, University of Colorado Anschutz Medical Campus, 1635 Aurora Ct, AOP 7th Fl, C-318, Aurora, CO 80045, USA.
| | - Elizabeth A Pomfret
- Division of Transplant Surgery, Igal Kam, MD Endowed Chair in Transplantation Surgery, Colorado Center for Transplantation Care, Research and Education (CCTCARE), University of Colorado Anschutz Medical Campus, 1635 Aurora Ct, AOP 7th Fl, C-318, Aurora, CO 80045, USA
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2
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Liggett MR, Rossi I, Rossi MB. Recognition and Surgical Management of Aberrant Right Hepatic Duct Originating From the Cystic Duct. Am Surg 2024; 90:154-156. [PMID: 37883202 DOI: 10.1177/00031348231211028] [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] [Indexed: 10/27/2023]
Abstract
An aberrant right hepatic duct is a rare congenital anomaly of the biliary system. Failure to recognize these anomalies can result in serious complications. In this case, we present a patient who underwent laparoscopic cholecystectomy for chronic cholecystitis. Post-operatively she developed a bile leak for which she underwent reoperation. On re-exploration, she was discovered to have a cystic stump leak and a rare Hisatsugu type V anatomic anomaly of the right hepatic duct originating from the cystic duct. She was subsequently managed with oversewing of the cystic duct stump and drainage. This case demonstrates the importance of recognizing these rare anomalies and the challenges of management in a rural, resource-limited setting.
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Affiliation(s)
- Marjorie R Liggett
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Isolina Rossi
- Department of Surgery, Hopedale Medical Complex, Hopedale, IL, USA
| | - Matthew B Rossi
- Department of Surgery, Hopedale Medical Complex, Hopedale, IL, USA
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Wang W, Huang H, He K, Wang L, Su S, Zhang Z, Wang P, Guo B, Ren X, Li O. Detection of the communicating accessory bile duct in laparoscopic resection of residual gallbladder by the combination of the indocyanine green fluorescence cholangiography and the intraoperative cholangiography: A case report. Photodiagnosis Photodyn Ther 2023; 42:103587. [PMID: 37146895 DOI: 10.1016/j.pdpdt.2023.103587] [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: 03/16/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND The partial cholecystectomy may be performed while in complicated laparoscopic cholecystectomy (LC). Biliary anomalies especially the accessory bile duct are established high risk of bile duct injury (BDI) in LC. Laparoscopic resection of residual gallbladder is a challenging procedure and extremely vulnerable to BDI. We report the execution of a laparoscopic resection of residual gallbladder with a communicating accessory bile duct using indocyanine green (ICG) fluorescence cholangiography and the intraoperative cholangiography (IOC). A case that has not been reported previously. PRESENTATION OF CASE A 29-year-old female with history of laparoscopic partial cholecystectomy was admitted in our hospital. Magnetic resonance cholangiopancreatography (MRCP) revealed the residual gallbladder with an accessory bile duct. Considering the complexity of this patient, we performed a laparoscopic surgery using ICG fluorescence cholangiography. ICG was injected intravenously 1h before the surgery, the residual gallbladder and the extrahepatic biliary structures including the accessory bile duct were imaged in green in fluorescence imaging that could be recognized clearly. IOC revealed that residual gallbladder communicated with intrahepatic bile duct through the accessory bile duct and drained into the common bile duct (CBD). The entire procedure was performed smoothly and successfully without bile duct injuries. DISCUSSION Laparoscopic resection of residual gallbladder is a challenging procedure. Fluorescence cholangiography using ICG is regarded as a novel technique that could provide a real-time imaging intraoperative, which allowed to recognize and identify the residual gallbladder and the extrahepatic bile duct. IOC is also important in identifying a communicating accessory bile duct. Under the guidance of them, we completed this laparoscopic surgery. CONCLUSIONS The combination of fluorescence cholangiography using ICG and IOC have profound significance in complicated LC.
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Affiliation(s)
- Wanli Wang
- Department of Hepatobiliary, Pancreatic, Splenic and Vascular Surgery, Bazhong Central Hospital, Bazhong, 636000, China.
| | - Hansheng Huang
- Department of Hepatobiliary, Pancreatic, Splenic and Vascular Surgery, Bazhong Central Hospital, Bazhong, 636000, China
| | - Kai He
- Department of Hepatobiliary, Pancreatic, Splenic and Vascular Surgery, Bazhong Central Hospital, Bazhong, 636000, China
| | - Liangjie Wang
- Department of Hepatobiliary, Pancreatic, Splenic and Vascular Surgery, Bazhong Central Hospital, Bazhong, 636000, China
| | - Song Su
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Zhiyong Zhang
- Department of Hepatobiliary, Pancreatic, Splenic and Vascular Surgery, Bazhong Central Hospital, Bazhong, 636000, China
| | - Piao Wang
- Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Bing Guo
- Department of Hepatobiliary, Pancreatic, Splenic and Vascular Surgery, Bazhong Central Hospital, Bazhong, 636000, China
| | - Xiaobin Ren
- Department of Hepatobiliary, Pancreatic, Splenic and Vascular Surgery, Bazhong Central Hospital, Bazhong, 636000, China
| | - Ou Li
- Department of Hepatobiliary, Pancreatic, Splenic and Vascular Surgery, Bazhong Central Hospital, Bazhong, 636000, China
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Khoonsari M, Mansoorian MR, Namazi A, Kabir A. Cystic duct entering to right hepatic duct; a case report with literature review. Int J Surg Case Rep 2023; 106:108222. [PMID: 37086502 PMCID: PMC10154732 DOI: 10.1016/j.ijscr.2023.108222] [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: 12/10/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/24/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Surgeons may mistakenly consider the right hepatic duct as cystic duct, ligate, and divide it. CASE PRESENTATION A 58-year-old woman presented with right upper quadrant (RUQ) abdominal pain, nausea, and RUQ tenderness, but negative Murphy's sign. Common bile duct was 10 mm based on abdominal ultrasound. Common hepatic duct and intrahepatic ducts consist of multiple common bile duct (CBD) stones with sludge and multiple small gallstones. Different diagnostic procedures (Computed tomography (CT) scan, magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP)) showed the connection of the cystic duct to the right hepatic duct. Balloon sweeping for stones extraction and then laparoscopic cholecystectomy was successfully done. CLINICAL DISCUSSION Radiologic evaluations like MRCP, CT scan, ERCP or sonography before or during the surgery/endoscopic interventions seem logical at least for selected patients. CONCLUSION Before endoscopic/surgical interventions we need to be sure about the anatomy of biliary tree by a suitable para-clinic evaluation.
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Affiliation(s)
- Mahmoodreza Khoonsari
- Gastrointestinal and Liver Disease Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Reza Mansoorian
- Gastrointestinal and Liver Disease Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran; Department of Surgery, Transplantation Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Tehran, Iran
| | - Abolfazl Namazi
- Gastrointestinal and Liver Disease Research Center, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Aberrant Right Posterior Sectoral Duct During Pancreaticoduodenectomy: a Case Series and Review of Literature. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03139-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Suzuki T, Asahi Y, Sawada A, Umemoto K, Kina M, Shinohara M, Yokoyama K, Masuko H. Laparoscopic cholecystectomy for a cholelithiasis patient with an aberrant biliary duct of B5: a case report. Surg Case Rep 2020; 6:240. [PMID: 32997206 PMCID: PMC7525413 DOI: 10.1186/s40792-020-00981-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An aberrant biliary duct of segment 5 (B5) is a rare anomaly of the biliary tract. All anatomical anomalies of the biliary tract are risk factors for bile duct injury during surgery. We report a case of cholelithiasis with an aberrant B5 that was detected during a detailed preoperative imaging examination and treated with laparoscopic cholecystectomy. CASE PRESENTATION A 69-year-old woman was admitted to the emergency room of our hospital with abdominal pain. She was diagnosed with cholelithiasis, and an aberrant B5 branching off the hepatic duct was suggested during preoperative imaging. Laparoscopic cholecystectomy was performed at our surgical department. There were no intra- or postoperative complications, and the patient was discharged on the fourth day after surgery. CONCLUSIONS Laparoscopic cholecystectomy can be safely performed without intra- or postoperative complications in patients with cholelithiasis and an aberrant B5 if it is accurately diagnosed preoperatively.
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Affiliation(s)
- Takuto Suzuki
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, 1-5-13, Shintomi-cho, Muroran, Hokkaido, 051-8501, Japan
| | - Yoh Asahi
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, 1-5-13, Shintomi-cho, Muroran, Hokkaido, 051-8501, Japan.
| | - Akifumi Sawada
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, 1-5-13, Shintomi-cho, Muroran, Hokkaido, 051-8501, Japan
| | - Kohei Umemoto
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, 1-5-13, Shintomi-cho, Muroran, Hokkaido, 051-8501, Japan
| | - Masaya Kina
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, 1-5-13, Shintomi-cho, Muroran, Hokkaido, 051-8501, Japan
| | - Masahiro Shinohara
- Department of Radiology, Nikko Memorial Hospital, 1-5-13, Shintomi-cho, Muroran, Hokkaido, 051-8501, Japan
| | - Kazunori Yokoyama
- Department of Gastroenterology, Nikko Memorial Hospital, 1-5-13, Shintomi-cho, Muroran, Hokkaido, 051-8501, Japan
| | - Hiroyuki Masuko
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, 1-5-13, Shintomi-cho, Muroran, Hokkaido, 051-8501, Japan
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7
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Ojo AS, Pollard A. Risk of Gallstone Formation in Aberrant Extrahepatic Biliary Tract Anatomy: A Review of Literature. Cureus 2020; 12:e10009. [PMID: 32864277 PMCID: PMC7449616 DOI: 10.7759/cureus.10009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The age-long mnemonic of '5Fs' (fat, female, fertile, forty, and fair) has traditionally been used in medical school instructions to describe the risk factors for gallstone disease. However, evidence suggests that aberrant extrahepatic biliary tract (EHBT) anatomy may contribute significantly to the risk of gallstone disease. This review explores the anatomy and embryological bases of EHBT variations as well as the prevalence of these variations. Also, we discuss the risk factors for gallstone formation in the relationship between gallstone disease and aberrant EHBT anatomy.
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Tringali A, Massinha P, Schepis T, Landi R, Boškoski I, Perri V, Bove V, Costamagna G. Long-term outcomes of endoscopic treatment of aberrant hepatic duct injuries after cholecystectomy. Gastrointest Endosc 2020; 91:584-592. [PMID: 31629720 DOI: 10.1016/j.gie.2019.09.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/27/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Right aberrant hepatic ducts are an anatomic variant with clinical relevance because of the risk of injury during cholecystectomy. Treatment options for aberrant hepatic duct injuries are not standardized. This study aims to analyze the long-term results of endoscopic treatment of aberrant hepatic duct lesions. METHODS Patients who underwent ERCP for aberrant hepatic duct lesions were retrospectively identified. Demographic data, type of aberrant duct lesion according to the Strasberg classification, type of treatment (number of plastic stents inserted, treatment duration, and number of ERCPs), and adverse events were recorded. Follow-up was obtained by telephone contact or medical examinations. RESULTS Between January 1996 and March 2019, 32 patients (78% women, mean age 51.7 years) with aberrant hepatic duct injuries underwent ERCP at our Endoscopy Unit. Six patients had Strasberg type B lesions, 11 patients had type C, and 8 patients had type E5, and 7 patients had a stenosis of the aberrant duct. A mean of 3.7 biliary plastic stents per patient were used; mean treatment duration was 6.3 months. All patients with isolated aberrant duct stenosis and 1 of 6 patients (17%) with type B Strasberg lesions achieved patency. Ten of 11 patients (91%) with type C Strasberg lesions achieved duct recanalization. After a mean follow-up of 109.3 ± 61.2 months, 29 of 32 patients (91%) were asymptomatic; 1 underwent surgery for recurrent cholangitis, 1 received a new endoscopic procedure because of cholangitis, and 1 reported episodic biliary colic without an increase in liver function test values and was successfully managed with a low-fat diet. CONCLUSIONS An endoscopic approach to aberrant hepatic duct lesions after cholecystectomy can be considered an effective first-line therapy.
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Affiliation(s)
- Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paulo Massinha
- Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy; Gastroenterology Department, Garcia de Orta Hospital, E.P.E, Almada, Portugal
| | - Tommaso Schepis
- Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosario Landi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Perri
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Bove
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Centre for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore, Rome, Italy
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Hite M, Chung C, Lancaster W. Surgical Management of Iatrogenic Bile Duct Injury in Patients with Atypical Ductal Anatomy. Am Surg 2020. [DOI: 10.1177/000313482008600206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Melissa Hite
- Division of GI and Laparoscopic Surgery Department of Surgery Medical University of South Carolina Charleston, South Carolina
| | - Catherine Chung
- Division of GI and Laparoscopic Surgery Department of Surgery Medical University of South Carolina Charleston, South Carolina
| | - William Lancaster
- Division of GI and Laparoscopic Surgery Department of Surgery Medical University of South Carolina Charleston, South Carolina
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Oyama K, Nakahira S, Ogawa H, Kato K, Hasegawa M, To T, Maki R, Himura H, Nishi H, Ohhara N, Mikami J, Makari Y, Nakata K, Tsujie M, Fujita J. Successful management of aberrant right hepatic duct during laparoscopic cholecystectomy: a rare case report. Surg Case Rep 2019; 5:74. [PMID: 31073708 PMCID: PMC6509294 DOI: 10.1186/s40792-019-0632-7] [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: 01/26/2019] [Accepted: 04/24/2019] [Indexed: 11/24/2022] Open
Abstract
Background Anatomic variants of the biliary tree present challenges to surgical management during laparoscopic cholecystectomy and affect perioperative outcomes. An aberrant right hepatic duct connecting into the cystic duct is a practically important variation because of the susceptibility to serious postoperative refractory bile leakage. We report a successful case of laparoscopic cholecystectomy in the aberrant right hepatic duct of a patient diagnosed with chronic cystitis. Case presentation A 49-year-old man was referred to our department for treatment of chronic cholecystitis. Magnetic resonance cholangiopancreatography indicated that the cystic duct branched from the common bile duct and an aberrant bile duct connected to the cystic duct. Intraoperative cholangiography revealed that the bile duct was not confluent to the major right branch of the intrahepatic bile duct and drained a narrow area. Preoperative magnetic resonance cholangiopancreatography had diagnostic value. Furthermore, intraoperative cholangiography with the Critical View of Safety method was paramount to achieving safe cholecystectomy based on confirmation of the biliary anatomy and the drainage area of the aberrant right hepatic duct. Conclusion We encountered a rare but clinically significant case of laparoscopic cholecystectomy. This case suggests that precise understanding of the anatomy and drainage area of the aberrant right hepatic duct preoperatively and intraoperatively can lead to safe cholecystectomy. Electronic supplementary material The online version of this article (10.1186/s40792-019-0632-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Keisuke Oyama
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarajicho, Nishi-ku, Sakai City, Osaka, 593-8304, Japan
| | - Shin Nakahira
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarajicho, Nishi-ku, Sakai City, Osaka, 593-8304, Japan.
| | - Hisataka Ogawa
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarajicho, Nishi-ku, Sakai City, Osaka, 593-8304, Japan
| | - Kazuya Kato
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarajicho, Nishi-ku, Sakai City, Osaka, 593-8304, Japan
| | - Makoto Hasegawa
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarajicho, Nishi-ku, Sakai City, Osaka, 593-8304, Japan
| | - Takayuki To
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarajicho, Nishi-ku, Sakai City, Osaka, 593-8304, Japan
| | - Ryosuke Maki
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarajicho, Nishi-ku, Sakai City, Osaka, 593-8304, Japan
| | - Hoshi Himura
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarajicho, Nishi-ku, Sakai City, Osaka, 593-8304, Japan
| | - Hidemi Nishi
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarajicho, Nishi-ku, Sakai City, Osaka, 593-8304, Japan
| | - Nobuyoshi Ohhara
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarajicho, Nishi-ku, Sakai City, Osaka, 593-8304, Japan
| | - Jota Mikami
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarajicho, Nishi-ku, Sakai City, Osaka, 593-8304, Japan
| | - Yoichi Makari
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarajicho, Nishi-ku, Sakai City, Osaka, 593-8304, Japan
| | - Ken Nakata
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarajicho, Nishi-ku, Sakai City, Osaka, 593-8304, Japan
| | - Masaki Tsujie
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarajicho, Nishi-ku, Sakai City, Osaka, 593-8304, Japan
| | - Junya Fujita
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarajicho, Nishi-ku, Sakai City, Osaka, 593-8304, Japan
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Tsuruda Y, Okumura H, Setoyama T, Hiwatashi K, Minami K, Ando K, Wada M, Maenohara S, Natsugoe S. Laparoscopic cholecystectomy with aberrant bile duct detected by intraoperative fluorescent cholangiography concomitant with angiography: A case report. Int J Surg Case Rep 2018; 51:14-16. [PMID: 30130667 PMCID: PMC6104581 DOI: 10.1016/j.ijscr.2018.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/27/2018] [Accepted: 08/07/2018] [Indexed: 12/18/2022] Open
Abstract
Usefulness and safety of combined vascular and biliary fluorescent ICG imaging during laparoscopic cholecystectomy was reported. Aberrant bile ducts are rare anatomical variation and clinically important because of the susceptibility to injury during cholecystectomy. We encountered a case of laparoscopic cholecystectomy with an aberrant bile duct detected by intraoperative fluorescent cholangiography concomitant with angiography.
Introduction Laparoscopic cholecystectomy is the standard surgical treatment for patients with benign gallbladder disease. However, bile duct injury continues to be reported as a surgical complication. Intraoperative cholangiography is recommended to reduce the risk of bile duct injury during laparoscopic cholecystectomy. Intraoperative cholangiography using indocyanine green, which is excreted into bile and shows fluorescence under infrared light, has recently been reported as useful in preventing bile duct injury during laparoscopic cholecystectomy. We report here a case of laparoscopic cholecystectomy with an aberrant bile duct detected by intraoperative fluorescent cholangiography concomitant with angiography. Presentation of case An 82-year-old woman was diagnosed with cholecystolithiasis and underwent laparoscopic cholecystectomy. An aberrant bile duct branching from the right side of the common hepatic duct was detected by intraoperative indocyanine green fluorescent cholangiography. Furthermore, we were able to confirm the cystic artery by reinjecting indocyanine green during the procedure. Laparoscopic cholecystectomy was performed safely without injuring the aberrant bile duct, despite no recognition of the abnormality on preoperative computed tomography or magnetic resonance imaging. Discussion and conclusions Aberrant bile ducts are rare anatomical variation and clinically important because of the susceptibility to injury during cholecystectomy. Our case reported for the first time that fluorescence cholangiography concomitant with angiography was useful for identifying an aberrant bile duct and the cystic artery during laparoscopic cholecystectomy.
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Affiliation(s)
- Yusuke Tsuruda
- Department of Surgery, Kagoshima Kouseiren Hospital, Yojiro 1-13-1, Kagoshima 890-0062, Japan.
| | - Hiroshi Okumura
- Department of Surgery, Kagoshima Kouseiren Hospital, Yojiro 1-13-1, Kagoshima 890-0062, Japan.
| | - Tetsuro Setoyama
- Department of Surgery, Kagoshima Kouseiren Hospital, Yojiro 1-13-1, Kagoshima 890-0062, Japan.
| | - Kiyokazu Hiwatashi
- Department of Surgery, Kagoshima Kouseiren Hospital, Yojiro 1-13-1, Kagoshima 890-0062, Japan.
| | - Koji Minami
- Department of Surgery, Kagoshima Kouseiren Hospital, Yojiro 1-13-1, Kagoshima 890-0062, Japan.
| | - Kei Ando
- Department of Surgery, Kagoshima Kouseiren Hospital, Yojiro 1-13-1, Kagoshima 890-0062, Japan.
| | - Masumi Wada
- Department of Surgery, Kagoshima Kouseiren Hospital, Yojiro 1-13-1, Kagoshima 890-0062, Japan.
| | - Shigeho Maenohara
- Department of Surgery, Kagoshima Kouseiren Hospital, Yojiro 1-13-1, Kagoshima 890-0062, Japan.
| | - Shoji Natsugoe
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima 890-8520, Japan.
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Matesan M, Bermo M, Cruite I, Shih CH, Elojeimy S, Behnia F, Lewis D, Vesselle H. Biliary Leak in the Postsurgical Abdomen: A Primer to HIDA Scan Interpretation. Semin Nucl Med 2017; 47:618-629. [DOI: 10.1053/j.semnuclmed.2017.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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13
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Sanjay P, Tagolao S, Dirkzwager I, Bartlett A. A survey of the accuracy of interpretation of intraoperative cholangiograms. HPB (Oxford) 2012; 14:673-6. [PMID: 22954003 PMCID: PMC3461373 DOI: 10.1111/j.1477-2574.2012.00501.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES There are few data in the literature regarding the ability of surgical trainees and surgeons to correctly interpret intraoperative cholangiograms (IOCs) during laparoscopic cholecystectomy (LC). The aim of this study was to determine the accuracy of surgeons' interpretations of IOCs. METHODS Fifteen IOCs, depicting normal, variants of normal and abnormal anatomy, were sent electronically in random sequence to 20 surgical trainees and 20 consultant general surgeons. Information was also sought on the routine or selective use of IOC by respondents. RESULTS The accuracy of IOC interpretation was poor. Only nine surgeons and nine trainees correctly interpreted the cholangiograms showing normal anatomy. Six consultant surgeons and five trainees correctly identified variants of normal anatomy on cholangiograms. Abnormal anatomy on cholangiograms was identified correctly by 18 consultant surgeons and 19 trainees. Routine IOC was practised by seven consultants and six trainees. There was no significant difference between those who performed routine and selective IOC with respect to correct identification of normal, variant and abnormal anatomy. CONCLUSIONS The present study shows that the accuracy of detection of both normal and variants of normal anatomy was poor in all grades of surgeon irrespective of a policy of routine or selective IOC. Improving operators' understanding of biliary anatomy may help to increase the diagnostic accuracy of IOC interpretation.
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Affiliation(s)
- Pandanaboyana Sanjay
- Hepatopancreaticobiliary Unit, Department of General SurgeryDundee, UK,Department of Hepatopancreatobiliary Surgery, Ninewells Hospital and Medical School, University of DundeeDundee, UK
| | - Sherry Tagolao
- Hepatopancreaticobiliary Unit, Department of General SurgeryDundee, UK
| | - Ilse Dirkzwager
- Department of Radiology, Auckland City HospitalAuckland, New Zealand
| | - Adam Bartlett
- Hepatopancreaticobiliary Unit, Department of General SurgeryDundee, UK,Department of Surgery, Faculty of Medicine and Health Sciences, University of AucklandAuckland, New Zealand
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