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Cushman CJ, Ibrahim AF, Rostas J, Montgomery J. Access and reattachment of biliary tree anomaly through Roux-en-Y hepaticojejunostomy: A case report. Radiol Case Rep 2024; 19:3358-3362. [PMID: 38832338 PMCID: PMC11145206 DOI: 10.1016/j.radcr.2024.04.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/21/2024] [Accepted: 04/23/2024] [Indexed: 06/05/2024] Open
Abstract
The right posterior segmental duct (RPSD) draining into the cystic duct is exceedingly rare. Ligation of the cystic duct in proximity to the junction of an aberrant right hepatic duct after a cholecystectomy can lead to life threatening complications. The present case study reveals a severed anomalous RPSD and subsequent Roux-en-Y hepaticojejunostomy procedure employed to fix biliary anomaly.
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Affiliation(s)
- Caroline J. Cushman
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Andrew F. Ibrahim
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jack Rostas
- Department of Surgery, Covenant Medical Center, Lubbock, TX, USA
| | - James Montgomery
- Department of Interventional Radiology, Covenant Medical Center, Lubbock, TX, USA
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2
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Kazi IA, Siddiqui MA, Thimmappa ND, Abdelaziz A, Gaballah AH, Davis R, Kimchi E, Hammoud G, Syed KA, Nasrullah A. Post-operative complications of cholecystectomy: what the radiologist needs to know. Abdom Radiol (NY) 2024:10.1007/s00261-024-04387-5. [PMID: 38940909 DOI: 10.1007/s00261-024-04387-5] [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: 03/31/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 06/29/2024]
Abstract
Cholecystectomy is one of the most performed surgical procedures. The safety of this surgery notwithstanding, the sheer volume of operations results in a notable incidence of post-cholecystectomy complications. Early and accurate diagnosis of such complications is essential for timely and effective management. Imaging techniques are critical for this purpose, aiding in distinguishing between expected postsurgical changes and true complications. This review highlights current knowledge on the indications for cholecystectomy, pertinent surgical anatomy and surgical technique, and the recognition of anatomical variants that may complicate surgery. The article also outlines the roles of various imaging modalities in identifying complications, the spectrum of possible postsurgical anatomical changes, and the implications of such findings. Furthermore, we explore the array of complications that can arise post-cholecystectomy, such as biliary system injuries, gallstone-related issues, vascular complications, and the formation of postsurgical collections. Radiologists should be adept at identifying normal and abnormal postoperative findings to guide patient management effectively.
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Affiliation(s)
- Irfan Amir Kazi
- Department of Radiology, University Hospital, University of Missouri, 1 Hospital Drive, Columbia, MO, 65212, USA.
| | - M Azfar Siddiqui
- Department of Radiology, University of Missouri, Columbia, MO, USA
| | | | - Amr Abdelaziz
- Department of Radiology, University of Missouri, Columbia, MO, USA
| | - Ayman H Gaballah
- Department of Radiology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Ryan Davis
- Department of Radiology, University of Missouri, Columbia, MO, USA
| | - Eric Kimchi
- Department of Surgical Oncology, University of Missouri, Columbia, MO, USA
| | - Ghassan Hammoud
- Department of Gastroenterology, University of Missouri, Columbia, MO, USA
| | - Kazi A Syed
- Medical Student, Kansas City University College of Osteopathic Medicine, Kansas, MO, USA
| | - Ayesha Nasrullah
- Department of Radiology, University of Missouri, Columbia, MO, USA
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Emara MH, Ahmed MH, Radwan MI, Emara EH, Basheer M, Ali A, Elfert AA. Post-cholecystectomy iatrogenic bile duct injuries: Emerging role for endoscopic management. World J Gastrointest Surg 2023; 15:2709-2718. [PMID: 38222007 PMCID: PMC10784825 DOI: 10.4240/wjgs.v15.i12.2709] [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: 09/20/2023] [Revised: 10/26/2023] [Accepted: 11/24/2023] [Indexed: 12/27/2023] Open
Abstract
Post-cholecystectomy iatrogenic bile duct injuries (IBDIs), are not uncommon and although the frequency of IBDIs vary across the literature, the rates following the procedure of laparoscopic cholecystectomy are much higher than open cholecystectomy. These injuries caries a great burden on the patients, physicians and the health care systems and sometime are life-threatening. IBDIs are associated with different manifestations that are not limited to abdominal pain, bile leaks from the surgical drains, peritonitis with fever and sometimes jaundice. Such injuries if not witnessed during the surgery, can be diagnosed by combining clinical manifestations, biochemical tests and imaging techniques. Among such techniques abdominal US is usually the first choice while Magnetic Resonance Cholangio-Pancreatography seems the most appropriate. Surgical approach was the ideal approach for such cases, however the introduction of Endoscopic Retrograde Cholangio-Pancreatography (ERCP) was a paradigm shift in the management of such injuries due to accepted success rates, lower cost and lower rates of associated morbidity and mortality. However, the literature lacks consensus for the optimal timing of ERCP intervention in the management of IBDIs. ERCP management of IBDIs can be tailored according to the nature of the underlying injury. For the subgroup of patients with complete bile duct ligation and lost ductal continuity, transfer to surgery is indicated without delay. Those patients will not benefit from endoscopy and hence should not do unnecessary ERCP. For low-flow leaks e.g. gallbladder bed leaks, conservative management for 1-2 wk prior to ERCP is advised, in contrary to high-flow leaks e.g. cystic duct leaks and stricture lesions in whom early ERCP is encouraged. Sphincterotomy plus stenting is the ideal management line for cases of IBDIs. Interventional radiologic techniques are promising options especially for cases of failed endoscopic repair and also for cases with altered anatomy. Future studies will solve many unsolved issues in the management of IBDIs.
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Affiliation(s)
- Mohamed H Emara
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mohammed Hussien Ahmed
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mohamed I Radwan
- Department of Tropical Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Emad Hassan Emara
- Department of Diagnostic and Interventional Radiology, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Magdy Basheer
- Department of Surgery, Mansoura University, Mansours 44176, Egypt
| | - Ahmed Ali
- Department of Emergency, Hargeisa Group Hospital, Hargeisa 1235, Somalia
| | - Asem Ahmed Elfert
- Department of Tropical Medicine, Tanta University, Tanta 33120, Egypt
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Jo SH, Choi HC, Park SE, Moon JI, Won JH, Na JB, Kim YW, Yang WJ, Koo BJ, Ahn JK, Kim SJ. A Case of Biliary Cast Syndrome with Cholangiocarcinoma-like Lesion in a Patient with No History of Liver Transplantation. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1272. [PMID: 37512083 PMCID: PMC10384888 DOI: 10.3390/medicina59071272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/29/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Biliary cast syndrome, which was first reported in 1975, is a rare disease that occurs after liver transplantation. The incidence is even lower in patients who have not undergone liver transplantation. This study reports a rare case of biliary cast syndrome with cholangiocarcinoma-like lesions in a patient who did not undergo liver transplantation. Case Report: Herein, we report a case of a 69-year-old man with right upper quadrant pain and elevated levels of alkaline phosphatase and gamma-glutamyl transferase, who had a history of total gastrectomy for gastric cancer and laparoscopic cholecystectomy for acute cholecystitis. Computed tomography (CT) revealed longitudinal bile stones in the extrahepatic and intrahepatic bile ducts and abrupt narrowing of the left main bile duct accompanied by a narrowing of the upstream bile duct in the left lobe of the liver. Based on the CT findings, the removal of the bile stones in the bile duct and additional examinations of the suspected cholangiocarcinoma were performed. The patient's symptoms improved, and examinations for suspected cholangiocarcinoma showed no abnormal findings, and he was discharged one month later. Conclusions: The purpose of this case report is to share a rare case of Biliary Cast Syndrome (BCS) occurring without liver transplantation. Additionally, the report aims to share image findings that mimic cancer in BCS, with the goal of reducing unnecessary repetitive biopsies, minimizing patient discomfort, and decreasing unnecessary costs by aiding in the diagnosis of BCS.
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Affiliation(s)
- Sa-Hong Jo
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea
| | - Ho-Cheol Choi
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
| | - Sung-Eun Park
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea
| | - Jin-Il Moon
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea
| | - Jung-Ho Won
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
| | - Jae-Boem Na
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
| | - Yang-Won Kim
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
| | - Won-Jeong Yang
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
| | - Byeong-Ju Koo
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
| | - Jae-Kyeong Ahn
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
| | - Seong-Je Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
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Klos D, Gregořík M, Pavlík T, Loveček M, Tesaříková J, Skalický P. Major iatrogenic bile duct injury during elective cholecystectomy: a Czech population register-based study. Langenbecks Arch Surg 2023; 408:154. [PMID: 37079112 PMCID: PMC10116090 DOI: 10.1007/s00423-023-02897-2] [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: 02/07/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE Bile duct injury (BDI) remains the most serious complication following cholecystectomy. However, the actual incidence of BDI in the Czech Republic remains unknown. Hence, we aimed to identify the incidence of major BDI requiring operative reconstruction after elective cholecystectomy in our region despite the prevailing modern 4 K Ultra HD laparoscopy and Critical View of Safety (CVS) standards implemented in daily surgical practice among the Czech population. METHODS In the absence of a specific registry for BDI, we analysed data from The Czech National Patient Register of Reimbursed Healthcare Services, where all procedures are mandatorily recorded. We investigated 76,345 patients who were enrolled for at least a year and underwent elective cholecystectomy during the period from 2018-2021. In this cohort, we examined the incidence of major BDI following the reconstruction of the biliary tract and other complications. RESULTS A total of 76,345 elective cholecystectomies were performed during the study period, and 186 major BDIs were registered (0.24%). Most elective cholecystectomies were performed laparoscopically (84.7%), with the remaining open (15.3%). The incidence of BDI was higher in the open surgery group (150 BDI/11700 cases/1.28%) than in laparoscopic cholecystectomy (36 BDI/64645 cases/0.06%). Furthermore, the total hospital stays with BDI after reconstruction was 13.6 days. However, the majority of laparoscopic elective cholecystectomies (57,914, 89.6%) were safe and standard procedures with no complications. CONCLUSION Our study corroborates the findings of previous nationwide studies. Therefore, though laparoscopic cholecystectomy is reliable, the risks of BDI cannot be eliminated.
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Affiliation(s)
- Dušan Klos
- Department of Surgery I., Faculty of Medicine and Dentistry, University Hospital Olomouc and Palacký University Olomouc, Zdravotníků 248/7, CZ-77900, Olomouc, Czech Republic
| | - Michal Gregořík
- Department of Surgery I., Faculty of Medicine and Dentistry, University Hospital Olomouc and Palacký University Olomouc, Zdravotníků 248/7, CZ-77900, Olomouc, Czech Republic
| | - Tomáš Pavlík
- Institute of Health Information and Statistics of the Czech Republic, Palackého náměstí 4, CZ-12801, Prague, Czech Republic
- Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Kamenice 753/5, CZ-62500, Brno, Czech Republic
| | - Martin Loveček
- Department of Surgery I., Faculty of Medicine and Dentistry, University Hospital Olomouc and Palacký University Olomouc, Zdravotníků 248/7, CZ-77900, Olomouc, Czech Republic
| | - Jana Tesaříková
- Department of Surgery I., Faculty of Medicine and Dentistry, University Hospital Olomouc and Palacký University Olomouc, Zdravotníků 248/7, CZ-77900, Olomouc, Czech Republic
| | - Pavel Skalický
- Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Kamenice 753/5, CZ-62500, Brno, Czech Republic.
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Abdelgawad MS, Eid M, Abokoura S, Elmazaly MA, Aly RA. Iatrogenic bile duct injuries after laparoscopic cholecystectomy: evaluation by MRCP before management. EGYPTIAN LIVER JOURNAL 2023. [DOI: 10.1186/s43066-023-00238-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract
Background
Iatrogenic bile duct injuries are unusual but possibly associated with fatal complications with increased incidence since the introduction of laparoscopic cholecystectomy. Appropriate estimation of these injuries is essential for proper management. Imaging is vital for the initial diagnosis, extent assessment and consequently, treatment guidance of bile duct injury with an ideal outcome. In this study, MRCP was carried out in 37 cases (28 females and 9 males, age range from 19 to 58 years) with suspected BDI following laparoscopic cholecystectomy. MRCP images were assessed for bile duct transection injury, strictures, biliary leakage, and intrahepatic biliary radicles (IHBR) dilatation. In positive cases, Strasberg classification system was used with the definitive diagnosis was done regarding the surgical findings and/or findings on endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC).
Results
Our study includes 37 cases with biliary injuries. On MRCP our cases were stratified regarding the Strasberg-Bismuth classification into five types (A to E). Most BDIs were type E2 (29.7%), followed by type E1 (18.9%), type A (16.2%), type E3 (10.8%), type E4 (8.2%), type C (5.4%), and type D and finally type E5 and B injuries with each one representing 2.7%. Twenty cases presented with biliary leakage and seventeen with bile duct obstruction, whether duct ligation or stricture.
Conclusion
MRCP is an essential imaging modality for assessment of iatrogenic BDIs enabling the radiologists to classify these injuries and helps to govern the management.
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A retrospective analysis of bile duct injuries treated in a tertiary center: the utility of a universal classification-the ATOM classification. Surg Endosc 2023; 37:347-357. [PMID: 35948807 DOI: 10.1007/s00464-022-09497-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: 05/12/2022] [Accepted: 07/16/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Bile duct injuries (BDI) are the most feared complications that can occur after laparoscopic cholecystectomy (LC). BDI have a high variability and complexity, several classifications being developed along the years in order to correctly assess and divide BDI. The EAES ATOM classification encompasses all the important details of a BDI: A (for anatomy), To (for time of), and M (for mechanism) but have not gained universal acceptance yet. Our study intents to analyze the cases of BDI treated in our institution with a focus on the clinical utility of the ATOM classification. METHODS We conducted a retrospective study, on a 10-year period (2011-2020), including patients diagnosed with BDI after LC, with their definitive treatment performed in our tertiary center. All injuries were retrospectively classified using the Strasberg, Hannover, and ATOM classifications. RESULTS We included in our study 100 patients; 15% of the BDI occurred in our center. No classification system was used in 73% of patients; 23% of the BDI were classified by the Strasberg system, 3% were classified by the Bismuth classification, 1% being classified by the ATOM classification. After retrospectively assessing all BDI, we observed that especially the Strasberg classification, as well as Hannover, over-simplifies the characteristics of the injury, many types of BDI according to ATOM being included in the same Strasberg or Hannover category. Most main bile duct injuries underwent a bilio-digestive anastomosis (60%), as a definitive treatment. An important percentage of cases (31%) underwent a primary treatment in the hospital of origin, reintervention with definitive treatment being done in our department. CONCLUSION The ATOM classification is the best suited for accurately describing the complexity of a BDI, serving as a template for discussing the correct management for each lesion. Efforts should be made toward increasing the use of this classification in day-to-day clinical practice.
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Patankar R, Mishra RK, Bindal V, Kothari CP, Rahate P, Patnaik S, Kankaria J, Nayak SR. Efficacy of near-infrared fluorescence cholangiography using indocyanine green in laparoscopic cholecystectomy: A retrospective study. J Minim Access Surg 2023; 19:57-61. [PMID: 36722531 PMCID: PMC10034797 DOI: 10.4103/jmas.jmas_369_21] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/16/2022] [Accepted: 03/31/2022] [Indexed: 02/03/2023] Open
Abstract
Context While laparoscopy has been the standard procedure for gallstone treatment, recent advances including the use of indocyanine green (ICG) in laparoscopic cholecystectomy have made it easier to understand the biliary tree and reduce the risk of bile duct injury. Aims In this retrospective study, we aim to determine the efficacy of ICG in near-infrared fluorescence cholangiography (NIRFC) for visualising biliary anatomy. Settings and Design A total of 90 patients with the symptoms of cholelithiasis were enrolled for this retrospective study. Subjects and Methods All the patients underwent cholecystectomy approximately 53.8 min (40-90 min) after the intravenous administration of mean volume 1.6 ml (1-2 ml) ICG. The surgeons used NIRFC along with ICG for real-time visualisation of biliary anatomy. Results The mean operative time for the surgery was 65.7 min (25-120 min) with no post-surgical complications observed in the patients. The average length of stay was 2 days (1-3 days). ICG usage with NIRFC enabled identification of cystic duct, common hepatic and common bile duct, the junction between common hepatic and bile duct, right and left hepatic duct in 87.7%, 94.4%, 80% and 14.4% of cases, respectively. Conclusions ICG fluorescence allowed successful visualisation of at least 1 biliary structure in 100% of cases.
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Affiliation(s)
- Roy Patankar
- Department of General Surgery, World Laparoscopy Hospital, Delhi NCR, Gurgaon, Haryana, India
| | - R. K. Mishra
- Department of General Surgery, Zen Multispecialty Hospital, Mumbai, Maharashtra, India
| | - Vivek Bindal
- Department of General Surgery, Max Super Specialty Hospital, New Delhi, India
| | - C. P. Kothari
- Department of General Surgery, CHL Apollo Hospital, Indore, Madhya Pradesh, India
| | - Prashant Rahate
- Department of General Surgery, Rahate Surgical Hospital, Nagpur, Maharashtra, India
| | - Sreejoy Patnaik
- Department of General Surgery, Shanti Memorial Hospital, Cuttack, Odisha, India
| | - Jeevan Kankaria
- Department of General Surgery, SMS Hospital, Jaipur, Rajasthan, India
| | - Samir Ranjan Nayak
- Department of General Surgery, GSL Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India
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The gallbladder: what's new in 2022? ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:2-28. [PMID: 35348807 DOI: 10.1007/s00261-022-03429-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 01/21/2023]
Abstract
This review focuses mainly on the imaging diagnosis, treatment, and complications of acute cholecystitis which is the most common benign disease of the gallbladder. The American College of Radiology appropriateness criteria for the imaging evaluation of patients with right upper quadrant pain and the Tokyo Guidelines for evaluating patients with acute cholecystitis and acute cholangitis are presented. The recent articles for using US, CT, MR, and HIDA in the evaluation of patients with suspected acute cholecystitis are reviewed in detail. The clinical management and postoperative complications are described. Because gallbladder polyps and adenomyomatosis can mimic gallbladder malignancies and acute cholecystitis, their imaging findings and management are presented. Finally, due the recent literature reporting better results with CT than US in the diagnosis of acute cholecystitis, a suggested approach for imaging patients with right upper quadrant pain and possible acute cholecystitis is presented in an addendum.
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Nawacki Ł, Kozłowska-Geller M, Wawszczak-Kasza M, Klusek J, Znamirowski P, Głuszek S. Iatrogenic Injury of Biliary Tree-Single-Centre Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:781. [PMID: 36613104 PMCID: PMC9819931 DOI: 10.3390/ijerph20010781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/18/2022] [Accepted: 12/29/2022] [Indexed: 05/02/2023]
Abstract
Cholecystolithiasis is among the most prevalent gastrointestinal disorders requiring surgical intervention, and iatrogenic damage to the bile tree is a severe complication. We aimed to present the frequency of bile duct injuries and how our facility handles these complications. We retrospectively analyzed bile duct injuries in patients undergoing surgery. We concentrated on factors such as sex, age, indications for surgery, type of surgery, primary procedure, bile tree injury, repair, and timing as well as early and late complications. There were 22 cases of bile duct injury in the studied material, primarily affecting women-15 individuals (68.2%). Eleven cases (45.7%) of acute cholecystitis were the primary reason for surgery, and an injury to the common bile duct that extended up to 2 cm from the common hepatic duct was the most common complication (European Association for Endoscopic Surgery grade 2). Roux-en-Y hepaticojejunostomy was the most common repair procedure in 14 cases (63.6%). Eleven patients (50%) experienced early complications following reconstruction surgery, whereas five patients (22.7%) experienced late complications. An annual mortality rate of 22.7% (five patients) was observed. Iatrogenic bile duct injury is a severe complication of surgical treatment for cholecystolithiasis. Reconstruction procedures are characterized by high complication rates and high mortality.
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Affiliation(s)
- Łukasz Nawacki
- Collegium Medicum, The Jan Kochanowski University in Kielce, 25-369 Kielce, Poland
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Callejas GH, Marques RA, Gestic MA, Utrini MP, Chaim FDM, Chaim EA, Callejas-Neto F, Cazzo E. Relationships of hepatic histopathological findings and bile microbiological aspects with bile duct injury repair surgical outcomes: A historical cohort. Ann Hepatobiliary Pancreat Surg 2022; 26:325-332. [PMID: 35851330 PMCID: PMC9721258 DOI: 10.14701/ahbps.22-003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 12/15/2022] Open
Abstract
Backgrounds/Aims To analyze relationships of hepatic histopathological findings and bile microbiological profiles with perioperative outcomes and risk of late biliary stricture in individuals undergoing surgical bile duct injury (BDI) repair. Methods A historical cohort study was carried out at a tertiary university hospital. Fifty-six individuals who underwent surgical BDI repair from 2014-2018 with a minimal follow-up of 24 months were enrolled. Liver biopsies were performed to analyze histopathology. Bile samples were collected during repair procedures. Hepatic histopathological findings and bile microbiological profiles were then correlated with perioperative and late outcomes through uni- and multi-variate analyses. Results Forty-three individuals (76.8%) were females and average age was 47.2 ± 13.2 years; mean follow-up was 38.1 ± 18.6 months. The commonest histopathological finding was hepatic fibrosis (87.5%). Bile cultures were positive in 53.5%. The main surgical technique was Roux-en-Y hepaticojejunostomy (96.4%). Overall morbidity was 35.7%. In univariate analysis, liver fibrosis correlated with the duration of the operation (R = 0.3; p = 0.02). In multivariate analysis, fibrosis (R = 0.36; p = 0.02) and cholestasis (R = 0.34; p = 0.02) independently correlated with operative time. Strasberg classification independently correlated with estimated bleeding (R = 0.31; p = 0.049). The time elapsed between primary cholecystectomy and BDI repair correlated with hepatic fibrosis (R = 0.4; p = 0.01). Conclusions Bacterial contamination of bile was observed in most cases. The degree of fibrosis and cholestasis correlated with operative time. The waiting time for definitive repair correlated with the severity of liver fibrosis.
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Affiliation(s)
| | - Rodolfo Araujo Marques
- Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Martinho Antonio Gestic
- Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Murillo Pimentel Utrini
- Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Elinton Adami Chaim
- Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Francisco Callejas-Neto
- Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Everton Cazzo
- Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil,Corresponding author: Everton Cazzo, MD, PhD Department of Surgery, School of Medical Sciences, State University of Campinas (UNICAMP), Cidade Universitária Zeferino Vaz - Barão Geraldo, Campinas 13085-000, Brazil Tel: +55-1935219450, Fax: +55-1935219448, E-mail: ORCID: https://orcid.org/0000-0002-5804-1580
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12
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Shang L, Shen X, Niu W, Zhang Y, Han J, Liu H, Liu L, Chen X, Zhang Y, Hai S. Update on the natural orifice transluminal endoscopic surgery for gallbladder preserving gallstones therapy: A review. Medicine (Baltimore) 2022; 101:e31810. [PMID: 36401453 PMCID: PMC9678607 DOI: 10.1097/md.0000000000031810] [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] [Indexed: 12/03/2022] Open
Abstract
Cholecystectomy remains the "gold standard" for the management of symptomatic gallstones. Minimally invasive laparoscopic cholecystectomy has been the treatment of choice for the past 3 decades. However, the technique of natural orifice transluminal endoscopic surgery cholecystolithotomy is evolving, with some experts advocating gallbladder stone removal without gallbladder excision in order to preserve gallbladder function and eliminate post-cholecystectomy syndromes, including complications of the surgical incision, bile duct injury, functional gastrointestinal, and psychological conditions, and possibly an increase in colon cancer. In addition, transluminal endoscopic cholecystolithotomy is an option for elderly patients who are not suitable candidates for open surgery and those who desire scar-free minimally invasive surgery with organ preservation. This article summarizes the established pure natural orifice transluminal endoscopic surgery gallbladder preserving gallstone removal techniques and highlights the pros and cons of different popular available endoscopic approaches to gallstone therapy and how flexible endoscopic surgery via the natural orifice is compared to the well-established cholecystectomy.
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Affiliation(s)
- Lifeng Shang
- Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an, P.R. China
| | - Xin Shen
- Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an, P.R. China
| | - Wenkai Niu
- Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an, P.R. China
| | - Yi Zhang
- Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an, P.R. China
| | - Junwei Han
- Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an, P.R. China
| | - Haiwang Liu
- Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an, P.R. China
| | - Lei Liu
- Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an, P.R. China
| | - Xinli Chen
- Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an, P.R. China
| | - Yiyue Zhang
- Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an, P.R. China
| | - Shi Hai
- Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an, P.R. China
- *Correspondence: Shi Hai, Department of Gastrointestinal Surgery, Xi’an Daxing Hospital, Xi’an 710000, P.R. China (e-mail: )
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13
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Patel N, Jensen KK, Shaaban AM, Korngold E, Foster BR. Multimodality Imaging of Cholecystectomy Complications. Radiographics 2022; 42:1303-1319. [PMID: 35904983 DOI: 10.1148/rg.210106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cholecystectomy is one of the most common surgeries performed in the United States. Although complications are uncommon, the high incidence of this surgery means that a radiologist will likely encounter these complications in practice. Complications may arise in the immediate postoperative period or can be delayed for weeks, months, or years after surgery. Vague and nonspecific symptoms make clinical diagnosis challenging. As a result, multimodality imaging is important in postoperative evaluation. US and multidetector CT are the usual first-line imaging modalities. Hepatobiliary scintigraphy, SPECT/CT, and MRI with conventional or gadoxetate hepatobiliary contrast material are important and complementary modalities that are used for workup. The authors begin with a brief discussion of surgical technique and expected postoperative findings and then describe complications organized into four groups: (a) biliary complications, (b) stone-related complications, (c) iatrogenic complications, and (d) gallbladder complications. Biliary complications include bile leaks and bilomas, acute biliary obstruction, and biliary stricture. Stone-related complications include retained and recurrent stones and spillage of stones into the peritoneum. Iatrogenic complications include hemorrhage, vasculobiliary injury, arterial pseudoaneurysms, duodenal injury, and migration of clips. Gallbladder complications include recurrent cholecystitis after subtotal reconstituting cholecystectomy and unexpected gallbladder cancer. An invited commentary by Mullens and Ibrahim is available online. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Neel Patel
- From the Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (N.P., K.K.J., E.K., B.R.F.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Kyle K Jensen
- From the Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (N.P., K.K.J., E.K., B.R.F.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Akram M Shaaban
- From the Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (N.P., K.K.J., E.K., B.R.F.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Elena Korngold
- From the Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (N.P., K.K.J., E.K., B.R.F.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.)
| | - Bryan R Foster
- From the Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 (N.P., K.K.J., E.K., B.R.F.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.)
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14
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Actuarial Patency Rates of Hepatico-Jejunal Anastomosis after Repair of Bile Duct Injury at a Reference Center. J Clin Med 2022; 11:jcm11123396. [PMID: 35743465 PMCID: PMC9224737 DOI: 10.3390/jcm11123396] [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: 05/25/2022] [Accepted: 06/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Bile duct injury complicates patients’ lives, despite the subsequent repair. Repairing the injury must restore continuity of the bile tree and bring the patient into a state of cure referred to as “patency”. Actuarial primary or actuarial secondary patency rates, depending on whether the patient underwent primary or secondary repair of injury, are proposed to be a proper metric in evaluating outcomes. This study was undertaken to assess outcomes of 669 patients with bile duct injuries Strasberg D and E type referred to the department from public surgical wards between 1990 and 2020. In 442 patients, no attempt was made to repair prior to a referral, and in 227 an attempt to repair was made which failed. Methods: Observations were summarized on December 31st, 2020. The retrospective analysis included: primary patency attained (Grade A result), secondary patency attained (Grade C result), patency loss, and actuarial patency rates of the bile tree at 2, 5, and 10 years. Results: Twenty-five (3.7%) patients died after repair surgery. Actuarial patency rates at 2, 5, and 10 years of follow-up were 93%, 88%, and 74% or 86%, 75%, and 55% in patients attaining Grade A and Grade C outcomes, respectively (p < 0.001). Conclusion: Bile duct injury stands out as a surgical challenge, requiring specialized management at a referral center. Improper proceeding after an injury is the factor leading to faster loss of anastomotic patency.
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Ullah S, Yang BH, Liu D, Lu XY, Liu ZZ, Zhao LX, Zhang JY, Liu BR. Are laparoscopic cholecystectomy and natural orifice transluminal endoscopic surgery gallbladder preserving cholecystolithotomy truly comparable? A propensity matched study. World J Gastrointest Surg 2022; 14:470-481. [PMID: 35734621 PMCID: PMC9160690 DOI: 10.4240/wjgs.v14.i5.470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/18/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cholecystectomy is the preferred treatment option for symptomatic gallstones. However, another option is gallbladder-preserving cholecystolithotomy which preserves the normal physiological functions of the gallbladder in patients desiring to avoid surgical resection.
AIM To compare the feasibility, safety and effectiveness of pure natural orifice transluminal endoscopic surgery (NOTES) gallbladder-preserving cholecystolithotomy vs laparoscopic cholecystectomy (LC) for symptomatic gallstones.
METHODS We adopted propensity score matching (1:1) to compare trans-rectal NOTES cholecystolithotomy and LC patients with symptomatic gallstones. We reviewed 2511 patients with symptomatic gallstones from December 2017 to December 2020; 517 patients met the matching criteria (NOTES, 110; LC, 407), yielding 86 pairs.
RESULTS The technical success rate for the NOTES group was 98.9% vs 100% for the LC group. The median procedure time was 119 min [interquartile ranges (IQRs), 95-175] with NOTES vs 60 min (IQRs, 48-90) with LC (P < 0.001). The frequency of post-operative pain was similar between NOTES and LC: 4.7% (4/85) vs 5.8% (5/95) (P = 0.740). The median duration of post-procedure fasting with NOTES was 1 d (IQRs, 1-2) vs 2 d with LC (IQRs, 1-3) (P < 0.001). The median post-operative hospital stay for NOTES was 4 d (IQRs, 3-6) vs 4 d for LC (IQRs, 3-5), (P = 0.092). During follow-up, diarrhea was significantly less with NOTES (5.8%) compared to LC (18.6%) (P = 0.011). Gallstones and cholecystitis recurrence within a median of 12 mo (range: 6-40 mo) following NOTES was 10.5% and 3.5%, respectively. Concerns regarding the presence of abdominal wall scars were present in 17.4% (n = 15/86) of patients following LC (mainly women).
CONCLUSION NOTES provides a feasible new alternative scar-free treatment for patients who are unwilling or unable to undergo cholecystectomy. This minimally invasive organ-sparing procedure both removes the gallstones and preserves the physiological function of the gallbladder. Reducing gallstone recurrence is essential to achieving widespread clinical adoption of NOTES.
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Affiliation(s)
- Saif Ullah
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Bao-Hong Yang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
- Department of Oncology, Weifang People's Hospital, Weifang 261000, Shandong Province, China
| | - Dan Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Xue-Yang Lu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Zhen-Zhen Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Li-Xia Zhao
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Ji-Yu Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Bing-Rong Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
- State Key Laboratory of Esophageal Cancer Prevention and Treatment, Zhengzhou University, Zhengzhou 450052, Henan Province, China
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16
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Boyd K, Bradley NA, Cannings E, Shearer C, Wadhawan H, Wilson MSJ, Crumley A. Laparoscopic subtotal cholecystectomy; change in practice over a 10-year period. HPB (Oxford) 2022; 24:759-763. [PMID: 34776369 DOI: 10.1016/j.hpb.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/27/2021] [Accepted: 10/06/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic subtotal cholecystectomy is a recognised safe, alternative strategy when a critical view of safety cannot be obtained. This study audits the change in practice at a District General Hospital following the adoption of subtotal cholecystectomy in 2013. METHODS Retrospective case series included consecutive cholecystectomies over a ten-year period in a single institution. Cases were divided into subgroups based on operation date. Primary outcome was the proportion of patients undergoing laparoscopic total cholecystectomy, laparoscopic subtotal and laparoscopic converted to open cholecystectomy. Secondary outcomes included incidence of bile leak, complication rate, return to theatre, and length of stay. RESULTS There were 4217 cases: 1381 in Group A (pre-adoption of subtotal cholecystectomy 2009-2012), and 2836 in Group B (post-adoption of subtotal cholecystectomy 2013-2019). The rate of laparoscopic total cholecystectomy was higher in Group A than Group B (95.4% vs. 92.8%, p < 0.001). In the subtotal group (n = 114, 14 (12.3%) patients had bile leak, 6 (5.3%) underwent re-laparoscopy, and median length of stay was 2 days. CONCLUSION Laparoscopic subtotal cholecystectomy appears to be an acceptable alternative technique at this centre, reducing the rate of open conversion and length of stay, with a low reintervention rate for bile leak.
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Affiliation(s)
- Kirsten Boyd
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, UK.
| | | | | | | | - Himanshu Wadhawan
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, UK
| | | | - Andrew Crumley
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, UK
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17
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Ban Y, Rosman G, Eckhoff JA, Ward TM, Hashimoto DA, Kondo T, Iwaki H, Meireles OR, Rus D. SUPR-GAN: SUrgical PRediction GAN for Event Anticipation in Laparoscopic and Robotic Surgery. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3156856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Yutong Ban
- Distributed Robotics Laboratory, CSAIL, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Guy Rosman
- Distributed Robotics Laboratory, CSAIL, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | | | | | | | | | | | - Daniela Rus
- Distributed Robotics Laboratory, CSAIL, Massachusetts Institute of Technology, Cambridge, MA, USA
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18
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Dotan M, Fried S, Har-Zahav A, Shamir R, Wells RG, Waisbourd-Zinman O. Periductal bile acid exposure causes cholangiocyte injury and fibrosis. PLoS One 2022; 17:e0265418. [PMID: 35294492 PMCID: PMC8926245 DOI: 10.1371/journal.pone.0265418] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/01/2022] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Bile duct integrity is essential for the maintenance of the structure and function of the biliary tree. We previously showed that cholangiocyte injury in a toxic model of biliary atresia leads to increased monolayer permeability. Increased epithelial permeability was also shown in other cholangiopathies. We hypothesized that after initial cholangiocyte injury, leakage of bile acids into the duct submucosa propagates cholangiocyte damage and fibrosis. We thus aimed to determine the impact of bile acid exposure on cholangiocytes and the potential therapeutic effect of a non-toxic bile acid. MATERIALS AND METHODS Extrahepatic bile duct explants were isolated from adult and neonatal BALB/c mice. Explants were cultured with or without glycochenodeoxycholic acid and ursodeoxycholic acid. They were then fixed and stained. RESULTS Explants treated with glycochenodeoxycholic acid demonstrated cholangiocyte injury with monolayer disruption and partial lumen obstruction compared to control ducts. Masson's trichrome stains revealed increased collagen fibers. Myofibroblast marker α-SMA stains were significantly elevated in the periductal region. The addition of ursodeoxycholic acid resulted in decreased cholangiocyte injury and reduced fibrosis. CONCLUSIONS Bile acid leakage into the submucosa after initial cholangiocyte injury may serve as a possible mechanism of disease propagation and progressive fibrosis in cholangiopathies.
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Affiliation(s)
- Miri Dotan
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Pediatric Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center, Petach Tiqva, Israel
| | - Sophia Fried
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Adi Har-Zahav
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Raanan Shamir
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Pediatric Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center, Petach Tiqva, Israel
| | - Rebecca G. Wells
- Departments of Medicine, Pathology and Laboratory Medicine, and Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Orith Waisbourd-Zinman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Pediatric Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center, Petach Tiqva, Israel
- * E-mail:
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19
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Are We Forgetting Open Cholecystectomy? Indian J Surg 2022. [DOI: 10.1007/s12262-022-03325-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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20
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Tong M, Li Y, Sun X, Wang Y, Yang S, Zhang B, Jia F, Peng L, Liu J. Choledocholithiasis caused by anatomical variation of cystic duct: A case report. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2022. [DOI: 10.1016/j.lers.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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21
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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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Hamada T, Nakamura A, Soyama A, Sakai Y, Miyoshi T, Yamaguchi S, Hidaka M, Hara T, Kugiyama T, Takatsuki M, Kamiya A, Nakayama K, Eguchi S. Bile duct reconstruction using scaffold-free tubular constructs created by Bio-3D printer. Regen Ther 2021; 16:81-89. [PMID: 33732817 PMCID: PMC7921183 DOI: 10.1016/j.reth.2021.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/16/2021] [Accepted: 02/08/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction Biliary strictures after bile duct injury or duct-to-duct biliary reconstruction are serious complications that markedly reduce patients’ quality of life because their treatment involves periodic stent replacements. This study aimed to create a scaffold-free tubular construct as an interposition graft to treat biliary complications. Methods Scaffold-free tubular constructs of allogeneic pig fibroblasts, that is, fibroblast tubes, were created using a Bio-3D Printer and implanted into pigs as interposition grafts for duct-to-duct biliary reconstruction. Results Although the fibroblast tube was weaker than the native bile duct, it was sufficiently strong to enable suturing. The pigs' serum hepatobiliary enzyme levels remained stable during the experimental period. Micro-computed tomography showed no biliary strictures, no biliary leakages, and no intrahepatic bile duct dilations. The tubular structure was retained in all resected specimens, and the fibroblasts persisted at the graft sites. Immunohistochemical analyses revealed angiogenesis in the fibroblast tube and absence of extensions of the biliary epithelium into the fibroblast tube's lumen. Conclusions This study's findings demonstrated successful reconstruction of the extrahepatic bile duct with a scaffold-free tubular construct created from pig fibroblasts using a novel Bio-3D Printer. This construct could provide a novel regenerative treatment for patients with hepatobiliary diseases.
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Key Words
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- Artificial bile duct
- Bio-3D printer
- Cr, creatinine
- DMEM, Dulbecco's Modified Eagle's Medium
- EDTA, trypsin-ethylenediaminetetraacetic acid
- FBS, fetal bovine serum
- IBDI, iatrogenic bile duct injury
- KCL, potassium chloride
- LDLT, living donor liver transplantation
- PBS, phosphate-buffered saline
- QOL, quality of life
- Reconstruction
- Scaffold-free tubular construct
- T-Bil, total bilirubin
- γ-GTP, γ-glutamyl transpeptidase
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Affiliation(s)
- Takashi Hamada
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Anna Nakamura
- Department of Regenerative Medicine and Biomedical Engineering, Faculty of Medicine, Saga University, Japan
| | - Akihiko Soyama
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Yusuke Sakai
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan.,Department of Chemical Engineering, Faculty of Engineering, Graduate School, Kyushu University, Japan
| | - Takayuki Miyoshi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Shun Yamaguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Masaaki Hidaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Takanobu Hara
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Tota Kugiyama
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Mitsuhisa Takatsuki
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Akihide Kamiya
- Department of Molecular Life Sciences, Tokai University School of Medicine, Japan
| | - Koichi Nakayama
- Department of Regenerative Medicine and Biomedical Engineering, Faculty of Medicine, Saga University, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Cantù P, Mauro A, Cassinotti E, Boni L, Vecchi M, Penagini R. Post-operative biliary strictures. Dig Liver Dis 2020; 52:1421-1427. [PMID: 32868211 DOI: 10.1016/j.dld.2020.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 07/14/2020] [Accepted: 07/23/2020] [Indexed: 12/11/2022]
Abstract
Post-operative biliary stricture is a cumbersome condition, secondary to biliary or vascular damage. Its risk factors include biliary or vascular anatomical variants, local inflammation, and poor surgical expertise. Intra-operative diagnosis is difficult, and in most cases, patients present with obstructive symptoms within a few weeks. Magnetic resonance cholangiography is a pivotal test to confirm the clinical picture, to study the level of the damage, and to guide treatment. Nowadays, endoscopic stenting is the first-line treatment in most centers. Multi-stenting treatment achieves long-term clinical success for more than 90% of patients, however multiple procedures are needed. In order to optimize healthcare provider costs, shorter duration endotherapies with covered metal stents are under evaluation. Radiological and surgical approaches are considered in the event of endoscopy failure.
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Affiliation(s)
- Paolo Cantù
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via F. Sforza 35, 20122 Milan, Italy.
| | - Aurelio Mauro
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via F. Sforza 35, 20122 Milan, Italy; Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via F. Sforza 35, 20122 Milan, Italy
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via F. Sforza 35, 20122 Milan, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via F. Sforza 35, 20122 Milan, Italy
| | - Roberto Penagini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via F. Sforza 35, 20122 Milan, Italy
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Koong JK, Ng GH, Ramayah K, Koh PS, Yoong BK. Early identification of the critical view of safety in laparoscopic cholecystectomy using indocyanine green fluorescence cholangiography: A randomised controlled study. Asian J Surg 2020; 44:537-543. [PMID: 33223453 DOI: 10.1016/j.asjsur.2020.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/24/2020] [Accepted: 11/03/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Achieving critical view of safety (CVS) is vital during laparoscopic cholecystectomy (LC). There is no known study determining use of indocyanine green fluorescence cholangiography (ICGFC) in early identification of CVS during LC. This study aims to compare use of ICGFC in LC against conventional LC in early identification of CVS. METHODOLOGY Patients undergoing LC in a single centre were randomized into ICGFC-LC and conventional LC. Surgery was performed by a single surgeon and the time taken to achieve CVS from the time of gallbladder fundus retraction was measured. Difficulty level for each surgery was rated and analysed using a modified scoring system (Level 1- Easy to Level 4-Very difficult). RESULTS 63 patients were recruited where mean time (min) to achieve CVS was 22.3 ± 12.9 in ICGFC-LC (n = 30) and 22.8 ± 14.3 in conventional LC (p = 0.867). The time taken to achieve CVS was shorter in ICGFC-LC group across all difficulty levels, although not significant (p > 0.05). No major complication was observed in the study. CONCLUSIONS This study had shown ICGFC-LC reduces time to CVS across all difficulty levels but not statistically significant. ICGFC-LC maybe useful in difficult LC and in surgical training. TRIAL REGISTRATION Clinical Trials NCT04228835. STUDY GRANT UMMI Surgical - Karl Storz Distributor (Malaysia).
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Affiliation(s)
- Jun Kit Koong
- Department of Surgery, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603, Kuala Lumpur, Wilayah Perseketuan, Malaysia.
| | - Gaik Huey Ng
- Department of Surgery, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603, Kuala Lumpur, Wilayah Perseketuan, Malaysia.
| | - Kamarajan Ramayah
- Department of Surgery, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603, Kuala Lumpur, Wilayah Perseketuan, Malaysia.
| | - Peng Soon Koh
- Department of Surgery, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603, Kuala Lumpur, Wilayah Perseketuan, Malaysia.
| | - Boon Koon Yoong
- Department of Surgery, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603, Kuala Lumpur, Wilayah Perseketuan, Malaysia.
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Grosek J, Čebron Ž, Janež J, Tomažič A. Bicycle handlebar injury in a child resulting in complex liver laceration with massive bleeding and bile leakage: A case report. Int J Surg Case Rep 2020; 72:386-390. [PMID: 32563827 PMCID: PMC7306525 DOI: 10.1016/j.ijscr.2020.06.049] [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: 03/17/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Bicycle accidents are a significant cause of traumatic morbidity in the paediatric population. The handlebar injuries are usually isolated and remain a major source of bicycle related morbidity. We present a case of severe liver laceration with left hepatic duct transection caused by handlebar trauma in a 13-year-old boy. CASE PRESENTATION An otherwise healthy 13-year-old Caucasian male patient was rushed to the hospital following a blunt abdominal trauma from a bicycle handlebar. An ultrasound revealed extensive free intraperitoneal fluid with accompanying features of hemodynamic instability. Operative findings included massive haemoperitoneum, a deep laceration almost separating left and right liver lobes, and a near-complete interruption of the left hepatic duct. Interestingly, the vascular anatomy of the left liver lobe was preserved. After haemostasis was established a duct-to-duct anastomosis of the ruptured left hepatic duct was performed. A T-tube biliary drainage was inserted, and intraoperative cholangiography showed no extraluminal spillage of contrast. During the recovery phase, cholangiography was performed several times revealing leakage from left hepatic duct. The leakage was managed conservatively and finally stopped. DISCUSSION Management of blunt hepatic injuries has remarkably changed from mandatory operation to mostly nonoperative interventions with selective operative management. Hemodynamic instability remains the main reason for exploratory laparotomy. Near-isolated laceration of main hepatic ducts is an extremely rare finding, and immediate reconstruction is the best option if an experienced surgeon is available. CONCLUSION Due to limited evidence, we recommend consultation with an experienced HPB surgeon on a case-by-case basis for every paediatric biliary injury.
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Affiliation(s)
- Jan Grosek
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Žan Čebron
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.
| | - Jurij Janež
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Aleš Tomažič
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
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26
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Cheruiyot I, Nyaanga F, Kipkorir V, Munguti J, Ndung'u B, Henry B, Cirocchi R, Tomaszewski K. The prevalence of the Rouviere's sulcus: A meta-analysis with implications for laparoscopic cholecystectomy. Clin Anat 2020; 34:556-564. [PMID: 32285514 DOI: 10.1002/ca.23605] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/24/2020] [Accepted: 04/06/2020] [Indexed: 12/19/2022]
Abstract
Rouvière's sulcus (RS) is increasingly being recognized as an important extra-biliary landmark during laparoscopic cholecystectomy (LC). The aim of this study was to conduct a systematic analysis of the prevalence and morphological types of RS. A systematic search was conducted through the major databases PubMed, ScienceDirect, Google Scholar, China National Knowledge Infrastructure (CNKI), SciELO, and the Cochrane Library to identify studies eligible for inclusion. The data were extracted and pooled into a random-effects meta-analysis using STATA software. The primary and secondary outcomes of the study were the pooled prevalence of RS and its morphological types, respectively. A total of 23 studies (n = 4,495 patients) were included. The overall pooled prevalence of RS was 83% (95% confidence interval [CI] [78, 87]). There were no significant differences in prevalence between cadaveric studies (82%, 95% CI [76, 87]) and laparoscopic studies (83%, 95% CI [77, 88]). The open RS constituted 66% (95% CI [61, 71]) of all cases, while the closed type was present in 34% (95% CI [29, 39]). RS is a relatively constant anatomical structure that can be reliably identified in most patients undergoing cholecystectomy. It can therefore be used as a fixed extra-biliary landmark for the appropriate site at which to start dissecting during LC to help prevent iatrogenic bile duct injury.
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Affiliation(s)
- Isaac Cheruiyot
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.,International Evidence-Based Anatomy Working Group, Jagiellonian University, Krakow, Poland
| | - Fiona Nyaanga
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Vincent Kipkorir
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Jeremiah Munguti
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Bernard Ndung'u
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Brandon Henry
- International Evidence-Based Anatomy Working Group, Jagiellonian University, Krakow, Poland.,Cincinnati Children's Medical Centre, Cincinnati, Ohio, USA
| | - Roberto Cirocchi
- Department of Surgical Science, University of Perugia, Perugia, Italy
| | - Krzysztof Tomaszewski
- International Evidence-Based Anatomy Working Group, Jagiellonian University, Krakow, Poland
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de Abreu GF, Batista LL, Adeodato DC, de Albuquerque AV, Ferraz-Carvalho RS, de Lima RP, de Souza VS, de Carvalho GL, Aguiar JLA. Use of bacterial cellulose film for repair of bile duct injury in pigs. J Biomater Appl 2020; 35:331-341. [PMID: 32501137 DOI: 10.1177/0885328220928221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVE The aim was to evaluate the use of bacterial cellulose film and bile duct autograft in repairing critical common bile duct injury in pigs. METHODS A prospective experimental analytical study was carried out on 20 Sus Domesticus, Piau suidae swine, divided into a control group (n = 10) and an experimental group (n = 10) divided into two subgroups: bacterial cellulose film E1 and bacterial cellulose film E2 to which bacterial cellulose film was randomly allocated. The control group underwent two complete critical common bile duct sections 10 mm apart, while the experimental group with a single critical common bile duct defect underwent a 10 mm section of the longitudinal shaft with edge resection. The defects in the control group were treated with end-to-end conventional anastomosis using polyglycolic 6-0 surgical thread and the experimental group with bacterial cellulose film by continuous suture using the same material. The animals were clinically evaluated throughout the experiment on days D150 (bacterial cellulose film E1), D225 (control group), and D330 (bacterial cellulose film E2) and by intraoperative ultrasound examination related to histopathological and biochemical findings. RESULTS The intraoperative ultrasonography detected the changes resulting from the common bile duct anastomosis in the control group that produced a considerable incidence of ductal narrowing and obstruction to the biliary flow. In the bacterial cellulose film E2 group, there was an increase in inflammation intensity, granulomatous reaction, fibrosis, and vessels density, without producing bile duct dilation in the ultrasonography assessment. Biochemical analysis of liver enzymes yielded results in the normal range confirming preservation of liver function at the different post-surgery time points. CONCLUSION Bacterial cellulose film, when used as a graft for bile duct repair, proved to be a biocompatible material that produced a complete healing process and biliary flow continuity.
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Affiliation(s)
- Gilberto Fs de Abreu
- General Surgery Service, University of Pernambuco (UPE), Brazil.,Department of Surgery, Federal University of Pernambuco (UFPE), Brazil
| | - Laécio L Batista
- Interventional Radiology Service, Clinical Hospital, Federal University of Pernambuco (UFPE), Brazil
| | | | | | | | - Rodrigo P de Lima
- Department of Surgery, Federal University of Pernambuco (UFPE), Brazil
| | | | | | - José LA Aguiar
- Department of Surgery, Federal University of Pernambuco (UFPE), Brazil
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Jategaonkar PA, Yadav SP, Dhaigude PR. A simple method of T-tube preparation for easy accommodation into a non-dilated biliary system. Ann R Coll Surg Engl 2020; 103:74-75. [PMID: 32441542 DOI: 10.1308/rcsann.2020.0111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- P A Jategaonkar
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
| | - S P Yadav
- Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, India
| | - P R Dhaigude
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
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29
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Moghadamyeghaneh Z, Badami A, Masi A, Misawa R, Dresner L. Unplanned readmission after outpatient laparoscopic cholecystectomy. HPB (Oxford) 2020; 22:702-709. [PMID: 31575471 DOI: 10.1016/j.hpb.2019.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/11/2019] [Accepted: 09/08/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Readmission after surgery has been considered as a measure of quality of hospital and surgical care. This study aims to investigate unplanned readmission after laparoscopic cholecystectomy. METHODS The NSQIP database was used to investigate 30 days unplanned readmission after laparoscopic cholecystectomy. Multivariate analysis was used to identify predictors of readmission. RESULTS We found a total of 117,248 patients who underwent outpatient laparoscopic cholecystectomy during 2014-2016. Of these 3315 (2.8%) had unplanned readmission. Overall, 90% of readmitted patients were discharged after one day of hospitalization. Pain (14.07%) followed by unspecified symptoms including fever, nausea, vomiting, ileus was the most common reason for readmission. After adjustment, factors such as renal failure on dialysis (AOR: 2.26, P < 0.01), discharge to a facility (AOR: 1.93, P < 0.01), and steroid use for chronic condition (AOR: 1.51, P < 0.01), were associated with unplanned readmission. CONCLUSION Overall, 2.8% of the patients undergoing outpatient laparoscopic cholecystectomy are readmitted to the hospital. Most of such patients are discharged after one day of hospitalization. Unspecified symptoms such as pain and vomiting were the most common reasons for readmission. Readmission strongly influences patients' comorbid factors and it is not a reliable measurement of quality of hospital and surgical care.
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Affiliation(s)
| | - Abbasali Badami
- Department of Surgery, State University of New York, Downstate, USA
| | - Antonio Masi
- Department of Surgery, State University of New York, Downstate, USA
| | - Ryosuke Misawa
- Department of Surgery, State University of New York, Downstate, USA
| | - Lisa Dresner
- Department of Surgery, State University of New York, Downstate, USA.
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30
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Current Scenario of Postcholecystectomy Bile Leak and Bile Duct Injury at a Tertiary Care Referral Centre of Nepal. Minim Invasive Surg 2020; 2020:4382307. [PMID: 32373362 PMCID: PMC7191355 DOI: 10.1155/2020/4382307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/17/2020] [Accepted: 04/04/2020] [Indexed: 11/29/2022] Open
Abstract
Objective With the adoption of safe cholecystectomy principles at an academic institute, the risk of major bile duct injury has decreased. This study aims at evaluating the present status of bile duct injury, compared to the study published in 2013 by index centre. Methods This is a retrospective review of a prospectively maintained database of bile leak and bile duct injury from 2014 to 2019. Patients who completed postcholecystectomy bile leak or bile duct injury treatment and were on regular follow-up were included. Results Eighteen patients (0.78%) among 2,300 consecutive cholecystectomies presented with bile duct injury, including 8 (0.35%) major bile duct injuries and 10 (0.43%) bile leaks compared to major bile duct injury rate of 0.68% (92/11,345 cholecystectomies) between 2001 and 2010. Injuries were classified as Strasberg's type A (52.9%), type D (5.9%), and type E (41.1%). Eight patients (47%) of bile leak were managed conservatively with drains, while two required laparotomy and lavage. The mean time for spontaneous closure of bile leak was 11 days. Intraoperative repair was done in three cases: Roux en Y hepaticojejunostomy in 2 and end-to-end repair over T-tube in 1 for sharp transection of the duct. Delayed repair (Roux-en-Y hepaticojejunostomy) was done in five patients. The median postcholecystectomy hospital stay was 8 days, with no mortality. There was no restricture at a median follow-up of 13 months. Conclusion With the adoption of a safe culture of cholecystectomy, the major bile duct injury rate has decreased currently. Repair of bile duct injury by experienced hepatobiliary surgeon results in excellent outcome.
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Chatzifotiou D, Schnell M, Lupascu B, Gundlach M. A Rare Case of a Left-sided Gallbladder Accompanied with an Aplastic Cystic Duct in a Patient with Acute Cholecystitis. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e920821. [PMID: 32071285 PMCID: PMC7048323 DOI: 10.12659/ajcr.920821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND A left-sided gallbladder without situs inversus is a rare congenital anomaly of the gallbladder with a prevalence ranging from 0.04-0.3%. CASE REPORT We present a case of a female patient, referred to our clinic with clinical features of an acute cholecystitis. After performing the standard preoperative investigations, which confirmed the diagnosis, the patient underwent a laparoscopic cholecystectomy. We found a left-sided gallbladder, attached to the lower surface of the left lobe of the liver. During the dissection in the Callot triangle an aplastic cystic duct was also identified. The extirpation of the gallbladder was performed anterograde, allowing a better exposition of the critical structures. CONCLUSIONS A left sided gallbladder is almost an incidental finding, which can be accompanied with further anomalies of the biliary tree. A combination of these 2 variations is very rare without any other reported cases in the literature.
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Affiliation(s)
| | - Martin Schnell
- Clinic of General-, Visceral- and Thoraxsurgery, Hegau Bodensee Clinic, Singen, Germany
| | - Bogdan Lupascu
- Clinic of General-, Visceral- and Thoraxsurgery, Hegau Bodensee Clinic, Singen, Germany
| | - Matthias Gundlach
- Clinic of General-, Visceral- and Thoraxsurgery, Hegau Bodensee Clinic, Singen, Germany
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32
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Abstract
Robotic cholecystectomy is safe and feasible approach and can be combined with common bile duct exploration to address complicated pathology in a single setting. This article summarizes reported outcomes after robotic biliary surgery. A technical overview of robotic multiport and single port cholecystectomy is provided. Last, the approach to benign bile duct disease during robotic cholecystectomy, including reconstruction of the biliary tree, is described.
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Affiliation(s)
- Karen Chang
- Good Samaritan Medical Center, Tufts University School of Medicine, 1 Pearl Street, Suite 2000, Brockton, MA 02301, USA
| | - Fahri Gokcal
- Good Samaritan Medical Center, Tufts University School of Medicine, 1 Pearl Street, Suite 2000, Brockton, MA 02301, USA
| | - Omar Yusef Kudsi
- Good Samaritan Medical Center, Tufts University School of Medicine, 1 Pearl Street, Suite 2000, Brockton, MA 02301, USA.
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33
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Sah DN, Bhandari RS. Iatrogenic bile duct injury during cholecystectomy presenting after 11 years as a biliary stricture: a case report. J Med Case Rep 2020; 14:16. [PMID: 31969183 PMCID: PMC6977348 DOI: 10.1186/s13256-019-2322-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 11/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Benign biliary stricture is an infrequent condition and the majority occur following cholecystectomy. This case report highlights the occurrence of such a stricture 11 years after cholecystectomy without development of biliary cirrhosis. CASE PRESENTATION Our patient was a 55-year-old Nepalese woman who presented to our hospital with cholangitis of 1-month duration and a history of cholecystectomy 11 years ago. A diagnosis of benign biliary stricture without features of biliary cirrhosis was made, and the patient was successfully managed with a multidisciplinary approach. CONCLUSION Benign biliary stricture can present even decades after cholecystectomy. Roux-en-Y hepaticojejunostomy is the treatment of choice, and a long-term favorable outcome can be expected.
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Affiliation(s)
- Dhruba Narayan Sah
- Institute of Medicine, TU Teaching Hospital, Kathmandu, 00977, Nepal. .,Department of Gastrointestinal and General Surgery, Maharajgunj, P.O. 1524, Kathmandu, Nepal.
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Martines G, Musa N, Lagouvardou E, Aquilino F, Caputi Iambrenghi O. Iatrogenic bile duct injuries in the era of laparoscopic cholecystectomy: a single center experience. Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04841-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Pesce A, Palmucci S, La Greca G, Puleo S. Iatrogenic bile duct injury: impact and management challenges. Clin Exp Gastroenterol 2019; 12:121-128. [PMID: 30881079 PMCID: PMC6408920 DOI: 10.2147/ceg.s169492] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Iatrogenic bile duct injuries (BDIs) after laparoscopic cholecystectomy, being one of the most common performed surgical procedures, remain a substantial problem in gastrointestinal surgery with a significant impact on patient's quality of life. The primary aim of this review was to discuss the classification of BDIs, the proposed methods to prevent biliary lesions, the associated risk factors, and the management challenges depending on the timing of recognition of the injury, its extension, the patient's clinical condition, and the availability of experienced hepatobiliary surgeons. Early recognition of BDI is of paramount importance and limiting the diagnosis delay is crucial for an optimal postoperative outcome. The therapeutic management depends on the type and gravity of the biliary lesion, and includes endoscopic, radiologic, and surgical approaches.
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Affiliation(s)
- Antonio Pesce
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy,
| | - Stefano Palmucci
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy,
| | - Gaetano La Greca
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy,
| | - Stefano Puleo
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Catania, Italy,
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36
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Muhl E. Management of Complications after Major Gastrointestinal Surgery. Visc Med 2017; 33:181-182. [PMID: 28785564 DOI: 10.1159/000477978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Elke Muhl
- Operative Intensivmedizin IOI-II/37a, Department of Anesthesiology and Intensive Care, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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