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Symeonidis S, Mantzoros I, Anestiadou E, Ioannidis O, Christidis P, Bitsianis S, Zapsalis K, Karastergiou T, Athanasiou D, Apostolidis S, Angelopoulos S. Biliary Anatomy Visualization and Surgeon Satisfaction Using Standard Cholangiography versus Indocyanine Green Fluorescent Cholangiography during Elective Laparoscopic Cholecystectomy: A Randomized Controlled Trial. J Clin Med 2024; 13:864. [PMID: 38337557 PMCID: PMC10856121 DOI: 10.3390/jcm13030864] [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: 12/26/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Intraoperative biliary anatomy recognition is crucial for safety during laparoscopic cholecystectomy, since iatrogenic bile duct injuries represent a fatal complication, occurring in up to 0.9% of patients. Indocyanine green fluorescence cholangiography (ICG-FC) is a safe and cost-effective procedure for achieving a critical view of safety and recognizing early biliary injuries. The aim of this study is to compare the perioperative outcomes, usefulness and safety of standard intraoperative cholangiography (IOC) with ICG-FC with intravenous ICG. Methods: Between 1 June 2021 and 31 December 2022, 160 patients undergoing elective LC were randomized into two equal groups: Group A (standard IOC) and group B (ICG-FC with intravenous ICG). Results: No significant difference was found between the two groups regarding demographics, surgery indication or surgery duration. No significant difference was found regarding the visualization of critical biliary structures. However, the surgeon satisfaction and cholangiography duration presented significant differences in favor of ICG-FC. Regarding the inflammatory response, a significant difference between the two groups was found only in postoperative WBC levels. Hepatic and renal function test results were not significantly different between the two groups on the first postoperative day, except for direct bilirubin. No statistically significant difference was noted regarding 30-day postoperative complications, while none of the complications noted included bile duct injury events. Conclusions: ICG-FC presents equivalent results to IOC regarding extrahepatic biliary visualization and postoperative complications. However, more studies need to be performed in order to standardize the optimal dose, timing and mode of administration.
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Affiliation(s)
- Savvas Symeonidis
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Ioannis Mantzoros
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Elissavet Anestiadou
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Orestis Ioannidis
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Panagiotis Christidis
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Stefanos Bitsianis
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Konstantinos Zapsalis
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Trigona Karastergiou
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Dimitra Athanasiou
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Stylianos Apostolidis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Stamatios Angelopoulos
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
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Doğan C, Borazan E, Yılmaz L, Balık AA. How much is the long-term quality of life impaired in cholecystectomy-related biliary tract injury? Turk J Surg 2023; 39:34-42. [PMID: 37275928 PMCID: PMC10234714 DOI: 10.47717/turkjsurg.2023.5780] [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: 05/15/2022] [Accepted: 11/26/2022] [Indexed: 06/07/2023]
Abstract
Objectives Iatrogenic bile duct injury (IBDI) is a serious complication of cholecystectomy that may crucially affect long-term quality of life and have major morbidities. Furthermore, even after reconstructive surgical treatment, such injuries still reduce the long-term quality of life. Therefore, there remains a need to investigate long-term quality of life of the patients since it is considered that there is a long-term decrease in both physical and mental quality of life. Accordingly, this study aimed to investigate the clinical evaluations and long-term quality of life of the patients who had undergone reconstructive surgery for iatrogenic bile duct injury. Material and Methods This clinical study included 49 patients (38 females/11 males) with cholecystectomy-associated bile duct injury and who underwent reconstruction surgery. Several parameters, including the type of bile duct injury, reconstructive surgical procedures, length of hospital stay, and complications were evaluated. Moreover, the effects of reconstructive surgical timing (perioperative, early postoperative, late postoperative) on quality of life were assessed. Long term quality of life (LTQL) levels were evaluated using the SF-36 questionnaire in patients whose follow-ups ranged from two to nine years. The SF-36 questionnaire scores were compared to the average SF-36 norm values of the healthy Turkish population. Results Our results showed that 73.5% of biliary tract injuries occurred after a laparoscopic surgery while 26.5% after open cholecystectomy. Of the injuries, 32.7% developed in patients with acute cholecystitis. Thirty of the patients were treated with hepaticojejunostomy. When SF-36 questionnaire scores of the study were compared to those of the healthy Turkish population, energy-vitality was found to be lower significantly in male patients (p= 0.041). However, there was no significant deterioration in female patients. Although general health perception was better in hepaticojejunostomy according to the type of reconstructive surgery performed, no significant difference was observed in the quality of life. Mental health, energy-vitality (p= 0.019), and general health perception (p= 0.026) were found to be lower in women who had E1 -E2 injuries. Only seven of the injuries were detected perioperatively. Physical function (p= 0.033) and general health perception (p= 0.035) were found to be lower in the early postoperative treatment group in male patients in terms of the time of reconstructive surgery. Conclusion IBDIs cause serious morbidity. Furthermore, even after reconstructive surgical treatment, such injuries still reduce LTQL. Our results suggest that LTQL is lower, especially in male patients undergoing postoperative early biliary repair for Strasberg E3 -E4 type injuries.
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Affiliation(s)
- Caner Doğan
- Department of General Surgery, Gaziantep University Faculty of Medicine, Gaziantep, Türkiye
| | - Ersin Borazan
- Department of General Surgery, Gaziantep University Faculty of Medicine, Gaziantep, Türkiye
| | - Latif Yılmaz
- Department of General Surgery, Gaziantep University Faculty of Medicine, Gaziantep, Türkiye
| | - Ahmet A. Balık
- Department of General Surgery, Gaziantep University Faculty of Medicine, Gaziantep, Türkiye
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Al Qahtani J, Mahmoud W, Al Kuwari H, Muhammad Ali S. A Case Report and Literature Review of Icterus Marginatus: Demarcated Subcutaneous Jaundice, A Sign of Retroperitoneal Bile Leak After Laparoscopic Cholecystectomy. Cureus 2022; 14:e27543. [PMID: 36060325 PMCID: PMC9428368 DOI: 10.7759/cureus.27543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2022] [Indexed: 11/05/2022] Open
Abstract
Laparoscopic cholecystectomy (LC) is one of the most commonly performed general surgical procedures worldwide. Common bile duct (CBD) injuries are occasionally seen after this procedure and manifest as biliary peritonitis or bile collection; however, retroperitoneal bile leak is an extremely rare phenomenon manifesting as yellow discoloration of the abdominal wall, and a few cases are reported in the English literature. In this article, we describe one case of retroperitoneal bile leak that manifested as flank discoloration and its management.
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Keyur B, Pankaj D, Dhaval M, Daxa K. Bile Duct Injury: Surgical Use of Endobiliary Stents for the Management in Emergency Situations. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Reddy S, Lopes Vendrami C, Mittal P, Borhani AA, Moreno CC, Miller FH. MRI evaluation of bile duct injuries and other post-cholecystectomy complications. Abdom Radiol (NY) 2021; 46:3086-3104. [PMID: 33576868 DOI: 10.1007/s00261-020-02947-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 12/14/2022]
Abstract
Laparoscopic cholecystectomy is one of the most common procedures performed each year and can be associated with various post-operative complications. Imaging is integral to diagnosis and management of patients with suspected cholecystectomy complications, and a thorough understanding of normal and abnormal biliary anatomy, risk factors for biliary injury, and the spectrum of adverse events is crucial for interpretation of imaging studies. Magnetic resonance cholangiography (MRC) enhanced with hepatobiliary contrast agent is useful in delineating biliary anatomy and pathology following cholecystectomy. In this article, we provide a protocol for contrast-enhanced MR imaging of the biliary tree. We also review the classification and imaging manifestations of post-cholecystectomy bile duct injuries in addition to other complications such as bilomas, retained/dropped gallstones, and vascular injuries.
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Affiliation(s)
- Shilpa Reddy
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Camila Lopes Vendrami
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Pardeep Mittal
- Department of Radiology, Medical College of Georgia, Augusta, GA, 30912, USA
| | - Amir A Borhani
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Courtney C Moreno
- Department of Radiology & Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA.
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Management of post-cholecystectomy bile duct injuries without operative mortality at Jakarta tertiary hospital in Indonesia - A cross-sectional study. Ann Med Surg (Lond) 2021; 62:211-215. [PMID: 33537132 PMCID: PMC7843359 DOI: 10.1016/j.amsu.2021.01.012] [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: 12/29/2020] [Accepted: 01/10/2021] [Indexed: 12/23/2022] Open
Abstract
Background Bile duct injuries (BDI) can occur after a cholecystectomy procedure performed by any surgeons. These ensured a poor experience for patients and surgeons and marred the minimally invasive surgery approach, which should have promised rapid recovery. This study aimed to evaluate the management of BDI following cholecystectomy procedure in Cipto Mangunkusumo Hospital, Jakarta, as a tertiary hospital. Method Descriptive retrospective cross-sectional design was used on open and laparoscopic cholecystectomy performed between January 2008 and December 2018. This study is reported in line with STROCSS 2019 Criteria. Result A total of 24 patients with BDI were included, with female preponderance (62,5%) with a median age 45 (21–58) years. Sixteen post-laparoscopy cases were classified according to Strasberg classification; 6 cases were type E3, 2 cases each of type E1 and E2, and one case each of Strasberg C and D. The remaining 4 were Strasberg A. Eight post-open cases were classified based on Bismuth criteria: 4 cases of Bismuth I, 1 case of Bismuth II, and 3 cases of Bismuth III. Five cases were presented with massive biloma, 7 with jaundice, and 10 cases with biliary-pancreatic fluid production through the surgical drain. The average time of problem recognition to patient's admission was 19 (7–152) days and admission to surgery was 14 days. Roux-en-Y hepaticojejunostomy was performed in 18 cases, choledocho-duodenostomy in 2 cases, and primary ligation cystic duct in 4 cases. Post-operative follow-up showed 2 patients had recurrent cholangitis, 2 superficial surgical site infection, and 2 relaparotomy due to bile anastomosis leakage and burst abdomen. The median length of hospital stay was 38 (14–53) days with zero hospital mortality. No stricture detected in long term follow-up. Conclusion Common bile duct was the most frequent site of BDI, and Roux-en-Y hepaticojejunostomy reconstruction performed by HPB surgeons on high volume center results in a good outcome. The common bile duct was the most frequent site of BDI Reconstruction of Roux-en-Y hepaticojejunostomy side-to-side by HPB surgeons on high volume center results in a good outcome with zero operative mortality One third of BDI cases referred to our center occurred after open approach. This data can be used as an information for evaluation of General Surgery Training Program in order to improve learning curve thus reduce rate of iatrogenic injury in open cholecystectomy Delay of treatment and reconstruction mostly in intermediate phase (2–12 weeks after event) can be advantageous for patients with optimal preoperative support. It is essential to evaluate the surgical difficulty appropriately and standardize treatment strategies to reduce serious complications.
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Özçay N, Özant A, Arslan K, Özkayalar H, Besim H. Platelet-rich fibrin can accelerate the healing of common bile duct anastomosis in a rat. Turk J Surg 2020; 36:256-263. [PMID: 33778380 DOI: 10.47717/turkjsurg.2020.4564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/30/2019] [Indexed: 12/29/2022]
Abstract
Objectives This study aimed to evaluate the effect of platelet-rich fibrin (PRF) concentrate on the bile duct anastomosis healing process in rats. Material and Methods Thirty male Sprague Dawley (SD) rats were used for the study. The animals were allocated into three groups: Group I Control Group (n=10): Anastomosis to the common bile duct (CBD) with a stent. Group II PRF Group (n=10): Anastomosis to the CBD with a stent and covered with PRF. Group III Sham Group (n=10): Preparation of the common bile duct, no anastomosis. The animals were followed up for 1 month, then sacrificed. Study parameters were adhesions around the anastomosis, thickness of the bridging bile duct tissue over the stent, and histopathologic examination of the bridging bile duct tissue. Results CBD anastomosis using a stent caused severe adhesion around the anastomosis, bridging bile duct tissues were weak and histopathologically, healing was incomplete in most of the control animals. However, PRF application significantly reduced the adhesions, increased the quality of the bridging bile duct tissues, and caused complete healing histologically. Conclusion PRF is an autologous, easily prepared membrane. The present study findings show that PRF prevents local complications and increases the healing capacity of the bile duct after CBD anastomosis. Therefore, it might be a new treatment option for preventing complications following common bile duct anastomosis in liver transplantation patients.
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Affiliation(s)
- Necdet Özçay
- Near East University, General Surgery, Nicosia, Cyprus
| | - Ali Özant
- Near East University, General Surgery, Nicosia, Cyprus
| | - Kalbim Arslan
- Near East University, General Surgery, Nicosia, Cyprus
| | | | - Hasan Besim
- Near East University, General Surgery, Nicosia, Cyprus
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Çavuşoğlu SD, Doğanay M, Birben B, Akkurt G, Akgul Ö, Keşkek M. Management of Bile Duct Injuries: A 6-year Experience in a High Volume Referral Center. Euroasian J Hepatogastroenterol 2020; 10:22-26. [PMID: 32742968 PMCID: PMC7376591 DOI: 10.5005/jp-journals-10018-1309] [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] [Indexed: 12/03/2022] Open
Abstract
Objectives The aim of our study was to determine operative and nonoperative treatments performed in bile duct injuries and the effect of a multidisciplinary approach on the treatment. Background Bile duct injuries may lead to morbidities such as biliary leakage, peritonitis, and mortality. Materials and methods A total of 83 patients with biliary complications (37 patients with iatrogenic bile duct injury referred to our clinic from other centers were also included in this study) were evaluated. Results Of the operated 6,663 patients, iatrogenic bile duct injury occurred in 46 (0.69%) of these patients. The most common type of injury was Strasberg type A injury, which was found in 48 (57.83%) patients. The time interval between the diagnosis and initiation of treatment after the operation was shorter in patients with an inserted cavity drainage catheter (p < 0.05). Of the patients with bile duct injury, 32.6% received surgical and 62.6% endoscopic treatment, while 4.8% were followed-up without intervention. The rate of mortality was found to be 2.4%. Conclusion Time interval to diagnosis is of great importance for management of the patients. How to cite this article Çavuşoğlu SD, Doğanay M, Birben B, et al. Management of Bile Duct Injuries: A 6-year Experience in a High Volume Referral Center. Euroasian J Hepato-Gastroenterol 2020;10(1):22–26.
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Affiliation(s)
| | - Mutlu Doğanay
- Department of General Surgery, Numune Training and Research Hospital, Ankara, Turkey
| | - Birkan Birben
- Department of General Surgery, Numune Training and Research Hospital, Ankara, Turkey
| | - Gökhan Akkurt
- Department of General Surgery, Numune Training and Research Hospital, Ankara, Turkey
| | - Özgur Akgul
- Department of General Surgery, Numune Training and Research Hospital, Ankara, Turkey
| | - Mehmet Keşkek
- Department of General Surgery, Numune Training and Research Hospital, Ankara, Turkey
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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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AlNaqrani FA. Biloma At The Lesser Sac Post Laparoscopic Cholecystectomy. Int J Gen Med 2019; 12:411-414. [PMID: 31807053 PMCID: PMC6844195 DOI: 10.2147/ijgm.s211600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 09/16/2019] [Indexed: 12/03/2022] Open
Abstract
Biloma after a laparoscopic cholecystectomy is a result of injury to the biliary tree. Most commonly the injury is due to an inadequately secured cystic duct stump, an accessory bile duct which seen in 2% of patients or duct of Luschka. In this case we describe biloma at the lesser sac after laparoscopic cholecystectomy.
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Affiliation(s)
- Faisal Abdullah AlNaqrani
- Surgical Department, Faculty of Medicine, University of Taiba and Ohud General Hospital Madina, Madina, Saudi Arabia
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Marino MV, Mirabella A, Guarrasi D, Lupo M, Komorowski AL. Robotic-assisted repair of iatrogenic common bile duct injury after laparoscopic cholecystectomy: Surgical technique and outcomes. Int J Med Robot 2019; 15:e1992. [PMID: 30773791 DOI: 10.1002/rcs.1992] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/13/2019] [Accepted: 02/08/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bile duct injury after cholecystectomy can be a life-threatening complication. Use of robotic approach to manage a complex biliary injury is in an early phase. METHODS We have performed an analysis of our prospectively maintained database that included 12 patients who underwent robotic-assisted repair of bile duct injury after laparoscopic cholecystectomy between 2014 and 2017. RESULTS All patients underwent robotic biliary repair within 2 weeks after primary injury. No conversion to open surgery was necessary, the estimated mean blood loss was 252 mL, and the mean operative time was 260 minutes. The mean length of stay was 9.4 days. The 30-day complication events were a subhepatic abscess and a recurrent episode of cholangitis. One patient underwent the reoperation. The mortality was null. CONCLUSION Robotic-assisted bile duct injury repair seems to be safe and feasible. It offers promising results, thus potentially capable of modifying the management of biliary injury.
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Affiliation(s)
- Marco Vito Marino
- Emergency and General Surgery Department, Azienda Ospedaliera, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.,General Surgery Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Antonello Mirabella
- Emergency and General Surgery Department, Azienda Ospedaliera, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Domenico Guarrasi
- Emergency and General Surgery Department, Azienda Ospedaliera, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Massimo Lupo
- Emergency and General Surgery Department, Azienda Ospedaliera, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Andrzej Lech Komorowski
- Oncologic Surgery Departments, Maria Sklodowska-Curie Memorial Institute of Oncology, Cancer Centre, Kraków, Poland
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Risk Factors and Predictors of Poor Outcome Following Hepaticojejunostomy for Postcholecystecomy Bile Duct Injury. Indian J Surg 2019. [DOI: 10.1007/s12262-019-01866-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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13
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Kulikovsky VF, Yarosh AL, Karpachev AA, Soloshenko AV, Nikolayev SB, Bitenskaya EP, Linkov NA, Gnashko AV. [Minimally invasive management of biliary leakage after cholecystectomy]. Khirurgiia (Mosk) 2018:36-40. [PMID: 29697681 DOI: 10.17116/hirurgia2018436-40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To analyze treatment of patients with de novo extrahepatic bile ducts lesions. MATERIAL AND METHODS The study included 37 patients with post-cholecystectomy biliary leakage which was confirmed intraoperatively and in postoperative period. Cystic duct stump failure was observed in 18 (55.3%) patients, marginal damage, complete intersection and excision of extrahepatic bile duct wall occurred in 7 (18.4%), 1 (2.6%) and 1 (2.6%) patients respectively. Injury of the duct of Lyushka was revelaed in 8 (21.1%) patients. RESULTS AND DISCUSSION Endobiliary stenting was performed in 32 (84.2%) patients. It was final independent method in 5 (13.2%) cases and combined with other procedures in 27 patients (drainage and puncture of bile accumulations (28.9%), laparoscopic external drainage of biliary ducts (42.1%)). The greatest efficacy of these interventions was proved for cystic duct stump failure - 21 of 21 (100.0%), marginal damage of bile ducts - 7% out of 7 (100%), as well as for intersection of ducts of Lychka - 6 out of 8 (75%). CONCLUSION Complex application of minimally invasive surgical interventions for extrahepatic bile ducts injury after cholecystectomy reduces likelihood of redo biliary surgery and may be independent treatment in some cases.
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Affiliation(s)
| | - A L Yarosh
- Belgorod State National Research University, Belgorod
| | - A A Karpachev
- St. Joasaph Belgorod Regional Clinical Hospital, Belgorod, Russia
| | - A V Soloshenko
- St. Joasaph Belgorod Regional Clinical Hospital, Belgorod, Russia
| | - S B Nikolayev
- St. Joasaph Belgorod Regional Clinical Hospital, Belgorod, Russia
| | - E P Bitenskaya
- St. Joasaph Belgorod Regional Clinical Hospital, Belgorod, Russia
| | - N A Linkov
- St. Joasaph Belgorod Regional Clinical Hospital, Belgorod, Russia
| | - A V Gnashko
- Belgorod State National Research University, Belgorod
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Ungewöhnliche Ursache rezidivierender Glutealabszessbildung. Chirurg 2017; 88:884-886. [DOI: 10.1007/s00104-017-0411-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Liu W, Chen W, He X, Qu Q, Hong T, Li B. Successful treatment using corticosteroid combined antibiotic for acute acalculous cholecystitis patients with systemic lupus erythematosus. Medicine (Baltimore) 2017; 96:e7478. [PMID: 28682919 PMCID: PMC5502192 DOI: 10.1097/md.0000000000007478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
There is no consensus of treatments for acute acalculous cholecystitis with systemic lupus erythematosus (SLE). The study was aimed to investigate the effect of the corticosteroid for these patients.A series of patients who were diagnosed as acute acalculous cholecystitis with SLE in the period from January 2012 to December 2016 at our hospital were included. They accepted 2 different conservative treatment strategies initially: the treatment using moxifloxacin (the antibiotic group), and the treatment using corticosteroid combined moxifloxacin (the corticosteroid group). Then clinical manifestations, laboratory features, and outcomes were analyzed.The study identified 22 women Han Chinese patients with the SLE history of 2.8 ± 1.4 year. There was no significant difference in SLE history, Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2000), Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SLICC/ACR), hematologic examination results, and corticosteroid dosage between 2 groups. And there was no significant difference in the symptom of acute cholecystitis, duration of the symptoms, white blood level, and the thickness of gallbladder wall between 2 groups either. However, the SLEDAI-2000 of the corticosteroid group was lower than that of the antibiotic group (7.3 ± 1.4 vs 10.7 ± 3.0, P = .03), so was the SLICC/ACR (0.1 ± 0.3 vs 0.3 ± 0.5, P = .01). Moreover, total 11 of 12 patients were successfully treated in the corticosteroid group, only 1 patient got cholecystectomy because no improvement after conservative treatment. While 4 of 10 patients were successfully treated by moxifloxacin alone, 6 patients had to accept cholecystectomy in the antibiotic group. The rate of successful conservative treatment in the corticosteroid group was higher than that of the antibiotic group (P = .02). All patients were followed up at least 6 months, there was no statistical difference in the rate of recurrence of abdominal pain between 2 groups (P = .37).The corticosteroid plays an important role in the management of the acalculous cholecystitis patient with SLE, and it should be considered as a first line of treatment.
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Renz BW, Bösch F, Angele MK. Bile Duct Injury after Cholecystectomy: Surgical Therapy. Visc Med 2017; 33:184-190. [PMID: 28785565 PMCID: PMC5527188 DOI: 10.1159/000471818] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Iatrogenic bile duct injuries (IBDI) after laparoscopic cholecystectomy (LC), being one of the most common performed surgical procedures, remain a substantial problem in gastrointestinal surgery. The most important aspect regarding this issue is the prevention of IBDI during index cholecystectomy. Once it occurs, early and accurate diagnosis of IBDI is very important for surgeons and gastroenterologists, because unidentified IBDI may result in severe complications such as hepatic failure and death. Laboratory tests, radiological imaging, and endoscopy play an important role in the diagnosis of biliary injuries. METHODS This review summarizes and discusses the current literature on the management of IBDI after LC from a surgical point of view. RESULTS AND CONCLUSION In general, endoscopic techniques are recommended for the initial diagnosis and treatment of IBDI and are important to classify them correctly. In patients with complete dissection or obstruction of the bile duct, surgical management remains the only feasible option. Different surgical reconstructions are performed in patients with IBDI. According to the available literature, Roux-en-Y hepaticojejunostomy is the most frequent surgical reconstruction and is recommended by most authors. Long-term results are most important in the assessment of effectiveness of IBDI treatment. Apart from that, adequate diagnosis and treatment of IBDI may avoid many serious complications and improve the quality of life of our patients.
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Affiliation(s)
| | | | - Martin K. Angele
- Department of General, Visceral, Vascular and Transplantation Surgery, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
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Dralle H, Kols K, Weimann A, Paul A, Hoyer DP. [Intraoperatively unrecognized central bile duct injury : In open converted, laparoscopically begun cholecystectomy]. Chirurg 2017; 88:442-445. [PMID: 28405716 DOI: 10.1007/s00104-017-0410-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- H Dralle
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Medizinisches Zentrum, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
| | - K Kols
- Schlichtungsstelle für Arzthaftpflichtfragen, Norddeutsche Ärztekammern, Hans Böckler Allee 3, 30173, Hannover, Deutschland.
| | - A Weimann
- Klinik für Allgemein-, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg gGmbH, Delitzscher Str. 141, 04129, Leipzig, Deutschland.
| | - A Paul
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
| | - D P Hoyer
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland
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