1
|
Asai K, Ohyama T, Watanabe M, Moriyama H, Kujiraoka M, Watanabe R, Shigeta K, Kakizaki N, Hagiwara O, Saida Y. Validation of a surgical difficulty grading system in laparoscopic cholecystectomy for acute cholecystitis. J Hepatobiliary Pancreat Sci 2024; 31:80-88. [PMID: 37803518 DOI: 10.1002/jhbp.1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
BACKGROUND The surgical difficulty of laparoscopic cholecystectomy (LC) for acute cholecystitis varies from case to case, and appropriate intraoperative evaluation would help prevent bile duct injury (BDI). METHODS We analyzed 178 patients who underwent LC for acute cholecystitis. Expert surgeons and trainees individually evaluated the surgical difficulty. The inter-rater agreement was analyzed using Conger's κ and Gwet's agreement coefficient (AC). Furthermore, we analyzed the predictive surgical difficulty item for performing subtotal cholecystectomy (STC). RESULTS Regarding the inter-rater agreement between expert surgeons and trainees, 15 of the 17 surgical difficulty items had a Gwet's AC of 0.5 or higher, indicating "moderate" agreement or higher. Furthermore, the highest and total surgical difficulty scores were deemed "substantial" agreement. Scarring and dense fibrotic changes around the Calot's triangle area with easy bleeding with/without necrotic changes were predictive of whether STC should be performed. CONCLUSIONS This surgical difficulty grading system is expected to be a tool that can be used by any surgeon with LC experience. STC should be performed to prevent BDI according to the changes around the Calot's triangle area.
Collapse
Affiliation(s)
- Koji Asai
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | | | - Manabu Watanabe
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Hodaka Moriyama
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Manabu Kujiraoka
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Ryutaro Watanabe
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Kenta Shigeta
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Nanako Kakizaki
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Osahiko Hagiwara
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yoshihisa Saida
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| |
Collapse
|
2
|
Zidan MHED, Seif-Eldeen M, Ghazal AA, Refaie M. Post-cholecystectomy bile duct injuries: a retrospective cohort study. BMC Surg 2024; 24:8. [PMID: 38172774 PMCID: PMC10765830 DOI: 10.1186/s12893-023-02301-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Bile duct injury (BDI) is still a major worrisome complication that is feared by all surgeons undergoing cholecystectomy. The overall incidence of biliary duct injuries falls between 0.2 and 1.3%. BDI classification remains an important method to define the type of injury conducted for investigation and management. Recently, a Consensus has been taken to define BDI using the ATOM classification. Early management brings better results than delayed management. The current perspective in biliary surgery is the laparoscopic role in diagnosing and managing BDI. Diagnostic laparoscopy has been conducted in various entities for diagnostic and therapeutic measures in minor and major BDIs. METHODS 35 cases with iatrogenic BDI following cholecystectomy (after both open and laparoscopic approaches) both happened in or were referred to Alexandria Main University Hospital surgical department from January 2019 till May 2022 and were analyzed retrospectively. Patients were classified according to the ATOM classification. Management options undertaken were mentioned and compared to the timing of diagnosis, and the morbidity and mortality rates (using the Clavien-Dindo classification). RESULTS 35 patients with BDI after both laparoscopic cholecystectomy (LC) (54.3%), and Open cholecystectomy (OC) (45.7%) (20% were converted and 25.7% were Open from the start) were classified according to ATOM classification. 45.7% were main bile duct injuries (MBDI), and 54.3% were non-main bile duct injuries (NMBDI), where only one case 2.9% was associated with vasculobiliary injury (VBI). 28% (n = 10) of the cases were diagnosed intraoperatively (Ei), 62.9% were diagnosed early postoperatively (Ep), and 8.6% were diagnosed in the late postoperative period (L). LC was associated with 84.2% of the NMBDI, and only 18.8% of the MBDI, compared to OC which was associated with 81.3% of the MBDI, and 15.8% of the NMBDI. By the Clavien-Dindo classification, 68.6% fell into Class IIIb, 20% into Class I, 5.7% into Class V (mortality rate), 2.9% into Class IIIa, and 2.9% into Class IV. The Clavien-Dindo classification and the patient's injury (type and time of detection) were compared to investigation and management options. CONCLUSION Management options should be defined individually according to the mode of presentation, the timing of detection of injury, and the type of injury. Early detection and management are associated with lower morbidity and mortality. Diagnostic Laparoscopy was associated with lower morbidity and better outcomes. A proper Reporting checklist should be designed to help improve the identification of injury types.
Collapse
Affiliation(s)
- Mohamed Hossam El-Din Zidan
- Faculty of Medicine, Alexandria University, Alexandria, Egypt.
- Alexandria Main University Hospital, Alexandria University, Alexandria, Egypt.
| | - Mostafa Seif-Eldeen
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Alexandria Main University Hospital, Alexandria University, Alexandria, Egypt
| | - Abdelhamid A Ghazal
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Alexandria Main University Hospital, Alexandria University, Alexandria, Egypt
| | - Mustafa Refaie
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Alexandria Main University Hospital, Alexandria University, Alexandria, Egypt
| |
Collapse
|
3
|
Spiers HVM, Lam S, Machairas NA, Sotiropoulos GC, Praseedom RK, Balakrishnan A. Liver transplantation for iatrogenic bile duct injury: a systematic review. HPB (Oxford) 2023; 25:1475-1481. [PMID: 37633743 DOI: 10.1016/j.hpb.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/17/2023] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Bile duct injury (BDI) is an infrequent but serious complication of cholecystectomy, often with life-changing consequences. Liver transplantation (LT) may be required following severe BDI, however given the rarity, few large studies exist to guide management for complex BDI. METHODS A systematic review was performed to assess post-operative complications, 30-day mortality, retransplant rate and 1-year and 5-year survival following LT for BDI in Medline, EMBASE, Web of Science or Cochrane Clinical Trials Database. RESULTS Seven articles met inclusion criteria, describing 179 patients that underwent LT for BDI. Secondary biliary cirrhosis (SBC) was the main indication for LT (82.2% of patients). Median model for end-stage liver disease (MELD) scores at time of LT ranged from 16 to 20.5. Median 30-day mortality was 20.0%. The 1-year and 5-year survival ranges were 55.0-84.3% and 30.0-83.3% respectively, and the overall retransplant rate was 11.5%. CONCLUSION BDI is rarely indicated for LT, predominantly for SBC following multiple prior interventions. MELD scores poorly reflect underlying morbidity, and exception criteria for waitlisting may avoid prolonged LT waiting times. 30-day mortality was higher than for non-BDI indications, with comparable long term survival, suggesting that LT remains a viable but high risk salvage option for severe BDI.
Collapse
Affiliation(s)
- Harry V M Spiers
- Department of Surgery, Addenbrooke's Hospital and the University of Cambridge, Cambridge, United Kingdom
| | - Shi Lam
- Department of Surgery, Addenbrooke's Hospital and the University of Cambridge, Cambridge, United Kingdom
| | - Nikolaos A Machairas
- 2nd Department of Propaedeutic Surgery, General Hospital Laiko, National and Kapodistrian University of Athens, Greece
| | - Georgios C Sotiropoulos
- 2nd Department of Propaedeutic Surgery, General Hospital Laiko, National and Kapodistrian University of Athens, Greece
| | - Raaj K Praseedom
- Department of Surgery, Addenbrooke's Hospital and the University of Cambridge, Cambridge, United Kingdom
| | - Anita Balakrishnan
- Department of Surgery, Addenbrooke's Hospital and the University of Cambridge, Cambridge, United Kingdom.
| |
Collapse
|
4
|
Raafat M, Morsy MM, Mohamed SI, Hamad MA, Sayed MM. Therapeutic Role of Subcutaneous Access Loop Created Adjunct to Hepaticojejunostomy for Management of Bile Duct Injury. Am Surg 2023; 89:5711-5719. [PMID: 37142256 DOI: 10.1177/00031348231173945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Roux-en-Y hepaticojejunostomy (RYHJ) is usually required for major bile duct injury (BDI) as a definitive treatment. Hepaticojejunostomy anastomotic stricture (HJAS) is the most feared long-term complication following RYHJ. The ideal management of HJAS remains undefined. The provision of permanent endoscopic access to the bilio-enteric anastomotic site can make endoscopic management of HJAS feasible and attractive option. In this cohort study, we aimed to evaluate short- and long-term outcomes of subcutaneous access loop created adjunct to RYHJ (RYHJ-SA) for management of BDI and its usefulness for endoscopic management of anastomotic stricture if occurred. MATERIALS AND METHODS This is a prospective study including patients who were diagnosed with iatrogenic BDI and underwent hepaticojejunostomy with subcutaneous access loop between September 2017 and September 2019. RESULTS This study included a total number of 21 patients whom ages ranged between 18 and 68 years. During follow-up, three cases had HJAS. One patient had the access loop in subcutaneous position. Endoscopy was done but failed to dilate the stricture. The other 2 patients had the access loop in subfascial position. Endoscopy of them failed to enter the access loop due to failure of fluoroscopy to identify the access loop. The three cases underwent redo-hepaticojejunostomy. Parajejunal (parastomal) hernia occurs in 2 patients in whom the access loop was fixed subcutaneous position. CONCLUSION In conclusion, modified RYHJ with subcutaneous access loop (RYHJ-SA) is associated with reduced quality of life and patient satisfaction. Moreover, its role in endoscopic management of HJAS after biliary reconstruction for major BDI is limited.
Collapse
Affiliation(s)
- Mohamad Raafat
- Department of General Surgery, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Morsy M Morsy
- Department of General Surgery, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Salah I Mohamed
- Department of General Surgery, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Mostafa A Hamad
- Department of General Surgery, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Mostafa M Sayed
- Department of General Surgery, Faculty of Medicine, Assiut University, Asyut, Egypt
| |
Collapse
|
5
|
Khalid MU, Laplante S, Masino C, Alseidi A, Jayaraman S, Zhang H, Mashouri P, Protserov S, Hunter J, Brudno M, Madani A. Use of artificial intelligence for decision-support to avoid high-risk behaviors during laparoscopic cholecystectomy. Surg Endosc 2023; 37:9467-9475. [PMID: 37697115 DOI: 10.1007/s00464-023-10403-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 08/14/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Bile duct injuries (BDIs) are a significant source of morbidity among patients undergoing laparoscopic cholecystectomy (LC). GoNoGoNet is an artificial intelligence (AI) algorithm that has been developed and validated to identify safe ("Go") and dangerous ("No-Go") zones of dissection during LC, with the potential to prevent BDIs through real-time intraoperative decision-support. This study evaluates GoNoGoNet's ability to predict Go/No-Go zones during LCs with BDIs. METHODS AND PROCEDURES Eleven LC videos with BDI (BDI group) were annotated by GoNoGoNet. All tool-tissue interactions, including the one that caused the BDI, were characterized in relation to the algorithm's predicted location of Go/No-Go zones. These were compared to another 11 LC videos with cholecystitis (control group) deemed to represent "safe cholecystectomy" by experts. The probability threshold of GoNoGoNet annotations were then modulated to determine its relationship to Go/No-Go predictions. Data is shown as % difference [99% confidence interval]. RESULTS Compared to control, the BDI group showed significantly greater proportion of sharp dissection (+ 23.5% [20.0-27.0]), blunt dissection (+ 32.1% [27.2-37.0]), and total interactions (+ 33.6% [31.0-36.2]) outside of the Go zone. Among injury-causing interactions, 4 (36%) were in the No-Go zone, 2 (18%) were in the Go zone, and 5 (45%) were outside both zones, after maximizing the probability threshold of the Go algorithm. CONCLUSION AI has potential to detect unsafe dissection and prevent BDIs through real-time intraoperative decision-support. More work is needed to determine how to optimize integration of this technology into the operating room workflow and adoption by end-users.
Collapse
Affiliation(s)
- Muhammad Uzair Khalid
- Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
- Surgical Artificial Intelligence Research Academy, University Health Network, Toronto, ON, Canada.
| | - Simon Laplante
- Surgical Artificial Intelligence Research Academy, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Caterina Masino
- Surgical Artificial Intelligence Research Academy, University Health Network, Toronto, ON, Canada
| | - Adnan Alseidi
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Shiva Jayaraman
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Surgery, St Joseph's Health Centre, Toronto, ON, Canada
| | - Haochi Zhang
- DATA Team, University Health Network, Toronto, ON, Canada
| | | | - Sergey Protserov
- DATA Team, University Health Network, Toronto, ON, Canada
- Department of Computer Science, University of Toronto, Toronto, ON, Canada
| | - Jaryd Hunter
- DATA Team, University Health Network, Toronto, ON, Canada
| | - Michael Brudno
- DATA Team, University Health Network, Toronto, ON, Canada
- Department of Computer Science, University of Toronto, Toronto, ON, Canada
| | - Amin Madani
- Surgical Artificial Intelligence Research Academy, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
6
|
Subedi SS, Neupane D, Lageju N. Critical View of Safety Dissection and Rouviere's Sulcus for Safe Laparoscopic Cholecystectomy: A Descriptive Study. J Laparoendosc Adv Surg Tech A 2023; 33:1081-1087. [PMID: 37844063 DOI: 10.1089/lap.2023.0262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
Objective: To determine the importance of a critical view of safety (CVS) techniques and Rouviere's sulcus (RS) in laparoscopic cholecystectomy (LC) and its relation to biliary duct injuries (BDIs) and to determine the frequency and the type of RS. Design, Setting, and Participants: A descriptive study was carried out among 76 patients presenting to the surgery department of a tertiary care center in Nepal. The study population included all patients in the age group 16-80 years undergoing LC. Outcome Measures: The main outcome of interest was to calculate the percentage of BDIs along with the frequency and the type of RS. Results: A total of 76 patients were enrolled in the study, out of which 57(75%) were female patients with a male-to-female ratio of 1:3 and a mean age of 45.87 ± 15.33 years. Seventy-one (93.4%) patients were diagnosed with symptomatic gallstone disease. The CVS was achieved in 75 (98.7%) of the cases, whereas in 1 case, the CVS could not be achieved, and in the same patient routine LC was converted into open cholecystectomy owing to the difficult laparoscopic procedure. In 56 (73.7%) cases, RS was first visible to the operating surgeons after port installation, alignment, and adequate traction of the gallbladder; in 20 (26.3%) cases, RS was not originally apparent. Conclusion: According to the findings of this study and the literature's critical assessment of safety, this method will soon become a gold standard for dissecting gall bladder components. The technique needs to be extended further, especially for training purposes. Major difficulties can be avoided by identifying RS before cutting the cystic artery or duct during LC.
Collapse
Affiliation(s)
| | - Durga Neupane
- Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Nimesh Lageju
- Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| |
Collapse
|
7
|
Carannante F, Mazzotta E, Miacci V, Bianco G, Mascianà G, D'Agostino F, Caricato M, Capolupo GT. Identification and management of subvesical bile duct leakage after laparoscopic cholecystectomy: A systematic review. Asian J Surg 2023; 46:4161-4168. [PMID: 37127504 DOI: 10.1016/j.asjsur.2023.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/10/2022] [Accepted: 04/12/2023] [Indexed: 05/03/2023] Open
Abstract
Bile leak is a rare complication after Laparoscopic Cholecystectomy. Subvesical bile duct (SVBD) injury is the second cause of minor bile leak, following the unsuccessful clipping of the cystic duct stump. The aim of this study is to pool available data on this type of biliary tree anatomical variation to summarize incidence of injury, methods used to diagnose and treat SVBD leaks after LC. Articles published between 1985 and 2021 describing SVBD evidence in patients operated on LC for gallstone disease, were included. Data were divided into two groups based on the intra or post-operative evidence of bile leak from SVBD after surgery. This systematic report includes 68 articles for a total of 231 patients. A total of 195 patients with symptomatic postoperative bile leak are included in Group 1, while Group 2 includes 36 patients describing SVBD visualized and managed during LC. Outcomes of interest were diagnosis, clinical presentation, treatment, and outcomes. The management of minor bile leak is controversial. In most of cases diagnosed postoperatevely, Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is the best way to treat this complication. Surgery should be considered when endoscopic or radiological approaches are not resolutive.
Collapse
Affiliation(s)
- F Carannante
- Colorectal Surgery Clinic and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy.
| | - E Mazzotta
- Colorectal Surgery Clinic and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - V Miacci
- Colorectal Surgery Clinic and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - G Bianco
- Colorectal Surgery Clinic and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - G Mascianà
- Colorectal Surgery Clinic and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - F D'Agostino
- Department of Anaesthesia, Intensive Care and Pain Medicine, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - M Caricato
- Colorectal Surgery Clinic and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - G T Capolupo
- Colorectal Surgery Clinic and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| |
Collapse
|
8
|
Thunnissen FM, Baars C, Arts R, Latenstein CSS, Drenth JPH, van Laarhoven CJHM, Lantinga MA, de Reuver PR. Persistent and new-onset symptoms after cholecystectomy in patients with uncomplicated symptomatic cholecystolithiasis: A post hoc analysis of 2 prospective clinical trials. Surgery 2023; 174:781-786. [PMID: 37541808 DOI: 10.1016/j.surg.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/14/2023] [Accepted: 06/18/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy is the gold standard for treating biliary colic in patients with gallstones, but post-cholecystectomy abdominal pain is commonly reported. This study investigates which symptoms are likely to persist and which may develop after a cholecystectomy. METHODS Patients from 2 previous prospective trials who underwent laparoscopic cholecystectomy for symptomatic cholecystolithiasis were included. Patients completed questionnaires on pain and gastrointestinal symptoms before surgery and at 6 months follow-up. The prevalence of persistent and new-onset abdominal symptoms was evaluated. RESULTS A total of 820 patients received cholecystectomy and were included, 75.4% female (n = 616/820) mean age 49.4 years (standard deviation 13.7). At baseline, 74.1% (n = 608/820) of patients met all criteria for biliary colic. Cholecystectomy successfully resolved biliary colic in 94.8% (n = 327/345) of patients, but 36.5% (n = 299/820) of patients reported persistent abdominal pain after 6 months of follow-up. The prevalence of most abdominal symptoms reduced significantly. Symptoms such as flatulence (17.8%, n = 146/820) or restricted eating (14.5%, n = 119/820) persisted most often. New-onset symptoms were frequent bowel movements (9.6%, n = 79/820), bowel urgency (8.5%, n = 70/820), and new-onset diarrhea (8.4%, 69/820). CONCLUSION Postcholecystectomy symptoms are mainly flatulence, frequent bowel movements, and restricted eating. Newly reported symptoms are mainly frequent bowel movements, bowel urgency, and diarrhea. The present findings give clinical guidance in informing, managing, and treating patients with symptoms after cholecystectomy.
Collapse
Affiliation(s)
- Floris M Thunnissen
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Cléo Baars
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Rianne Arts
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | | | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Cornelis J H M van Laarhoven
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marten A Lantinga
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, University Medical Centres Amsterdam, The Netherlands. https://twitter.com/PhilipReuver
| | - Philip R de Reuver
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
| |
Collapse
|
9
|
Zhu AY, Seyfi D, Sandroussi C, Abeysinghe JD. Aberrant Vascular Anatomy During Laparoscopic Cholecystectomy: A Case Report of Double Cystic Artery. CRSLS 2023; 10:e2023.00038. [PMID: 37942207 PMCID: PMC10629475 DOI: 10.4293/crsls.2023.00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Introduction Laparoscopic cholecystectomy is the standard surgical procedure for the management of benign gallbladder pathology. Anatomical variation, including aberrant cystic artery, increases the risk of complications during laparoscopic cholecystectomy. Obtaining a critical view of safety is important to avoid major vascular and bile duct injury. Case description We present a case of aberrant anatomy with two cystic arteries of equal caliber in a 41-year-old female undergoing laparoscopic cholecystectomy for acute cholecystitis. Discussion This case report aims to emphasize the importance of thorough knowledge of hepatobiliary vascular anatomy, as well as variations beyond the critical view of safety, which will contribute to the safety and success of laparoscopic cholecystectomy.
Collapse
Affiliation(s)
- Alison Y Zhu
- Department of General Surgery, Canterbury Hospital, Campsie, Australia. (Drs Zhu and Abeysinghe)
| | - Doruk Seyfi
- Department of Upper Gastrointestinal Surgery, Chris O'Brien Lifehouse, Camperdown, Australia. (Drs. Seyfi and Sandroussi)
| | - Charbel Sandroussi
- Department of Upper Gastrointestinal Surgery, Chris O'Brien Lifehouse, Camperdown, Australia. (Drs. Seyfi and Sandroussi)
| | - Jayantha D Abeysinghe
- Department of General Surgery, Canterbury Hospital, Campsie, Australia. (Dr. Zhu and Mr. Abeysinghe)
| |
Collapse
|
10
|
Sucandy I, Giovannetti A, Spence J, Ross S, Rosemurgy A. Robotic Roux-en-Y Hepaticojejunostomy for Right Hepatic Duct Transection. Application of Minimally Invasive Technique for High Bile Duct Injury. Am Surg 2023; 89:1309-1310. [PMID: 33787353 DOI: 10.1177/0003134820956358] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Minimally Invasive bile duct repair is an emerging modern technique in hepatobiliary surgery. Conventional laparoscopic technique had been sporadically reported by high volume surgeons as an alternative to open operation, however, the majority of those repairs were undertaken for biliary injury below the biliary bifurcation. Roux-en-Y Hepaticojejunostomy below the biliary bifurcation is technically much simpler to complete when compared to that above the hilar plate (high bile duct injury). The risk of long-term anastomotic stricture is also higher as bile duct caliber decreases. This is anatomically inherent as we travel further cranial beyond the hilar plate. In this multimedia article, we describe our minimally invasive technique for high bile duct injury repair using robotic technology.
Collapse
Affiliation(s)
| | | | - Janelle Spence
- Digestive Health Institute of AdventHealth Tampa, FL, USA
| | - Sharona Ross
- Digestive Health Institute of AdventHealth Tampa, FL, USA
| | | |
Collapse
|
11
|
Cheng L, Peng S, Huo S, Liu W. Risk factors for the development of biliary tract infection after choledochal-malformation surgery. Asian J Surg 2023; 46:478-482. [PMID: 35697611 DOI: 10.1016/j.asjsur.2022.05.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/28/2022] [Accepted: 05/26/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To explore the risk factors of biliary tract infection after bile duct dilatation surgery. METHODS The study included 135 patients with choledochal malformation after bile duct dilatation surgery at our hospital from January 2019 to June 2021. We analyzed general data of infected and uninfected groups after bile duct dilatation surgery. Single/multiple factor logistic regression was used to analyse the factors influencing postoperative biliary tract infection in bile duct dilatation. RESULTS There were statistically significant differences in preoperative history of biliary tract infection, partial hepatectomy, hilar anastomosis, and Todani staging between the two groups. Single factor Logistic regression analysis showed that preoperative history of biliary tract infection, partial hepatectomy, hepatic portal anastomosis and Todani staging IV and V were positively correlated with postoperative biliary tract infection following biliary duct dilatation (P<0.05). In addition, logistic regression analysis of these general data with differential indicators as independent variables and postoperative biliary tract infection in biliary duct dilatation as a dependent variable showed that history of preoperative biliary tract infection and hepatic portal anastomosis were risk factors of postoperative biliary tract infection following biliary duct dilatation. CONCLUSION Risk factors of biliary tract infection after bile duct dilatation include a history of preoperative biliary tract infection and hepatoportal anastomosis, which should be noted during clinical procedures to prevent or reduce the development of biliary tract infection after bile duct dilatation.
Collapse
Affiliation(s)
- Lin Cheng
- Outpatient Department, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, China
| | - Sisi Peng
- General Department, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, China
| | - Shuyu Huo
- Department of Hospital Infection Management, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, China.
| | - Wen Liu
- Department of Hepatological Surgery, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan, China.
| |
Collapse
|
12
|
Abstract
BACKGROUND To explore the risk factors of bile duct injury in laparoscopic cholecystectomy (LC) in China through meta-analysis. METHODS The study commenced with a search and selection of case-control studies on the risk factors for bile duct injury in LC in China using the following databases: PubMed, EMBASE, ScienceNet.cn, CNKI, Wanfang Data, and VIP. Data were extracted from the collected documents independently by 2 researchers, following which a meta-analysis of these data was performed using Revman 5.3. RESULTS The compilation of all data from a total of 19 case-control studies revealed that among 41,044 patients, 458 patients experienced bile duct injury in LC, accounting for the incidence rate of 1.12% for bile duct injury. The revealed risk factors for bile duct injury were age (≥40 years) (odds ratio [OR] = 6.23, 95% CI [95% confidence interval]: 3.42-11.33, P < .001), abnormal preoperative liver function (OR = 2.01, 95% CI: 1.50-2.70, P < .001), acute and subacute inflammation of gallbladder (OR = 8.35, 95% CI: 5.32-13.10, P < .001; OR = 4.26, 95% CI: 2.73-6.65, P < .001), thickening of gallbladder wall (≥4 mm) (OR = 3.18, 95% CI: 2.34-4.34, P < .001), cholecystolithiasis complicated with effusion (OR = 3.05, 95% CI: 1.39-6.71, P = .006), and the anatomic variations of the gallbladder triangle (OR = 11.82, 95% CI: 6.32-22.09, P < .001). However, the factors of gender and overweight (body mass index ≥ 25 kg/m2) were not significantly correlated with bile duct injury in LC. CONCLUSIONS In the present study, age (≥40 years), abnormal preoperative liver function, gallbladder wall thickening, acute and subacute inflammation of the gallbladder, cholecystolithiasis complicated with effusion, and anatomic variations of the gallbladder triangle were found to be closely associated with bile duct injury in LC.
Collapse
Affiliation(s)
- Shaohua Yang
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Sheng Hu
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaohui Gu
- The Second People’s Hospital of Qujing City, Qujing, China
| | - Xiaowen Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
- *Correspondence: Xiaowen Zhang, Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Kunming Medical University, Kunming 650105, China (e-mail: )
| |
Collapse
|
13
|
Lucocq J, Scollay J, Patil P. Elective laparoscopic cholecystectomy: recurrent biliary admissions predispose to difficult cholecystectomy. Surg Endosc 2022; 36:6403-6409. [PMID: 35024925 PMCID: PMC9402724 DOI: 10.1007/s00464-021-08986-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/31/2021] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Patients undergoing elective laparoscopic cholecystectomy (ELLC) represent a heterogeneous group making it challenging to stratify risk. The aim of this paper is to identify pre-operative factors associated with adverse peri- and post-operative outcomes in patients undergoing ELLC. This knowledge will help stratify risk, guide surgical decision making and better inform the consent process. METHODS All patients who underwent ELLC between January 2015 and December 2019 were included in the study. Pre-operative data and both peri- and post-operative outcomes were collected retrospectively from multiple databases using a deterministic records-linkage methodology. Patients were divided into groups based on clinical indication (i.e. biliary colic versus cholecystitis) and adverse outcomes were compared. Multivariate regression models were generated for each adverse outcome using pre-operative independent variables. RESULTS Two-thousand one hundred and sixty-six ELLC were identified. Rates of peri- and post-operative adverse outcomes were significantly higher in the cholecystitis versus biliary colic group and increased with number of admissions of cholecystitis (p < 0.05). Rates of subtotal (29.5%), intra-operative complication (9.8%), post-operative complications (19.6%), prolonged post-operative stay (45.9%) and re-admission (16.4%) were significant in the group of patients with ≥ 2 admissions with cholecystitis. CONCLUSION Our data demonstrate that patients with repeated biliary admission (particularly cholecystitis) ultimately face an increased risk of a difficult ELLC with associated complications, prolonged post-operative stay and readmissions. These data provide robust evidence that individualised risk assessment and consent are necessary before ELLC. Strategies to minimise recurrent biliary admissions prior to LC should be implemented.
Collapse
Affiliation(s)
- James Lucocq
- Department of General and Upper GI Surgery, Ninewells Hospital, University of Dundee, Dundee, UK
| | - John Scollay
- Department of General and Upper GI Surgery, Ninewells Hospital, University of Dundee, Dundee, UK
| | - Pradeep Patil
- Department of General and Upper GI Surgery, Ninewells Hospital, University of Dundee, Dundee, UK
| |
Collapse
|
14
|
Georgiou K, Sandblom G, Alexakis N, Enochsson L. Intraoperative cholangiography 2020: Quo vadis? A systematic review of the literature. Hepatobiliary Pancreat Dis Int 2022; 21:145-153. [PMID: 35031229 DOI: 10.1016/j.hbpd.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/03/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND There are few randomized controlled trials with sufficient statistical power to assess the effectiveness of intraoperative cholangiography (IOC) in the detection and treatment of common bile duct injury (BDI) or retained stones during cholecystectomy. The best evidence so far regarding IOC and reduced morbidity related to BDI and retained common bile duct stones was derived from large population-based cohort studies. Population-based studies also have the advantage of reflecting the outcome of the procedure as it is practiced in the community at large. However, the outcomes of these population-based studies are conflicting. DATA SOURCES A systematic literature search was conducted in 2020 to search for articles that contained the terms "bile duct injury", "critical view of safety", "bile duct imaging" or "retained stones" in combination with IOC. All identified references were screened to select population-based studies and observational studies from large centers where socioeconomic or geographical selections were assumed not to cause selection bias. RESULTS The search revealed 273 references. A total of 30 articles fulfilled the criteria for a large observational study with minimal risk for selection bias. The majority suggested that IOC reduces morbidity associated with BDI and retained common bile duct stones. In the short term, IOC increases the cost of surgery. However, this is offset by reduced costs in the long run since BDI or retained stones detected during surgery are managed immediately. CONCLUSIONS IOC reduces morbidity associated with BDI and retained common bile duct stones. The reports reviewed are derived from large, unselected populations, thereby providing a high external validity. However, more studies on routine and selective IOC with well-defined outcome measures and sufficient statistical power are needed.
Collapse
Affiliation(s)
- Konstantinos Georgiou
- First Department of Propaedeutic Surgery, Hippokration General Hospital of Athens, Athens Medical School, National and Kapodistrian University of Athens, Athens 10679, Greece
| | - Gabriel Sandblom
- Department of Clinical Science and Education, Department of Surgery, Karolinska Institutet, Södersjukhuset, Stockholm 17177, SE, Sweden
| | - Nicholas Alexakis
- First Department of Propaedeutic Surgery, Hippokration General Hospital of Athens, Athens Medical School, National and Kapodistrian University of Athens, Athens 10679, Greece
| | - Lars Enochsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå 90187, SE, Sweden.
| |
Collapse
|
15
|
Bosley ME, Nunn AM, Westcott CJ, Neff LP. Antegrade balloon sphincteroplasty as an adjunct to laparoscopic common bile duct exploration for the acute care surgeon. J Trauma Acute Care Surg 2022; 92:e47-e51. [PMID: 34797812 DOI: 10.1097/ta.0000000000003478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Maggie E Bosley
- From the Atrium Health Wake Forest Baptist, Department of Surgery, 1 Medical Center Blvd, Winston-Salem, North Carolina 27157
| | | | | | | |
Collapse
|
16
|
Abstract
Iatrogenic bile duct injury still represents a serious complication mostly connected with minimally invasive cholecystectomy. This complication has an important impact both on short- and long-term morbidity and is associated with non-negligible mortality. The objective of our study was to provide a comprehensive summary of information based on the most recent guidelines with recommendations for how to prevent a bile duct injury, how to reach an early diagnosis and finally, how to proceed should they occur in order to minimize further damage. We also present ATOM, a new classification of bile duct injuries that provides clear information not only about the extent of anatomical damage, but also about the time and mechanism of its occurrence.
Collapse
|
17
|
Zhang WL, Fang ZP, Shi BY, Chen T, Lv SD, Wang C, Hu P, Zhang FB. Low-pressure pulse flushing choledochoscopy combined with neodymium laser lithotripsy for the treatment of intrahepatic bile duct stones. Hepatobiliary Pancreat Dis Int 2021; 20:383-386. [PMID: 33931315 DOI: 10.1016/j.hbpd.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 04/06/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Wen-Long Zhang
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
| | - Zhe-Ping Fang
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
| | - Bin-Yao Shi
- Department of Hepatobiliary Surgery, Enze Hospital, Wenzhou Medical University, Taizhou 318000, China
| | - Ting Chen
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
| | - Shang-Dong Lv
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
| | - Cheng Wang
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
| | - Peng Hu
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
| | - Fa-Biao Zhang
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China.
| |
Collapse
|
18
|
El Nakeeb A, Sultan A, Ezzat H, Attia M, Abd ElWahab M, Kayed T, Hassanen A, AlMalki A, Alqarni A, Mohammed MM. Impact of referral pattern and timing of repair on surgical outcome after reconstruction of post-cholecystectomy bile duct injury: A multicenter study. Hepatobiliary Pancreat Dis Int 2021; 20:53-60. [PMID: 33268245 DOI: 10.1016/j.hbpd.2020.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 10/09/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Bile duct injury (BDI) after cholecystectomy remains a significant surgical challenge. No guideline exists to guide the timing of repair, while few studies compare early versus late repair BDI. This study aimed to analyze the outcomes in patients undergoing immediate, intermediate, and delayed repair of BDI. METHODS We retrospectively analyzed 412 patients with BDI from March 2015 to January 2020. The patients were divided into three groups based on the time of BDI reconstruction. Group 1 underwent an immediate reconstruction (within the first 72 hours post-cholecystectomy, n = 156); group 2 underwent an intermediate reconstruction (from 4 days to 6 weeks post-cholecystectomy, n = 75), and group 3 underwent delayed reconstruction (after 6 weeks post-cholecystectomy, n = 181). RESULTS Patients in group 2 had significantly more early complications including anastomotic leakage and intra-abdominal collection and late complications including anastomotic stricture and secondary liver cirrhosis compared with groups 1 and 3. Favorable outcome was observed in 111 (71.2%) patients in group 1, 31 (41.3%) patients in group 2, and 157 (86.7%) patients in group 3 (P = 0.0001). Multivariate analysis identified that complete ligation of the bile duct, level E1 BDI and the use of external stent were independent factors of favorable outcome in group 1, the use of external stent was an independent factor of favorable outcome in group 2, and level E4 BDI was an independent factor of unfavorable outcome in group 3. Transected BDI and level E4 BDI were independent factors of unfavorable outcome. CONCLUSIONS Favorable outcomes were more frequently observed in the immediate and delayed reconstruction of post-cholecystectomy BDI. Complete ligation of the bile duct, level E1 BDI and the use of external stent were independent factors of a favorable outcome.
Collapse
Affiliation(s)
- Ayman El Nakeeb
- Gastrointestinal Surgical Center, Mansoura University, Mansoura, Egypt.
| | - Ahmad Sultan
- Gastrointestinal Surgical Center, Mansoura University, Mansoura, Egypt
| | - Helmy Ezzat
- Gastrointestinal Surgical Center, Mansoura University, Mansoura, Egypt
| | - Mohamed Attia
- Gastrointestinal Surgical Center, Mansoura University, Mansoura, Egypt
| | | | | | | | | | | | | |
Collapse
|
19
|
Ohyama K, Furuta S, Shima H, Tuji S, Nagae H, Tanaka K, Obayashi J, Kawaguchi K, Kawaguchi T, Nishiya Y, Kudou K, Kawase K, Wakisaka M, Kitagawa H. Differences in post-operative complications after reconstruction for congenital biliary dilatation in a single institution-Roux-en-Y hepaticojejunostomy versus hepaticoduodenostomy. Pediatr Surg Int 2021; 37:241-245. [PMID: 33483835 DOI: 10.1007/s00383-020-04790-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The standard surgical procedure for congenital biliary dilatation (CBD) consists of excision of extrahepatic bile duct and Roux-en-Y hepaticojejunostomy (HJ). However, alternative reconstructive operations for CBD includes hepaticoduodenostomy (HD). We compared postoperative complications and therapeutic outcomes of these two operations at our institution. METHODS From 1981 to 2009, there were 23 traceable patients who underwent operation for CBD, They were divided into an HJ Group (n = 15) and an HD Group (n = 8). Demographic and outcome data were compared. RESULTS There were no significant differences in postoperative complications (cholangitis, pancreatitis, and anastomotic stenosis) and current blood test data (AST, ALT, Total Bilirubin, Direct Bilirubin, Amylase) between the two groups. Current abdominal pain and carcinogenesis were not observed in either group. Intrahepatic stones occurred in one patient in each group, both > 25 years post-operation. CONCLUSION HD is considered to be an acceptable reconstruction method compared to HJ, based on our results. There has been a suggestion that inadequate diversion in HD might increase the risk of cholangiocarcinoma. To date, in this series, that has not happened.
Collapse
Affiliation(s)
- Kei Ohyama
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Shigeyuki Furuta
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Hideki Shima
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Shiho Tuji
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Hideki Nagae
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kunihide Tanaka
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Juma Obayashi
- Department of Pediatric Surgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital, 1197-1 Yasashicho, Asahi, Yokohama, Kanagawa, 241-0811, Japan
| | - Kouhei Kawaguchi
- Department of Pediatric Surgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital, 1197-1 Yasashicho, Asahi, Yokohama, Kanagawa, 241-0811, Japan
| | - Takuya Kawaguchi
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yuri Nishiya
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kousuke Kudou
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kouichi Kawase
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Munechika Wakisaka
- Department of Pediatric Surgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital, 1197-1 Yasashicho, Asahi, Yokohama, Kanagawa, 241-0811, Japan
| | - Hiroaki Kitagawa
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan.
| |
Collapse
|
20
|
Poley JW, Ponchon T, Puespoek A, Bruno M, Roy A, Peetermans J, Rousseau M, Lépilliez V, Dolak W, Tringali A, Blero D, Carr-Locke D, Costamagna G, Devière J. Fully covered self-expanding metal stents for benign biliary stricture after orthotopic liver transplant: 5-year outcomes. Gastrointest Endosc 2020; 92:1216-1224. [PMID: 32417298 DOI: 10.1016/j.gie.2020.04.078] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/26/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Minimally invasive treatments of anastomotic benign biliary stricture (BBS) after orthotopic liver transplantation (OLT) include endoscopic placement of multiple plastic stents or fully covered self-expandable metal stents (FCSEMSs). No multiyear efficacy data are available on FCSEMS treatment after OLT. METHODS We prospectively studied long-term efficacy and safety of FCSEMS treatment in adults aged ≥18 years with past OLT, cholangiographically confirmed BBS, and an indication for ERCP with stent placement. Stent removal was planned after 4 to 6 months, with subsequent follow-up until 5 years or stricture recurrence. Long-term outcomes were freedom from stricture recurrence, freedom from recurrent stent placement, and stent-related serious adverse events (SAEs). RESULTS In 41 patients, long-term follow-up began after FCSEMS removal (n = 33) or observation of complete distal migration (CDM) (n = 8). On an intention-to-treat basis, the 5-year probability of remaining stent-free after FCSEMS removal or observation of CDM was 48.9% (95% confidence interval [CI], 33.2%-64.7%) among all patients and 60.9% (95% CI, 43.6%-78.2%) among 31 patients with over 4 months of FCSEMS indwell time. In 28 patients with stricture resolution at FCSEMS removal or observed CDM (median, 5.0 months indwell time), the 5-year probability of no stricture recurrence was 72.6% (95% CI, 55.3%-90%). Sixteen patients (39%) had at least 1 related SAE, most commonly cholangitis (n = 10). CONCLUSIONS By 5 years after temporary FCSEMS treatment of post-OLT BBS, approximately half of all patients remained stent-free on an intention-to-treat basis. Stent-related SAEs (especially cholangitis) were common. FCSEMS placement is a viable long-term treatment option for patients with post-OLT BBS. (Clinical trial registration number: NCT01014390.).
Collapse
Affiliation(s)
- Jan-Werner Poley
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Thierry Ponchon
- Service d'Hépato-Gastroentérologie, Hôpital Edouard Herriot, Lyon, France
| | - Andreas Puespoek
- Department of Medicine, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Marco Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - André Roy
- Département de Chirurgie, Hôpital Saint-Luc, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | | | | | - Vincent Lépilliez
- Service d'Hépato-Gastroentérologie, Hôpital Edouard Herriot, Lyon, France
| | - Werner Dolak
- Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Vienna, Austria
| | - Andrea Tringali
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| | - Daniel Blero
- Department of Gastroenterology and Hepato-pancreatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - David Carr-Locke
- The Center for Advanced Digestive Care, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Guido Costamagna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Centre for Endoscopic Research Therapeutics and Training (CERTT), Rome, Italy
| | - Jacques Devière
- Department of Gastroenterology and Hepato-pancreatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
21
|
Cedrón-Cheng H, Chirinos Vega J. [Retrograde cholangiography performed with simple balloon-assisted enteroscopy in patients with altered anatomy by surgery in a private level III clinic]. Rev Gastroenterol Peru 2020; 40:136-141. [PMID: 32876629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To evaluate the usefulness of retrograde cholangiography performed with simple balloon-assisted enteroscopy for the management of bile duct pathology in patients with altered anatomy by surgery at the Anglo American Clinic. MATERIALS AND METHODS This is a retrospective descriptive study where all patients with altered anatomy who came for bile duct problems to undergo a retrograde cholangiography assisted by simple balloon enteroscopy at the Anglo American Clinic during the January period from 2014 to January 2020. RESULTS We performed 10 studies of retrograde cholangiography assisted by simple balloon enteroscopy. Cannulation of the bile duct was successful in 80% of our cases, in two cases the bile duct could not be located. The findings of the retrograde cholangiography were biliary stones in 7 cases, stenosis of the biliodigestive anastomosis in 5 cases, and an ampuloma. The most frequent therapeutic procedures were CRE progressive balloon dilation of the bilioenteric anastomosis and extraction of stones with a Dormia basket. There were no complications associated with the procedure. CONCLUSION Retrograde cholangiography assisted by simple balloon enteroscopy is a safe and effective method to resolve biliary pathology in our patients with altered anatomy.
Collapse
|
22
|
Lindemann J, Jonas E, Kotze U, Krige JEJ. Evolution of bile duct repair in a low and middle-income country (LMIC): a comparison of diagnosis, referral, management and outcomes in repair of bile duct injury after laparoscopic cholecystectomy from 1991 to 2004 and 2005-2017. HPB (Oxford) 2020; 22:391-397. [PMID: 31427062 DOI: 10.1016/j.hpb.2019.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/30/2019] [Accepted: 07/19/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is a paucity of data from the developing world regarding laparoscopic cholecystectomy (LC) bile duct injuries (BDIs), despite the fact that most of the world's population live in a developing country. We assessed how referral patterns, management and outcomes after LC-BDI repair have evolved over time in patients treated at a tertiary referral center in a low and middle-income country (LMIC). METHODS Patients with LC-BDIs requiring hepaticojejunostomy were identified from a prospective database. Clinical characteristics, geographic distance from referral hospital, timing of referral and repair, and post-operative outcomes were compared in two cohorts treated during 1991-2004 and 2005-2017. RESULTS Of 125 patients, 32 underwent repair in the early period, 93 in the latter. There was no difference in demographic or clinical characteristics, but a 45.6% increase in geographically distant referrals in the 2005-2017 period. Time from diagnosis to referral and referral to repair increased significantly (p = 0.031, p < 0.001), necessitating more intermediate repairs. Despite this, the number of severe complications decreased (p = 0.022) while long-term outcomes remained unchanged. CONCLUSION In this study from an LMIC, geographic and logistic constraints necessitated deviation from accepted algorithms devised for well-resourced countries. When appropriately adapted, results comparable to those reported from developed countries are achievable.
Collapse
Affiliation(s)
- Jessica Lindemann
- Department of Surgery, University of Cape Town Health Sciences Faculty, Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa; Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA.
| | - Eduard Jonas
- Department of Surgery, University of Cape Town Health Sciences Faculty, Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Urda Kotze
- Department of Surgery, University of Cape Town Health Sciences Faculty, Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Jake E J Krige
- Department of Surgery, University of Cape Town Health Sciences Faculty, Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
| |
Collapse
|
23
|
Nervo A, Ragni A, Gallo M, Ferraris A, Fonio P, Piovesan A, Arvat E. Symptomatic Biliary Disorders During Lenvatinib Treatment for Thyroid Cancer: An Underestimated Problem. Thyroid 2020; 30:229-236. [PMID: 31854230 DOI: 10.1089/thy.2019.0355] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: The prognosis of several human malignancies has dramatically improved after the introduction of tyrosine kinase inhibitors (TKIs); however, their use has been associated with a large spectrum of adverse events, including symptomatic biliary disorders. In the phase III trial of lenvatinib in radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC) patients, gallbladder (GB) and biliary duct (BD) diseases and complications were reported. We evaluated symptomatic biliary disorders during treatment with lenvatinib in real-life practice to provide a more exhaustive understanding of its toxicity. Methods: We retrospectively evaluated all consecutive patients treated with lenvatinib in our center for progressive RAI-refractory DTC, excluding those who underwent cholecystectomy before the start of therapy. We report all radiologically confirmed symptomatic GB/BD disorders, which were subsequently treated with cholecystectomy, and we describe their management along with relevant biochemical and histological findings. All available GB/BD imaging of patients who developed biliary toxicity during lenvatinib was reviewed by a single experienced radiologist, including computed tomography scans performed for tumor assessment at baseline and during TKI therapy. Results: Five patients (14.7%) developed symptomatic radiologically confirmed biliary disease after a median time of 4.4 months of lenvatinib treatment [interquartile range 3.4-14.4 months] and thus underwent cholecystectomy. A scheduled surgical approach was possible only in two cases; in the remaining patients, presurgical TKI interruption was shorter than one week. After wound healing, treatment was resumed by all subjects. Three patients showed mild biochemical alterations in the two previous monthly follow-up visits. Before the start of treatment, GB/BD abnormalities were radiologically detected only in one case. Conclusions: In our cohort, an unexpectedly high proportion of RAI-refractory DTC patients treated with lenvatinib developed a symptomatic biliary disorder with the need of surgical intervention. Further studies are required to optimize the diagnosis and treatment of patients at higher risk of developing a symptomatic GB/BD disease during assumption of lenvatinib.
Collapse
Affiliation(s)
- Alice Nervo
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Alberto Ragni
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Marco Gallo
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Andrea Ferraris
- Division of Diagnostic Imaging, Department of Surgical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Paolo Fonio
- Division of Diagnostic Imaging, Department of Surgical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Alessandro Piovesan
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Emanuela Arvat
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| |
Collapse
|
24
|
Lu H, Yang H, Wu L, Liao W, He X, Li E, Wu R, Shi S, Yang Z. A novel prognostic model for diagnosing atypical bile duct hyperplasia in patients with intrahepatic lithiasis. Medicine (Baltimore) 2019; 98:e15364. [PMID: 31027122 PMCID: PMC6831388 DOI: 10.1097/md.0000000000015364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 12/18/2022] Open
Abstract
There is no specific method for the preoperative diagnosis of atypical bile duct hyperplasia, which is a precursor of cholangiocarcinoma. This study aimed to create a new model for diagnosing atypical bile duct hyperplasia based on routine laboratory tests in patients with intrahepatic lithiasis.The new diagnostic model was developed with a derivation cohort that included 375 patients with intrahepatic lithiasis. Clinical and pathological data were retrospectively collected. Prognostic factors were evaluated with univariate and logistic regression analyses. The validation cohort included 136 patients who were retrospectively screened to quantify the model's predictive value.Age and Carbohydrate Antigen 19-9 (CA-199) were revealed to be diagnostic indicators of atypical bile duct hyperplasia in patients with intrahepatic lithiasis. The new diagnostic model was created with the formula: -6.612 + (0.002 × CA-199) + (0.072 × Age). The area under the receiver operating curve of the model was 0.721. With 0.25 as the cutoff point, the sensitivity and specificity of this model in the derivation cohort were 13.9% and 95.9%, respectively. In the validation cohort, these values were 28.5% and 88.7%, respectively. The novel model has an acceptable and stable ability to predict atypical hyperplasia in the intrahepatic bile duct.This novel model provides a simple system for diagnosing atypical bile duct hyperplasia before surgery in patients with intrahepatic lithiasis.
Collapse
Affiliation(s)
- Hongcheng Lu
- Second Affiliated Hospital of Nanchang University, Research Center of Hepatobiliary Disease, Nanchang
| | - Hao Yang
- Second Affiliated Hospital of Nanchang University, Research Center of Hepatobiliary Disease, Nanchang
| | - Linquan Wu
- Second Affiliated Hospital of Nanchang University, Research Center of Hepatobiliary Disease, Nanchang
| | - Wenjun Liao
- Second Affiliated Hospital of Nanchang University, Research Center of Hepatobiliary Disease, Nanchang
| | - Xianping He
- Second Affiliated Hospital of Nanchang University, Research Center of Hepatobiliary Disease, Nanchang
| | - Enliang Li
- Second Affiliated Hospital of Nanchang University, Research Center of Hepatobiliary Disease, Nanchang
| | - Rongshou Wu
- The First Affiliated Hospital of Gannan Medical College, General Surgery, Ganzhou
| | - Shidai Shi
- Ji’an People's Hospital, Hepatobiliary Surgery, Jian
| | - Zhilong Yang
- Jingdezhen People's Hospital, General Surgery, Jingdezhen, Jiangxi, China
| |
Collapse
|
25
|
Canbak T, Acar A, Basak F, Ozdil K, Bas G, Unal E. Risk factors for complications after endoscopic retrograde cholangiopancreatography A referral Center experience. Ann Ital Chir 2019; 90:520-523. [PMID: 31541544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM Endoscopic retrograde cholangiopancreatography (ERCP) is an important diagnostic and therapeutic tool in patients with hepato-pancreatobiliary diseases. In the present study, we sought to determine predictors of post-ERCP complications at our institution. METHODS A retrospective analysis of patients who underwent ERCP in between January 2010 and November 2011 was done. Demographics, indications, ERCP findings, success rate, complications and the need of repeat procedure were evaluated with special emphasis on the difficulty in cannulation procedure, the primary etiology of the disease (benign/malign) and age. Chi-square analysis was applied for statistical analysis. The differences were considered statistically significant, if the p value was less than 0.05. RESULTS A total of 112 ERCP was performed in 81 patients. Thirty-eight were male (46.9 %) and 43 were female (53.1%). Mean age was 61.3 (range 17-88), and 31 patients was seventy years and older (38.3 %). Complications were detected in 28 patients (34.6 %). Nine cases with difficult or unsuccessful cannulation (69.2 %) had complications (p=0.001). Patients with benign diseases showed less complications (21/70), in comparison with those with malignancies (7/11) (30 % vs. 63.6 %, respectively; p<0.05). Complication rate in patients 70 years and older was 32.2 % (n=10) compared to 35.3 % in patients younger than 70 (n= 18) (p<0.05). CONCLUSION Risk factors such as difficult or incomplete cannulation and malignancy are considered as possible predisposing factors for complications. Age is an independent factor. KEY WORDS Endoscopic cholangiopancreatography, Risk factors.
Collapse
|
26
|
Abstract
RATIONALE The clinical manifestations of VACTERL association include vertebral anomalies, anal atresia, congenital heart diseases, tracheoesophageal fistula, renal dysplasia, and limb abnormalities. The association of intrahepatic anomalies and VACTERL syndrome is a rare coincidence. VACTER syndrome and intrahepatic bile drainage anomalies might be genetically related. PATIENT CONCERNS A 12-year-old girl presented with episodic colicky abdominal pain, nausea, and vomiting for several years. The individual episodes resolved spontaneously within a few days. She had a history of VACTERL syndrome, including a butterfly shape of the L3 vertebra, anal atresia, and an atrial septal defect. DIAGNOSES On laboratory findings, abnormal liver function tests included elevated total bilirubin, alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyltransferase. There was no significant abnormal finding in hepatobiliary system sonography except mild gallbladder wall thickening. We performed magnetic resonance cholangiopancreatography and demonstrated an abnormal intrahepatic bile duct confluence, which showed 3 bile ducts draining directly into the neck of the gallbladder. INTERVENTION Her symptoms related to bile reflux during gallbladder contraction. Cholecystectomy with choledochojejunostomy was undertaken because segments of the bile drainage were intertwined. OUTCOMES After surgery, her symptoms decreased, but abdominal discomfort remained due to uncorrected left intrahepatic anomalies. LESSONS Although hepatobiliary anomalies are not included in VACTERL association diagnostic criteria, detailed hepatobiliary work up is needed when gastrointestinal symptoms are present in VACTERL association patients.
Collapse
Affiliation(s)
| | | | - Suk Keu Yeom
- Department of Radiology, College of Medicine, Korea University, Seoul
- Department of Radiology
| | - JeeHyun Lee
- Department of Pediatrics
- Department of Pediatrics, Korea University Medical Center Ansan Hospital, Korea
| | | |
Collapse
|
27
|
Abstract
BACKGROUND Endoscopic placement of multiple plastic stents (MPS) has been the first-line treatment for benign biliary stricture (BBS). Covered self-expanding metal stents (cSEMS) have been used in treatment of BBS; however, the efficacy has not been verified. Therefore, we conducted this meta-analysis according to PRISMA guidelines. METHODS PubMed, Embase, and the Cochrane Library were electronically and manually searched for studies published between January 1, 1990 and April 12, 2017. Of 153 studies screened, 90 were excluded because of duplications. After scanning the title or abstract, only 24 studies were eligible for review and 6 were finally included. The investigators selected publications according to inclusion and exclusion criteria, processed the data, and assessed the quality of the selected studies. The primary endpoint outcome was stricture resolution, and the secondary endpoint outcomes included stricture recurrence rate, the number of endoscopic retrograde cholangiopancreatography (ERCP) sessions, and stent migration. RESULTS A total of 6 randomized controlled trials with 330 participants were included in the current meta-analysis. There was no significant difference in stricture resolution between the cSEMS and MPS groups (odds ratio [OR] = 1.05, 95% confidence interval [CI] = 0.53-2.07, I = 29%, P = .23, Z = 0.13, P = .90). Similarly, the stricture recurrence rates (OR = 1.39, 95% CI = 0.69-2.81, I = 38%, P = .17, Z = 0.91, P = .36) were comparable between cSEMS and MPS groups. Stent migration rates (OR = 1.71, 95% CI = 0.84-3.50, I = 4%, P = .241, Z = 1.47, P = .14) were similar between cSEMS and MPS groups. There were fewer ERCP sessions in the cSEMS group than in the MPS group. CONCLUSIONS This meta-analysis showed that cSEMS were comparable to MPS in achieving resolution of BBSs with fewer ERCP procedures.
Collapse
Affiliation(s)
- Xinjing Zhang
- School of Clinical Medicine
- Department of Hepatopancreatobiliary Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping, Beijing, China
| | - Xuedong Wang
- School of Clinical Medicine
- Department of Hepatopancreatobiliary Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping, Beijing, China
| | - Liang Wang
- School of Clinical Medicine
- Department of Hepatopancreatobiliary Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping, Beijing, China
| | - Rui Tang
- School of Clinical Medicine
- Department of Hepatopancreatobiliary Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping, Beijing, China
| | - Jiahong Dong
- School of Clinical Medicine
- Department of Hepatopancreatobiliary Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping, Beijing, China
| |
Collapse
|
28
|
Barrett M, Asbun HJ, Chien HL, Brunt LM, Telem DA. Bile duct injury and morbidity following cholecystectomy: a need for improvement. Surg Endosc 2018; 32:1683-1688. [PMID: 28916877 DOI: 10.1007/s00464-017-5847-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 08/22/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bile duct injury (BDI) remains the most dreaded complication following cholecystectomy with serious repercussions for the surgeon, patient and entire healthcare system. In the absence of registries, the true incidence of BDI in the United States remains unknown. We aim to identify the incidence of BDI requiring operative intervention and overall complications after cholecystectomy. METHODS Utilizing the Truven Marketscan® research database, 554,806 patients who underwent cholecystectomy in calendar years 2011-2014 were identified using ICD-9 procedure and diagnosis codes. The final study population consisted of 319,184 patients with at least 1 year of continuous enrollment and who met inclusion criteria. Patients were tracked for BDI and other complications. Hospital cost information was obtained from 2015 Premier data. RESULTS Of the 319,184 patients who were included in the study, there were a total of 741 (0.23%) BDI identified requiring operative intervention. The majority of injuries were identified at the time of the index procedure (n = 533, 72.9%), with 102 (13.8%) identified within 30-days of surgery and the remainder (n = 106, 14.3%) between 31 and 365 days. The operative cumulative complication rate within 30 days of surgery was 9.84%. The most common complications occurring at the index procedure were intestinal disorders (1.2%), infectious (1%), and shock (0.8%). The most common complications identified within 30-days of surgery included infection (1.5%), intestinal disorders (0.7%) and systemic inflammatory response syndrome (SIRS) (0.7%) for cumulative rates of infection, intestinal disorders, shock, and SIRS of 2.0, 1.9, 1.0, and 0.8%, respectively. CONCLUSION BDI rate requiring operative intervention have plateaued and remains at 0.23% despite increased experience with laparoscopy. Moreover, cholecystectomy is associated with a 9.84% 30-day morbidity rate. A clear opportunity is identified to improve the quality and safety of this operation. Continued attention to educational programs and techniques aimed at reducing patient harm and improving surgeon skill are imperative.
Collapse
Affiliation(s)
- Meredith Barrett
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
| | | | - Hung-Lung Chien
- Minimally Invasive Therapy Group, Medtronic, Minneapolis, MA, USA
| | - L Michael Brunt
- Department of Surgery, Washington University, Saint Louis, MO, USA
| | - Dana A Telem
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
29
|
Abstract
Comparative studies and large-scale case series that confirm the advantages of laparoscopy in children with hepatobiliary diseases are scarce, and the use of laparoscopy remains a matter of debate. This article reviews the current literature on the role of laparoscopic and robotic surgery in pediatric patients with choledochal cyst, biliary atresia, gallbladder diseases, and hepatobiliary malignancies. Studies were identified through a search of the MEDLINE database. Laparoscopy may be beneficial for resection of choledochal cyst and cholecystectomy. However, more data are required before recommendations on the use of minimally invasive techniques for other hepatobiliary conditions can be published.
Collapse
Affiliation(s)
- Omid Madadi-Sanjani
- Centre of Pediatric Surgery Hannover, Hannover Medical School, Carl-Neuberg-Street 1, Hannover 30625, Germany.
| | - Claus Petersen
- Centre of Pediatric Surgery Hannover, Hannover Medical School, Carl-Neuberg-Street 1, Hannover 30625, Germany
| | - Benno Ure
- Centre of Pediatric Surgery Hannover, Hannover Medical School, Carl-Neuberg-Street 1, Hannover 30625, Germany
| |
Collapse
|
30
|
Abstract
RATIONALE Abdominal pain is one of the most common complaints for patients in emergency department. It's difficult to make an accurate diagnosis by emergency physician in time, especially in patients with situs inversus totalis. PATIENT CONCERNS A patient with acute exacerbation of chronic left upper quadrant abdominal pain.DIAGNOSES:: cholangiolithiasis with situs inversus totalis. INTERVENTIONS laparoscopic cholecystectomy and laparoscopic exploration of common bile duct. OUTCOMES The patient had an uneventful recovery. LESSONS High suspicion and adequate evaluation are important for diagnosis in patients with abdominal pain and situs inversus totalis in emergency department, and physical examination, electrocardiogrphy and radiological investigations are necessary.
Collapse
Affiliation(s)
- Ying Liu
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu
- Department of Emergency Medicine
| | - Lile Wu
- Department of Hepatobiliary Surgery, Affiliated Hospital of Southwest Medical University
| | - Yanhong Chen
- Department of Gastroenterology, Luzhou People's Hospital
| | - Dongze Li
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu
| | - Jun Jiang
- Department of Vascular Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Wu Zhong
- Department of Emergency Medicine
| | - Yu Cao
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu
| |
Collapse
|
31
|
Ng JJ, Kow AWC. Pedicled omental patch as a bridging procedure for iatrogenic bile duct injury. World J Gastroenterol 2017; 23:6741-6746. [PMID: 29085219 PMCID: PMC5643295 DOI: 10.3748/wjg.v23.i36.6741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/22/2017] [Accepted: 08/25/2017] [Indexed: 02/06/2023] Open
Abstract
Iatrogenic bile duct injuries during cholecystectomy can present as fulminant intra-abdominal sepsis which precludes immediate repair or biliary reconstruction. We report the case of a 29-year-old female patient who sustained a bile duct injury after an open cholecystectomy in a neighboring country. She presented to our institution 22 d after initial surgery with septic shock and multiple intra-abdominal collections. Endoscopic retrograde cholangiography revealed a large common hepatic duct defect corresponding to a Strasberg type D bile duct injury. Definitive reconstruction such as a hepaticojejunostomy cannot be performed due to the presence of dense adhesions with infected and friable tissues. She underwent a combination of endoscopic biliary stenting and pedicled omental patch repair of the bile duct to control bile leak and sepsis as a bridging procedure to definite hepaticojejunostomy three months later.
Collapse
Affiliation(s)
- Jun Jie Ng
- Department of Surgery, National University Hospital, Singapore 119074, Singapore
| | - Alfred Wei Chieh Kow
- Department of Surgery, National University Hospital, Singapore 119074, Singapore
| |
Collapse
|
32
|
Imanishi M, Ogura T, Kurisu Y, Onda S, Takagi W, Okuda A, Miyano A, Amano M, Nishioka N, Masuda D, Higuchi K. A feasibility study of digital single-operator cholangioscopy for diagnostic and therapeutic procedure (with videos). Medicine (Baltimore) 2017; 96:e6619. [PMID: 28403110 PMCID: PMC5403107 DOI: 10.1097/md.0000000000006619] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Recently, the novel SpyGlass DS Direct Visualization system (SPY DS) has become available. This system offers several advantages over the conventional SPYGlass system. This study evaluated the clinical feasibility and efficacy of diagnostic and therapeutic procedures for biliary disorder using SPY DS.In this retrospective study, consecutive patients who had biliary disorder were enrolled between November 2015 and February 2016. All patients could not be diagnosed or treated by standard endoscopic retrograde cholangiopancreatography in our hospital or at another hospital.A total of 28 consecutive patients (21 men and 7 women; median age, 73 years; age range, 55-87 years) were retrospectively enrolled in this study. Among them, diagnostic procedure was performed in 20 patients, and 8 patients underwent therapeutic procedures. The technical success rate for diagnostic procedures was 100% (20/20). Diagnostic accuracy was 100% (19/19). The technical success rate for therapeutic procedures was 88% (7/8). Among these 8 patients, 4 patients with common bile duct stones underwent electrohydraulic lithotripsy. One patient successfully underwent guidewire insertion to remove a migrated plastic stent. The 3 remaining patients underwent SPY DS to insert a guidewire for left bile duct obstruction and for posterior bile duct branch. In the patient who underwent guidewire insertion for left hepatic bile duct obstruction cause by primary sclerosing cholangitis, we could not advance the guidewire into the left hepatic bile duct. No adverse events were seen. Median SPY DS insertion time was 21 min (range, 8-32 min).Single-operator cholangioscopy using SPY DS was feasible and had a marked clinical impact in patients with biliary disease. Additional case reports and prospective studies are needed to examine further applications of this system.
Collapse
Affiliation(s)
- Miyuki Imanishi
- Second Department of Internal Medicine, Osaka Medical College
| | - Takeshi Ogura
- Second Department of Internal Medicine, Osaka Medical College
| | | | - Saori Onda
- Second Department of Internal Medicine, Osaka Medical College
| | - Wataru Takagi
- Second Department of Internal Medicine, Osaka Medical College
| | - Atsushi Okuda
- Second Department of Internal Medicine, Osaka Medical College
| | - Akira Miyano
- Second Department of Internal Medicine, Osaka Medical College
| | - Mio Amano
- Second Department of Internal Medicine, Osaka Medical College
| | - Nobu Nishioka
- Second Department of Internal Medicine, Osaka Medical College
| | - Daisuke Masuda
- Second Department of Internal Medicine, Osaka Medical College
| | | |
Collapse
|
33
|
Uylas U, Tolan HK, Ince V, Kayaalp C, Yilmaz S. Living Donor Liver Transplantation for Hepatocellular Carcinoma with Bile Duct Tumor Thrombi. J Gastrointest Cancer 2017; 49:510-512. [PMID: 28353162 DOI: 10.1007/s12029-017-9935-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ufuk Uylas
- Liver Transplantation Institute, Department of Surgery, Inonu University, 44315, Malatya, Turkey
| | - Huseyin Kerem Tolan
- Liver Transplantation Institute, Department of Surgery, Inonu University, 44315, Malatya, Turkey
| | - Volkan Ince
- Liver Transplantation Institute, Department of Surgery, Inonu University, 44315, Malatya, Turkey
| | - Cuneyt Kayaalp
- Liver Transplantation Institute, Department of Surgery, Inonu University, 44315, Malatya, Turkey.
| | - Sezai Yilmaz
- Liver Transplantation Institute, Department of Surgery, Inonu University, 44315, Malatya, Turkey
| |
Collapse
|
34
|
Cai M, Cheng J, Li W, Shuai X, Gao J, Cai K, Wang J, Bai J, Rog C, Wang G, Tao K. Combination of laparoscope and choledochoscope to treat biliary ascariasis: A CARE-compliant case report. Medicine (Baltimore) 2017; 96:e6291. [PMID: 28353561 PMCID: PMC5380245 DOI: 10.1097/md.0000000000006291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Ascariasis is an endemic parasitic disease caused by Ascaris lumbricoides, which severely burdens the healthcare system as well as harms the personal life quality, especially among less developed regions. Biliary ascariasis is a critical complication of intestinal ascariasis with painful and life-threatening manifestations. The exploration of proper strategies as its medical interventions remains largely controversial. PATIENT CONCERNS A 16 year-old patient complained of abdominal pain and yellow sclera. DIAGNOSES Biliary ascariasis INTERVENTIONS:: Laparoscopic cholecystectomy and bile duct exploration. OUTCOMES More than one hundred ascarids were extracted and the patient had been discharged from hospital without any complications. LESSONS The combination of laparoscope and choledochoscope is an efficient method to treat biliary ascariasis, despite of large worm burden in the common bile duct.
Collapse
Affiliation(s)
- Ming Cai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ji Cheng
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Li
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoming Shuai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinbo Gao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kailin Cai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiliang Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Bai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Colin Rog
- Baylor College of Medicine, Huston, TX
| | - Guobin Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaixiong Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
35
|
Łubowska-Pająk E, Kołomecki K. Assessment of Pharmacological Prophylaxis for Acute Pancreatitis Following ERCP in Patients with Choledoholithiasis. Pol Przegl Chir 2017; 87:620-5. [PMID: 26963056 DOI: 10.1515/pjs-2016-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Indexed: 11/15/2022]
Abstract
UNLABELLED Endoscopic retrograde cholangiopancreatography (ERCP) is an effective tool in the diagnostics and treatment of bile duct diseases. Although minimally invasive, the procedure is associated with a risk of complications, with acute pancreatitis being the most serious. In recent years, high hopes have been placed on pharmacological prevention of acute pancreatitis after ERCP. The aim of the study was assessment of the efficacy of low-molecular-weight heparin and somatostatin in combination with diclofenac in the prevention of acute pancreatitis after ERCP. MATERIAL AND METHODS The study enrolled three groups of 30 patients diagnosed with cholelithiasis; group I: patients who received low-molecular-weight heparin prior to ERCP, group II: patients who received somatostatin and diclofenac, group III: control group. The study assessed the incidence of acute pancreatitis, hyperamylasemia and increased CRP levels. RESULTS Acute pancreatitis was observed in 13.3% of group I patients, 10% of group II patients and 16.7% of group III patients (no statistical significance). Hyperamylasemia was observed in 16.7% of group I patients, 16.7% of group II patients and 43.3% of group III patients. These differences were statistically significant. No significant differences were found in the occurrence of increased CRP levels among the study groups. CONCLUSIONS No significant reduction in the occurrence of acute pancreatitis after ERCP was observed in patients who received pharmacological prophylaxis. A significant reduction in the occurrence of hyperamylasemia was found in drug-treated patients.
Collapse
|
36
|
Iida H, Matsui Y, Kaibori M, Matsui K, Ishizaki M, Hamada H, Kon M. Single-Center Experience with Subvesical Bile Ducts (Ducts of Luschka). Am Surg 2017; 83:e43-e45. [PMID: 28228189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
|
37
|
Mansor SM, Abdalla SI, Bendardaf RS. Laparoscopy assisted transjejunal endoscopic retrograde cholangiography for treatment of intrahepatic duct stones in a post Roux-en-Y patient. Saudi Med J 2016; 36:104-7. [PMID: 25630013 PMCID: PMC4362179 DOI: 10.15537/smj.2015.1.10404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a case of a 17-year-old female patient, who was operated on for choledocal cyst with Roux-en Y hepatojejunostomy. She was admitted to hospital with recurrent attacks of acute ascending cholangitis due to left intrahepatic duct stones. After a failed attempt at conventional endoscopic retrograde cholangiopancreatography through the anatomical route, she was treated successfully with laparoscopy assisted transjejunal endoscopic retrograde cholangiography.
Collapse
Affiliation(s)
- Salah M Mansor
- Department of General Surgery, Al-Jalla University Hospital, Benghazi University, Benghazi, Libya. E-mail.
| | | | | |
Collapse
|
38
|
Verweij KE, van Buuren H. Oriental cholangiohepatitis (recurrent pyogenic cholangitis): a case series from the Netherlands and brief review of the literature. Neth J Med 2016; 74:401-405. [PMID: 27905307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Oriental cholangiohepatitis is a condition occurring in the Asian population, characterised by recurrent bacterial cholangitis and presence of calculi within the intrahepatic bile ducts, biliary strictures and an increased risk for cholangiocarcinoma. It is an uncommon disease in the West that may not always be considered. The therapeutic approach is multidisciplinary and highly individual, and includes antibiotic therapy, endoscopic and percutaneous biliary drainage with stone removal and dilation of strictures, and in selected cases surgical resection of affected liver segments. We report our experience with five relatively young adult patients largely originating from China, who presented with pyogenic cholangitis and were considered to suffer from oriental cholangiohepatitis. To our knowledge this is the first report of this condition in the Netherlands. Physicians treating patients with pyogenic cholangitis should be aware of this disease and consider the diagnosis in all Asian immigrants with biliary tract disease.
Collapse
Affiliation(s)
- K E Verweij
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands
| | | |
Collapse
|
39
|
Navaneethan U, Hasan MK, Kommaraju K, Zhu X, Hebert-Magee S, Hawes RH, Vargo JJ, Varadarajulu S, Parsi MA. Digital, single-operator cholangiopancreatoscopy in the diagnosis and management of pancreatobiliary disorders: a multicenter clinical experience (with video). Gastrointest Endosc 2016; 84:649-55. [PMID: 26995690 DOI: 10.1016/j.gie.2016.03.789] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 03/04/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Digital cholangioscopes provide higher-resolution imaging of the pancreatobiliary tract compared with fiberoptic instruments. The role of a new, digital, single-operator cholangiopancreatoscopy (SOC) system for diagnosis and treatment of pancreatobiliary disorders in clinical practice is not known. METHODS We performed a multicenter, observational study of 105 consecutive patients with suspected pancreatobiliary disorders. The main outcome measures were (1) sensitivity and specificity of SOC visual appearance and biopsies in the diagnosis of indeterminate biliary strictures and (2) achieving complete duct clearance in patients with biliary or pancreatic duct stones. RESULTS A total of 98 cholangioscopy and 7 pancreatoscopy procedures were performed in 105 patients. Superior views of the ductal lumen and mucosa were obtained in all 44 patients with indeterminate biliary strictures. Among the 44 patients who underwent SOC-guided biopsies, the specimen was adequate for histologic evaluation in 43 patients (97.7%). The sensitivity and specificity of SOC visual impression for diagnosis of malignancy was 90% (95% confidence interval [CI], 69.9%-97.2%) and 95.8% (95% CI, 79.8%-99.3%), respectively. The sensitivity and specificity of SOC-guided biopsies for diagnosis of malignancy was 85% (95% CI, 64.0%-94.8%) and 100% (95% CI, 86.2%-100%). In patients with biliary or pancreatic duct stones (N = 36), complete duct clearance with stone removal in 1 session was accomplished in 86.1% of patients (31/36). Three patients (2.9%) experienced SOC-related adverse events that included cholangitis in 2 patients and postprocedure pancreatitis in 1 patient. CONCLUSIONS SOC has become an integral part of the ERCP armamentarium and has high accuracy in the evaluation of indeterminate biliary strictures. Complete stone clearance was achieved in all but 1 patient with challenging biliary or pancreatic duct stones. ( CLINICAL TRIAL REGISTRATION NUMBER NCT01815619.).
Collapse
Affiliation(s)
| | | | | | - Xiang Zhu
- Center for Interventional Endoscopy, Orlando, Florida, USA
| | | | - Robert H Hawes
- Center for Interventional Endoscopy, Orlando, Florida, USA
| | - John J Vargo
- Center for Endoscopy and Pancreatobiliary Disorders, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Mansour A Parsi
- Center for Endoscopy and Pancreatobiliary Disorders, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
40
|
Alli VV, Yang J, Xu J, Bates AT, Pryor AD, Talamini MA, Telem DA. Nineteen-year trends in incidence and indications for laparoscopic cholecystectomy: the NY State experience. Surg Endosc 2016; 31:1651-1658. [PMID: 27604366 DOI: 10.1007/s00464-016-5154-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 07/25/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Since the introduction of laparoscopic cholecystectomy (LC), there has been continued evolution in technique, instrumentation and postoperative management. With increased experience, LC has migrated to the outpatient setting. We asked whether increased availability and experience has impacted incidence of and indications for LC. METHODS The New York (NY) State Planning and Research Cooperative System longitudinal administrative database was utilized to identify patients who underwent cholecystectomy between 1995 and 2013. ICD-9 and CPT procedure codes were extracted corresponding to laparoscopic and open cholecystectomy and the associated primary diagnostic codes. Data were analyzed as relative change in incidence (normalized to 1000 LC patients) for respective diagnoses. RESULTS From 1995 to 2013, 711,406 cholecystectomies were performed in NY State: 637,308 (89.58 %) laparoscopic. The overall frequency of cholecystectomy did not increase (1.23 % increase with a commensurate population increase of 6.32 %). Indications for LC during this time were: 72.81 % for calculous cholecystitis (n = 464,032), 4.88 % for biliary colic (n = 31,124), 8.98 % for acalculous cholecystitis (n = 57,205), 3.01 % for gallstone pancreatitis (n = 19,193), and 1.59 % for biliary dyskinesia (n = 10,110). The incidence of calculous cholecystitis declined (-20.09 %, p < 0.0001) between 1995 and 2013; meanwhile, other diagnoses increased in incidence: biliary colic (+54.96 %, p = 0.0013), acalculous cholecystitis (+94.24 %, p < 0.0001), gallstone pancreatitis (+107.48 %, p < 0.0001), and biliary dyskinesia (+331.74 %, p < 0.0001). Outpatient LC incidence catapulted to 48.59 % in 2013, from 0.15 % in 1995, increasing >320-fold. Analysis of LC through 2014 revealed increasing rates of digestive, infectious, respiratory, and renal complications, with overall cholecystectomy complication rates of 9.29 %. CONCLUSION A shifting distribution of operative indications and increasing rates of complications should prompt careful consideration prior to surgery for benign biliary disease. For what is a common procedure, LC carries substantial risk of complications, thus requiring the patient to be an active participant and to share in the decision-making process.
Collapse
Affiliation(s)
- Vamsi V Alli
- Division of Minimally Invasive Surgery, Penn State Hershey Medical Center, 500 University Drive (H149), Hershey, PA, 17033, USA.
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook Medicine, Stony Brook, NY, USA
| | - Jianjin Xu
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
| | - Andrew T Bates
- Department of Surgery, Health Sciences Center T19-053, Stony Brook Medicine, 100 Nicolls Rd, Stony Brook, NY, 11794-8191, USA
| | - Aurora D Pryor
- Department of Surgery, Health Sciences Center T19-053, Stony Brook Medicine, 100 Nicolls Rd, Stony Brook, NY, 11794-8191, USA
| | - Mark A Talamini
- Department of Surgery, Health Sciences Center T19-053, Stony Brook Medicine, 100 Nicolls Rd, Stony Brook, NY, 11794-8191, USA
| | - Dana A Telem
- Department of Surgery, University of Michigan Health Systems, 1500 E. Medical Center Drive, Ann Arbor, 48109-5343, MI, USA
| |
Collapse
|
41
|
García-Cano J, Ferri-Bataller R, Gómez-Ruiz CJ. Common bile duct perforation sealed with a metal fully-covered stent. Rev Esp Enferm Dig 2016; 108:495-496. [PMID: 27554382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A common bile duct perforation due to sphincteroplasty is reported. It was managed by temporary insertion of a metal fully covered stent with good outcomes. Images from the procedure are provided.
Collapse
|
42
|
Song ME, Chung MJ, Lee DJ, Oh TG, Park JY, Bang S, Park SW, Song SY, Chung JB. Cholecystectomy for Prevention of Recurrence after Endoscopic Clearance of Bile Duct Stones in Korea. Yonsei Med J 2016; 57:132-7. [PMID: 26632393 PMCID: PMC4696944 DOI: 10.3349/ymj.2016.57.1.132] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 01/22/2015] [Accepted: 02/12/2015] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Cholecystectomy in patients with an intact gallbladder after endoscopic removal of stones from the common bile duct (CBD) remains controversial. We conducted a case-control study to determine the risk of recurrent CBD stones and the benefit of cholecystectomy for prevention of recurrence after endoscopic removal of stones from the CBD in Korean patients. MATERIALS AND METHODS A total of 317 patients who underwent endoscopic CBD stone extraction between 2006 and 2012 were included. Possible risk factors for the recurrence of CBD stones including previous cholecystectomy history, bile duct diameter, stone size, number of stones, stone composition, and the presence of a periampullary diverticulum were analyzed. RESULTS The mean duration of follow-up after CBD stone extraction was 25.4±22.0 months. A CBD diameter of 15 mm or larger [odds ratio (OR), 1.930; 95% confidence interval (CI), 1.098 to 3.391; p=0.022] and the presence of a periampullary diverticulum (OR, 1.859; 95% CI, 1.014 to 3.408; p=0.045) were independent predictive factors for CBD stone recurrence. Seventeen patients (26.6%) in the recurrence group underwent elective cholecystectomy soon after endoscopic extraction of CBD stones, compared to 88 (34.8%) in the non-recurrence group; the difference was not statistically significant (p=0.212). CONCLUSION A CBD diameter of 15 mm or larger and the presence of a periampullary diverticulum were found to be potential predictive factors for recurrence after endoscopic extraction of CBD stones. Elective cholecystectomy after clearance of CBD stones did not reduce the incidence of recurrent CBD stones in Korean patients.
Collapse
Affiliation(s)
- Myung Eun Song
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Moon Jae Chung
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
| | - Dong Jun Lee
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Tak Geun Oh
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Youp Park
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seungmin Bang
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Woo Park
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Si Young Song
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Bock Chung
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
43
|
Vuong B, Tejirian T, Chen GL, Collins JC. Cracking the Code: The Unexpected Challenge of Identifying Major Bile Duct Injuries. Am Surg 2015; 81:1088-1092. [PMID: 26463314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The reported rate of major bile duct injury (BDI) after cholecystectomy is 0.2 to 0.5 per cent. We evaluated the accuracy of coding major BDIs integrating both Current Procedural Terminology (CPT) and ICD-9 coding. A retrospective review was conducted for more than 3.5 million members of a large managed health-care organization from January 2007 to December 2013. A total of 56,194 cholecystectomies were captured over this 6-year period. Major BDIs were defined as unintended transection of a major bile duct, Bismuth-Strasberg classification E1-E5, and requiring biliary reconstruction within one year of cholecystectomy. Based on two published study methods (CPT 47760, 47765, 47780 and ICD-9 code 998.2), 173 possible BDIs were identified. Only 13 (7.5%) were confirmed to have a major BDI. The remaining 160 cases were minor complications or were unrelated to cholecystectomy. This reflects an overall BDI rate of 0.02 per cent, an order of magnitude less than commonly published rates. There is a lack of consistent methodology to identify major bile duct injuries. This calls into question the accuracy of published rates. We suspect that some major injuries were not captured. We recommend a universal clinical registry and specific ICD codes to accurately identify this serious complication.
Collapse
Affiliation(s)
- Brooke Vuong
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | | | | | | |
Collapse
|
44
|
Eskander MF, Bliss LA, Yousafzai OK, de Geus SWL, Ng SC, Callery MP, Kent TS, Moser AJ, Khwaja K, Tseng JF. A nationwide assessment of outcomes after bile duct reconstruction. HPB (Oxford) 2015; 17:753-62. [PMID: 26096061 PMCID: PMC4557648 DOI: 10.1111/hpb.12436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/01/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bile duct reconstruction (BDR) is used to manage benign and malignant neoplasms, congenital anomalies, bile duct injuries and other non-malignant diseases. BDR outcomes overall, by year, and by indication were compared. METHODS Retrospective analysis of Nationwide Inpatient Sample discharges (2004-2011) including ICD-9 codes for BDR. All statistical testing was performed using survey weighting. Univariate analysis of admission characteristics by chi square testing. Multivariate modelling for inpatient complications and inpatient death by logistic regression. RESULTS Identified 67 160 weighted patient admissions: 2.5% congenital anomaly, 37.4% malignant neoplasm, 2.3% benign neoplasm, 9.9% biliary injury, 47.9% other non-malignant disease. Most BDRs were performed in teaching hospitals (69.6%) but only 25% at centres with a BDR volume more than 35/year. 32.3% involved ≥ 1 complication, and 84.7% were discharges home. There was a 4.2% inpatient death rate. The complication rate increased but the inpatient death rate decreased over time. The rates of acute renal failure increased. Significant multivariate predictors of inpatient death include indication of biliary injury or malignancy, and predictors of any complication include public insurance and non-elective admission. CONCLUSION This is the first national description of BDRs using a large database. In this diverse sampling, both procedure indication and patient characteristics influence morbidity and mortality.
Collapse
Affiliation(s)
- Mariam F Eskander
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Lindsay A Bliss
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Osman K Yousafzai
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Susanna W L de Geus
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sing Chau Ng
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mark P Callery
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tara S Kent
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - A James Moser
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Khalid Khwaja
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jennifer F Tseng
- Surgical Outcomes Analysis & Research, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
45
|
Benjaminov F, Barkay O, Konikoff FM. [BILE DUCT PROBLEMS - ENDOSCOPIC SOLUTIONS]. Harefuah 2015; 154:525-539. [PMID: 26480620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Patients with symptomatic bile duct stones are at increased risk for complications, which can be life-threatening. In the last four decades, with the development of endoscopic retrograde cholangiopancreatography (ERCP) and biliary sphincterotomy, endoscopic treatment has almost totally replaced surgical treatment of bile duct stones. In addition, a variety of benign and malignant conditions such as iatrogenic strictures (post cholecystectomy/post liver transplant), PSC, papillary adenoma or malignant tumors of bile duct or pancreas, are now amenable to endoscopic treatment. In the early years, ERCP served as a diagnostic and therapeutic tool With the development of non-invasive imaging alternatives, ERCP became a purely therapeutic procedure. However, in recent years, advanced technologies have restored diagnostic abilities to FRCP.
Collapse
|
46
|
Wallace DR, Ballard DH, Vea R, Zibari GB, Shokouh-Amiri HM, D'Agostino HB. Torsed hepaticoileostomy-an unusual complication of Bile Duct injury repair. Clin Imaging 2015; 39:692-4. [PMID: 25676260 DOI: 10.1016/j.clinimag.2014.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 12/10/2014] [Accepted: 12/15/2014] [Indexed: 11/30/2022]
Abstract
We present a 42-year-old male with strictured bilioenteric anastomosis after bile duct injury repair. The patient improved after percutaneous biliary drainage and balloon dilation of the stricture. Persistent bile reflux around the catheter insertion site prompted a cholangiogram that suggested an error in the enteric limb. Surgical exploration revealed that a torsed ileal loop was used for bilioenteric anastomosis. This error was repaired surgically. The patient had immediate and long-term resolution of symptoms.
Collapse
Affiliation(s)
- David R Wallace
- Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, Louisiana, 71130
| | - David H Ballard
- School of Medicine, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, Louisiana, 71130
| | - Romulo Vea
- Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, Louisiana, 71130
| | - Gazi B Zibari
- John C. McDonald Regional Transplant Center, Willis Knighton Health System, Shreveport, LA
| | - Hosein M Shokouh-Amiri
- John C. McDonald Regional Transplant Center, Willis Knighton Health System, Shreveport, LA
| | - Horacio B D'Agostino
- Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Highway, Shreveport, Louisiana, 71130.
| |
Collapse
|
47
|
Alpendre C, Judd S, Mostafa G, Anees M. Endoscopic clipping of iatrogenic duodenal perforation. Am Surg 2014; 80:E276-E277. [PMID: 25347476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Cristiano Alpendre
- Department of Surgery, Wayne State University, Detroit Medical Center, John D. Dingell VA Hospital, Detroit, Michigan, USA
| | | | | | | |
Collapse
|
48
|
Atkinson JJ, Davenport M. Controversies in choledochal malformation. S Afr Med J 2014; 104:816-819. [PMID: 26038796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Choledochal malformations (some of which are choledochal cysts) may be characterised as an abnormal dilatation of the biliary tract in the absence of acute obstruction. Most appear to be of congenital origin, probably related to distal bile duct stenosis, and almost 15% can now be detected antenatally. Excision and biliary reconstruction using a Roux loop as an open operation is still the standard to compare against, although laparoscopic reconstruction is increasingly reported. This article discusses recent advances in the understanding of choledochal malformation aetiology and classification, together with the role of newer modalites of surgical treatment such as laparoscopic excision and biliary reconstruction. Although these are definitely feasible, care should be taken before dispensing with standard open techniques that have minimal complications and proven long-term benefit.
Collapse
|
49
|
Verbeek FPR, Schaafsma BE, Tummers QRJG, van der Vorst JR, van der Made WJ, Baeten CIM, Bonsing BA, Frangioni JV, van de Velde CJH, Vahrmeijer AL, Swijnenburg RJ. Optimization of near-infrared fluorescence cholangiography for open and laparoscopic surgery. Surg Endosc 2014; 28:1076-82. [PMID: 24232054 DOI: 10.1007/s00464-013-3305-9] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 08/23/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND During laparoscopic cholecystectomy, common bile duct (CBD) injury is a rare but severe complication. To reduce the risk of injury, near-infrared (NIR) fluorescent cholangiography using indocyanine green (ICG) has recently been introduced as a novel method of visualizing the biliary system during surgery. To date, several studies have shown feasibility of this technique; however, liver background fluorescence remains a major problem during fluorescent cholangiography. The aim of the current study was to optimize ICG dose and timing for NIR cholangiography using a quantitative intraoperative camera system during open hepatopancreatobiliary (HPB) surgery. Subsequently, these results were validated during laparoscopic cholecystectomy using a laparoscopic fluorescence imaging system. METHODS Twenty-seven patients who underwent NIR imaging using the Mini-FLARE image-guided surgery system during open HPB surgery were analyzed to assess optimal dosage and timing of ICG administration. ICG was intravenously injected preoperatively at doses of 5, 10, and 20 mg, and imaged at either 30 min (early) or 24 h (delayed) post-injection. Next, the optimal doses found for early and delayed imaging were applied to two groups of seven patients (n = 14) undergoing laparoscopic NIR fluorescent cholangiography during laparoscopic cholecystectomy. RESULTS Median liver-to-background contrast was 23.5 (range 22.1–35.0), 16.8 (range 11.3–25.1), 1.3 (range 0.7–7.8), and 2.5 (range 1.3–3.6) for 5 mg/30 min, 10 mg/30 min, 10 mg/24 h, and 20 mg/24 h, respectively. Fluorescence intensity of the liver was significantly lower in the 10 mg delayed-imaging dose group compared with the early imaging 5 and 10 mg dose groups (p = 0.001), which resulted in a significant increase in CBD-to-liver contrast ratio compared with the early administration groups (p < 0.002). These findings were qualitatively confirmed during laparoscopic cholecystectomy. CONCLUSION This study shows that a prolonged interval between ICG administration and surgery permits optimal NIR cholangiography with minimal liver background fluorescence.
Collapse
|
50
|
Grolich T, Crha M, Novotný L, Kala Z, Hep A, Nečas A, Hlavsa J, Mitáš L, Misík J. Self-expandable biodegradable biliary stents in porcine model. J Surg Res 2014; 193:606-12. [PMID: 25201575 DOI: 10.1016/j.jss.2014.08.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 07/18/2014] [Accepted: 08/05/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Treatment or prevention of a benign biliary tree stricture is an unresolved problem. A novel self-expandable biodegradable polydioxanon biliary stent in a porcine model was studied. MATERIALS AND METHODS This new stent was used in 23 pigs. Feasibility and safety of surgical stenting, time of biodegradation, and histologic reaction in 2, 8, 13, and 20 wk of a follow-up were studied. All stents were inserted into a common bile duct through a duodenal papilla following small dilatation. After surgical evaluation of abdominal cavities, the pigs were sacrificed to remove common bile ducts with the stents. All bile ducts were assessed by macroscopic and histopathologic examination. RESULTS Self-expansion was correct in all cases. Neither bile duct obstruction nor postsurgical complications were observed. Macroscopic evaluation indicated lightening of the stent color in 2 wk, a partial disintegration in 8 wk, and a complete absorption in 13 and 20 wk. Histologic evaluation in general substantiated a mild-to-moderate inflammatory reaction in the lamina propria during the whole follow up and had no clinical consequences. No cholangitis, necrosis, abscess, or excessive fibroplasia was found in a hepatoduodenal ligament. CONCLUSIONS Our results suggest that polydioxanon biodegradable self-expanding stents seem to be useful for biliary system implantation, offer a good biocompatibility, and completely degrade within 13 wk.
Collapse
Affiliation(s)
- Tomáš Grolich
- Department of Surgery, Masaryk University, Brno, Czech Republic.
| | - Michal Crha
- CEITEC - Central European Institute of Technology, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic
| | - Ladislav Novotný
- Institute of Pathology and Parasitology, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic; Finn Pathologists, Department of histology, Weybread, United Kingdom
| | - Zdeněk Kala
- Department of Surgery, Masaryk University, Brno, Czech Republic
| | - Aleš Hep
- Department of Hepatogastroenterology, Masaryk University, Brno, Czech Republic
| | - Alois Nečas
- CEITEC - Central European Institute of Technology, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic
| | - Jan Hlavsa
- Department of Surgery, Masaryk University, Brno, Czech Republic
| | - Ladislav Mitáš
- Department of Surgery, Masaryk University, Brno, Czech Republic
| | - Jan Misík
- Faculty of Military Health Sciences, Department of Toxicology, University of Defence, Hradec Kralove, Czech Republic
| |
Collapse
|