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Hirata Y, Aoyama Y, Mizukami R, Doi M, Maeda A, Orita D, Okabe Y. Endoscopic lithotripsy for an impacted biliary stone at the confluence of the cystic duct and common bile duct using a novel drill dilator. Endoscopy 2024; 56:E294-E295. [PMID: 38569498 PMCID: PMC10990605 DOI: 10.1055/a-2281-9683] [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] [Indexed: 04/05/2024]
Affiliation(s)
- Yuichi Hirata
- Department of Gastroenterology, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Yuichiro Aoyama
- Department of Gastroenterology, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Ryosuke Mizukami
- Department of Gastroenterology, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Mayumi Doi
- Department of Gastroenterology, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Atsunori Maeda
- Department of Gastroenterology, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Daisuke Orita
- Department of Gastroenterology, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Yoshihiro Okabe
- Department of Gastroenterology, Kakogawa Central City Hospital, Kakogawa, Japan
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O'Rear J, Wong P, Pollini T, Maker VK, Maker AV. "Mickey Mouse sign" to identify and remove cystic duct stones in postcholecystectomy syndrome. J Gastrointest Surg 2024; 28:334-335. [PMID: 38445928 DOI: 10.1016/j.gassur.2023.12.013] [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: 08/16/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 03/07/2024]
Affiliation(s)
- Jamie O'Rear
- Department of Surgery, University of Illinois Chicago, Chicago, Illinois, United States
| | - Paul Wong
- Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, California, United States
| | - Tommaso Pollini
- Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, California, United States
| | - Vijay K Maker
- Department of Surgery, University of Illinois Chicago, Chicago, Illinois, United States
| | - Ajay V Maker
- Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, California, United States.
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Al-Azzawi M, Abouelazayem M, Parmar C, Singhal R, Amr B, Martinino A, Atıcı SD, Mahawar K. A systematic review on laparoscopic subtotal cholecystectomy for difficult gallbladders: a lifesaving bailout or an incomplete operation? Ann R Coll Surg Engl 2024; 106:205-212. [PMID: 37365939 PMCID: PMC10904265 DOI: 10.1308/rcsann.2023.0008] [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] [Accepted: 02/16/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Laparoscopic subtotal cholecystectomy (LSTC) is a bailout procedure that is undertaken when it is not safe to proceed with a laparoscopic total cholecystectomy owing to dense adhesions in Calot's triangle. The main aim of this review was to investigate the early (≤30 days) and late (>30 days) morbidity and mortality of LSTC. METHODS A literature search of the PubMed® (MEDLINE®), Google Scholar™ and Embase® databases was conducted to identify all studies on LSTC published between 1985 and December 2020. A systematic review was then performed. RESULTS Overall, 45 studies involving 2,166 subtotal cholecystectomy patients (51% female) were identified for inclusion in the review. The mean patient age was 55 years (standard deviation: 15 years). Just over half (53%) of the patients had an elective procedure. The conversion rate was 6.2% (n=135). The most common indication was acute cholecystitis (49%). Different techniques were used, with the majority having a closed cystic duct/gallbladder stump (71%). The most common closure technique was intracorporeal suturing (53%), followed by endoloop closure (15%). Four patients (0.18%) died within thirty days of surgery. Morbidity within 30 days included bile duct injury (0.23%), bile leak (18%) and intra-abdominal collection (4%). Reoperation was reported in 23 patients (1.2%), most commonly for unresolving intra-abdominal collections and failed endoscopic retrograde cholangiopancreatography to control bile leak. Long-term follow-up was reported in 30 studies, the median follow-up duration being 22 months. Late morbidity included incisional hernias (6%), symptomatic gallstones (4%) and common bile duct stones (2%), with 2% of cases requiring completion of cholecystectomy. CONCLUSIONS LSTC is an acceptable alternative in patients with a "difficult" Calot's triangle.
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Affiliation(s)
| | - M Abouelazayem
- St George’s University Hospitals NHS Foundation Trust, UK
| | - C Parmar
- Whittington Health NHS Trust, UK
| | - R Singhal
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - B Amr
- University Hospitals Plymouth NHS Trust, UK
| | | | - SD Atıcı
- Izmir Tepecik Training and Research Hospital, Turkey
| | - K Mahawar
- South Tyneside and Sunderland NHS Foundation Trust, UK
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Toro A, Rapisarda M, Maugeri D, Terrasi A, Gallo L, Ansaloni L, Catena F, Di Carlo I. Acute cholecystitis: how to avoid subtotal cholecystectomy-preliminary results. World J Emerg Surg 2024; 19:6. [PMID: 38281952 PMCID: PMC10822154 DOI: 10.1186/s13017-024-00534-x] [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: 11/14/2023] [Accepted: 01/17/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND The aim of this manuscript is to illustrate a new method permitting safe cholecystectomy in terms of complications with respect to the common bile duct (CBD). METHODS The core of this new technique is identification of the continuity of the cystic duct with the infundibulum. The cystic duct can be identified between the inner gallbladder wall and inflamed outer wall. RESULTS In the last 2 years, from January 2019 until December 2021, 3 patients have been treated with the reported technique without complications. CONCLUSIONS Among the various cholecystectomy procedures, this is a new approach that ensures the safety of the structures of Calot's triangle while providing the advantages gained from total removal of the gallbladder.
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Affiliation(s)
- Adriana Toro
- Department of Surgery, University of Catania, Via Santa Sofia 78, 95100, Catania, Italy.
| | - Martina Rapisarda
- Department of Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Cannizzaro Hospital, General Surgery, Catania, Italy
| | - Davide Maugeri
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Alessandro Terrasi
- Department of Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Cannizzaro Hospital, General Surgery, Catania, Italy
| | - Luisa Gallo
- Department of Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Cannizzaro Hospital, General Surgery, Catania, Italy
| | - Luca Ansaloni
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Fausto Catena
- General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Cannizzaro Hospital, General Surgery, Catania, Italy
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Nan L, Wang C, Wang J, Xu S, Bo X, Liu H, Wang Y. Cystic duct carcinoma and type I/II perihilar cholangiocarcinoma: Clinicopathological features and a new differential diagnosis model. Eur J Surg Oncol 2023; 49:107099. [PMID: 37826965 DOI: 10.1016/j.ejso.2023.107099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/17/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Lingxi Nan
- Department of Biliary Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd., Shanghai, 200032, China; Biliary Tract Diseases Institute, Fudan University, 180 Fenglin Rd., Shanghai, 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, China
| | - Changcheng Wang
- Department of Biliary Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd., Shanghai, 200032, China; Biliary Tract Diseases Institute, Fudan University, 180 Fenglin Rd., Shanghai, 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, China
| | - Jie Wang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Shijie Xu
- Department of Biliary Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd., Shanghai, 200032, China; Biliary Tract Diseases Institute, Fudan University, 180 Fenglin Rd., Shanghai, 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, China
| | - Xiaobo Bo
- Department of Biliary Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd., Shanghai, 200032, China; Biliary Tract Diseases Institute, Fudan University, 180 Fenglin Rd., Shanghai, 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, China.
| | - Houbao Liu
- Department of Biliary Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd., Shanghai, 200032, China; Biliary Tract Diseases Institute, Fudan University, 180 Fenglin Rd., Shanghai, 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, China; Department of General Surgery, Zhongshan-Xuhui Hospital Affiliated to Fudan University, 966 Middle Huaihai Rd., Shanghai, 200031, China.
| | - Yueqi Wang
- Department of Biliary Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd., Shanghai, 200032, China; Biliary Tract Diseases Institute, Fudan University, 180 Fenglin Rd., Shanghai, 200032, China; Cancer Center, Zhongshan Hospital, Fudan University, China; Shanghai Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention, Fudan University, China.
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Nagaoka T, Ogawa K, Sakamoto K, Tanaka K, Ito C, Iwata M, Sakamoto A, Nishi Y, Uraoka M, Shine M, Honjo M, Tamura K, Funamizu N, Takada Y. The impact of cystic duct tube on the onset time of postoperative bile leakage after hepatectomy: A propensity score-matched analysis. Asian J Surg 2023; 46:5444-5448. [PMID: 37301625 DOI: 10.1016/j.asjsur.2023.05.112] [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: 03/28/2023] [Revised: 05/09/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The cystic duct tube (C-tube) was used to reduce bile leakage (BL) incidence after hepatectomy. Nevertheless, delayed BL is sometimes experienced even using C-tube. This study investigates the impact of C-tube use on the onset time of post-hepatectomy BL. METHODS Data from 455 consecutive patients who underwent hepatectomy without biliary reconstruction between November 2007 and July 2020 were analyzed retrospectively. A C-tube was used for intraoperative biliary injury or in consideration of BL risk. BL was divided into two groups according to the postoperative onset time: early onset and late onset. To assess the association between C-tube use and BL, propensity score matching in a 1:1 ratio was performed to match BL risk factors between the C-tube and no-C-tube groups. RESULTS BL occurred in 30 (6.6%) of the 455 included patients. C-tubes were used in 51 patients (11.2%) with open hepatectomy, high-risk hepatectomy, massive blood loss, long operation time, or prophylactic drain placement. After propensity score matching, BL occurred in 17 of 102 patients (16.7%). Early-onset BL occurred significantly less frequently in the C-tube group than in the no-C-tube group (3.9% vs. 15.7%, p = 0.046); however, late-onset BL was more common in the C-tube group (9.8% vs. 3.9%, p = 0.24). Six of seven patients (85.7%) with BL with C-tube use developed BL after C-tube removal. CONCLUSION C-tube drainage may reduce early-onset BL in cases having risk factors for BL. Conversely, since late-onset BL often occurs after C-tube removal, attention should be paid to those cases.
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Affiliation(s)
- Tomoyuki Nagaoka
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kohei Ogawa
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Katsunori Sakamoto
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Keiko Tanaka
- Department of Epidemiology and Public Health, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Chihiro Ito
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Miku Iwata
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Akimasa Sakamoto
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yusuke Nishi
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Mio Uraoka
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Mikiya Shine
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Masahiko Honjo
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kei Tamura
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Naotake Funamizu
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yasutsugu Takada
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
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Bhowmick M, Mahajan G, Mangipudi UK, Yadav A, Jearth V, Shah J, Rana S. Prophylactic EUS-guided gallbladder drainage in patients with malignant biliary obstruction and cystic duct orifice involvement: Need more answers! Gastrointest Endosc 2023; 98:675. [PMID: 37734818 DOI: 10.1016/j.gie.2023.04.2069] [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: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Mithu Bhowmick
- Department of Gastroenterology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Gaurav Mahajan
- Department of Gastroenterology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Uday Kiran Mangipudi
- Department of Gastroenterology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Abhishek Yadav
- Department of Gastroenterology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Vaneet Jearth
- Department of Gastroenterology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Jimil Shah
- Department of Gastroenterology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
| | - Surinder Rana
- Department of Gastroenterology, Postgraduate Institution of Medical Education and Research, Chandigarh, India
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Robles-Medranda C, Oleas R, Puga-Tejada M, Alcivar-Vasquez J, Del Valle R, Olmos J, Arevalo-Mora M, Egas-Izquierdo M, Tabacelia D, Baquerizo-Burgos J, Pitanga-Lukashok H. Prophylactic EUS-guided gallbladder drainage prevents acute cholecystitis in patients with malignant biliary obstruction and cystic duct orifice involvement: a randomized trial (with video). Gastrointest Endosc 2023; 97:445-453. [PMID: 36328209 DOI: 10.1016/j.gie.2022.10.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 05/31/2022] [Revised: 10/19/2022] [Accepted: 10/23/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Patients with distal malignant biliary obstruction (MBO) and cystic duct orifice tumoral involvement have an increased risk for the development of acute cholecystitis after self-expandable metallic stent (SEMS) placement. We aimed to determine whether primary EUS-guided gallbladder drainage prevents acute cholecystitis in these patients. METHODS This was a single-center, randomized control trial in patients with distal MBO enrolled from July 2018 to July 2020. Patients were randomized into 2 groups: an interventional group treated with conventional ERCP biliary drainage with SEMS placement and subsequent primary EUS-guided gallbladder drainage (EUS-GBD) and a control group treated with conventional biliary drainage alone. The primary outcome of the study was the occurrence of post-treatment acute cholecystitis, assessed for ≤12 months or until death. The secondary outcomes were hospitalization length and median survival time. RESULTS Forty-four patients were included in the study: 22 in each group. Five patients in the control group (22.7%) and none in the intervention group experienced acute cholecystitis. The median hospitalization time was significantly lower in the interventional group than in the control group (2 days vs 1 day, P = .017). There was no difference in the observed median survival rates in the primary EUS-GBD group (2.9 months) and the control group (2.8 months) (P = .580). CONCLUSION In this single-center study of patients with unresectable MBO and occlusion of the cystic duct orifice, prophylactic EUS-GBD demonstrated a reduced incidence of acute cholecystitis.
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Affiliation(s)
| | - Roberto Oleas
- Instituto Ecuatoriano de Enfermedades Digestivas, Guyaquil, Ecuador
| | | | | | - Raquel Del Valle
- Instituto Ecuatoriano de Enfermedades Digestivas, Guyaquil, Ecuador
| | - Juan Olmos
- Instituto Ecuatoriano de Enfermedades Digestivas, Guyaquil, Ecuador
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Esposito C, Alberti D, Settimi A, Pecorelli S, Boroni G, Montanaro B, Escolino M. Indocyanine green (ICG) fluorescent cholangiography during laparoscopic cholecystectomy using RUBINA™ technology: preliminary experience in two pediatric surgery centers. Surg Endosc 2021; 35:6366-6373. [PMID: 34231069 PMCID: PMC8523512 DOI: 10.1007/s00464-021-08596-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/06/2021] [Indexed: 11/26/2022]
Abstract
Background Recently, we reported the feasibility of indocyanine green (ICG) near-infrared fluorescence (NIRF) imaging to identify extrahepatic biliary anatomy during laparoscopic cholecystectomy (LC) in pediatric patients. This paper aimed to describe the use of a new technology, RUBINA™, to perform intra-operative ICG fluorescent cholangiography (FC) in pediatric LC. Methods During the last year, ICG-FC was performed during LC using the new technology RUBINA™ in two pediatric surgery units. The ICG dosage was 0.35 mg/Kg and the median timing of administration was 15.6 h prior to surgery. Patient baseline, intra-operative details, rate of biliary anatomy identification, utilization ease, and surgical outcomes were assessed. Results Thirteen patients (11 girls), with median age at surgery of 12.9 years, underwent LC using the new RUBINA™ technology. Six patients (46.1%) had associated comorbidities and five (38.5%) were practicing drug therapy. Pre-operative workup included ultrasound (n = 13) and cholangio-MRI (n = 5), excluding biliary and/or vascular anatomical anomalies. One patient needed conversion to open surgery and was excluded from the study. The median operative time was 96.9 min (range 55–180). Technical failure of intra-operative ICG-NIRF visualization occurred in 2/12 patients (16.7%). In the other cases, ICG-NIRF allowed to identify biliary/vascular anatomic anomalies in 4/12 (33.3%), including Moynihan's hump of the right hepatic artery (n = 1), supravescicular bile duct (n = 1), and short cystic duct (n = 2). No allergic or adverse reactions to ICG, post-operative complications, or reoperations were reported. Conclusion Our preliminary experience suggested that the new RUBINA™ technology was very effective to perform ICG-FC during LC in pediatric patients. The advantages of this technology include the possibility to overlay the ICG-NIRF data onto the standard white light image and provide surgeons a constant fluorescence imaging of the target anatomy to assess position of critical biliary structures or presence of anatomical anomalies and safely perform the operation. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08596-7.
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Affiliation(s)
- Ciro Esposito
- Division of Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy.
| | - Daniele Alberti
- Division of Pediatric Surgery, ASST Spedali Civili, Brescia, Italy
| | - Alessandro Settimi
- Division of Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Silvia Pecorelli
- Division of Pediatric Surgery, ASST Spedali Civili, Brescia, Italy
| | - Giovanni Boroni
- Division of Pediatric Surgery, ASST Spedali Civili, Brescia, Italy
| | | | - Maria Escolino
- Division of Pediatric Surgery, Federico II University of Naples, Via Pansini 5, 80131, Naples, Italy
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10
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Chen X, Cheng B, Wang D, Zhang W, Dai D, Zhang W, Yu B. Retrograde tracing along " cystic duct" method to prevent biliary misidentification injury in laparoscopic cholecystectomy. Updates Surg 2020; 72:137-143. [PMID: 32008215 DOI: 10.1007/s13304-020-00716-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/08/2019] [Accepted: 01/23/2020] [Indexed: 11/26/2022]
Abstract
Bile duct injury remains the most serious complication of laparoscopic cholecystectomy (LC), the main cause was misidentification of cystic duct (CD). The aim of this study was to evaluate the effectiveness and security of retrograde tracing along "cystic duct" (RTACD) method for the prevention of biliary misidentification injury in LC. The conception of RTACD method was first described and then illustrated by simulation dissection with extrahepatic biliary structure charts. A total of 840 patients undergoing LC were selected. After the "CD" was separated during operation, its authenticity was identified by RTACD method according to its course and origin. The "CD" can be clipped/divided only when it was identified to be true CD. Among 840 patients, the initially separated "CD" was identified as actual CD in 831 cases, common hepatic (bile) duct in six cases, accessory right posterior sectoral duct in two cases, and right haptic duct in one case. LCs were successfully finished in 837 patients, and converted to open cholecystectomy in three cases. The average operation time was 64.23 min (range 25-225 min), and the average blood loss was 8.07 ml (range 2-200 ml). No biliary misidentification injury was found. All patients recovered smoothly. No jaundice or abdominal pain was noted in the patients during 1-19 months follow-up. RTACD method is a safe and effective new technique of preventing biliary misidentification injury.
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Affiliation(s)
- Xiaopeng Chen
- First Department of Hepatobiliary Surgery, Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, China.
| | - Bin Cheng
- Department of Hepatobiliary Surgery, Huangshan People's Hospital, Huangshan, China
| | - Dong Wang
- First Department of Hepatobiliary Surgery, Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Wenjun Zhang
- First Department of Hepatobiliary Surgery, Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Dafei Dai
- First Department of Hepatobiliary Surgery, Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Weidong Zhang
- First Department of Hepatobiliary Surgery, Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Beibei Yu
- First Department of Hepatobiliary Surgery, Affiliated Yijishan Hospital of Wannan Medical College, Wuhu, China
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11
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Ochi F, Yamamoto T, Shibamoto J, Takashima Y, Hiramoto H, Tsujiura M, Nakashima S, Fujiyama J, Masuyama M. [A Case of Laparoscopic Cholecystectomy(TANKO)for Gallbladder Cancer with Torsion]. Gan To Kagaku Ryoho 2018; 45:2211-2213. [PMID: 30692334] [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: 06/09/2023]
Abstract
UNLABELLED Gallbladder torsion is comparatively rare. Gallbladder cancer is found in 1.5% of cases of acute cholecystitis. We report a case of laparoscopic cholecystectomy(TANKO)for gallbladder cancer with torsion. CASE A 54-year-old woman with epigastric pain underwent enhanced computed tomography. Gallbladder torsion and a tumor at the gallbladder neck were suspected, and ascites was observed. She was diagnosed with gallbladder torsion, and surgery was performed the same day. Intraoperative findings: The gallbladder was movable, minimally attached to the liver bed, rotated 360°around the cystic duct and cystic artery, and appeared necrotic. The torsion was relieved and laparoscopic cholecystectomy(TANKO)was performed. We accidentally perforated the gallbladder and bile leaked out. COURSE The patient did well postoperatively. Pathological diagnosis revealed gallbladder cancer. DISCUSSION Gallbladder cancer with torsion has been reported in 14 cases, not including ours. Among these, none were performed using laparoscopic cholecystectomy(TANKO). We believe that laparoscopic cholecystectomy is appropriate for such cases, but the approach must be carefully considered because of the risk of perforation.
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Zubair M, Habib L, Yousuf M, Ghazanfar S, Quraishi S, Quraishi MS, Mirza MR. Audit of Laparoscopic Cholecystectomy: Impact of Procedure Recording on Clinical Practice. Mymensingh Med J 2018; 27:645-649. [PMID: 30141458] [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: 06/08/2023]
Abstract
Recorded videos of laparoscopic surgery can be used to audit surgical practice with a view to improve clinical practice and surgical outcomes. The objective was to audit our own practice by reviewing video recordings of laparoscopic cholecystectomies to improve our dissection in Calot's triangle and to prevent gall bladder perforation. We used recorded videos of laparoscopic cholecystectomy. In this study initially one hundred consecutive videos were reviewed for: a) establishment of critical view of safety, b) optimization of critical view of safety by division of cystic artery before cystic duct, c) perforation of gall bladder and d) use of diathermy for cystic artery. This prospective interventional audit was performed in a Civil Hospital, Karachi and Hamdard University Hospital, Karachi, Pakistan from January 2008 to March 2010. Recommendations were made according to published literature to change the practice in these steps of procedures. These recommendations were implemented in practice and the following 100 videos were reviewed for the same criteria to see the impact on clinical practice. In the first group, critical view of safety was established in 91 patients compared with 99 patients in 2nd group (p=0.009), optimization of view was done in 54 and 83 patients respectively (p<001), perforation occurred in 32 and 19 patients respectively (p=0.035) and use of diathermy for cystic artery, which was the routine, was stopped completely in the 2nd group. Audit of recorded videos of laparoscopic cholecystectomy can be used as an effective tool to improve surgical practice for safer and better outcome.
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Affiliation(s)
- M Zubair
- Dr Muhammad Zubair, Associate Professor, Surgical Unit IV, Department of Surgery, Dow University of Health Sciences & Civil Hospital, Karachi, Pakistan
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Timbergen MJM, Fransen SAF, Bell AVRJ. [A woman with increasing pain after cholecystectomy]. Ned Tijdschr Geneeskd 2015; 159:A8720. [PMID: 25970671] [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: 06/04/2023]
Abstract
A 25-year-old female presented with abdominal pain and collapse 3 days after a laparoscopic cholecystectomy. The MRCP images suggested a leakage from the stump of the cystic duct. However, an ERCP showed a leakage of a subvesical bile duct arriving from the left hepatic duct. Diagnostic and treatment modalities are discussed.
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Larsen SS, Schulze S, Bisgaard T. Non-radiographic intraoperative fluorescent cholangiography is feasible. Dan Med J 2014; 61:A4891. [PMID: 25162446] [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: 06/03/2023]
Abstract
INTRODUCTION Intraoperative fluorescent cholangiography (IFC) with concomitant fluorescent angiography was recently developed for non-invasive identification of the anatomy during laparoscopic cholecystectomy. The objective of this study was to assess the time required for routine-use of IFC and to evaluate the success rate of the procedures. MATERIAL AND METHODS A total of 35 patients scheduled for laparoscopic cholecystectomy and operated by the same surgeon were consecutively enrolled. A standardised protocol with IFC including angiography was performed during laparoscopic cholecystectomy. Intraoperative time and exposure of predefined anatomical structures were recorded. RESULTS The median time used for IFC was 2.6 minutes (range: 1.5-11.4 minutes) corresponding to a median of 6.2% (range: 3.0-15.2%) of the operation time. The junction between the cystic duct, the common bile duct and the common hepatic duct was identified by IFC in all patients. In 29 of the 35 patients (83%; 95% confidence interval: 71-96%), the cystic artery was visualised by fluorescent angiography. No adverse effects or complications were recorded. CONCLUSION Routine-use of IFC with fluorescent angiography during laparoscopic cholecystectomy is feasible and associated with an acceptable time expenditure and a satisfactory success-rate. FUNDING Not relevant. TRIAL REGISTRATION The Regional Ethics Committee approved the study (J. No. H-3-2013-FSP45). The study is registered with clinicaltrials.gov (ID: NCT02136095).
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Affiliation(s)
- Søren S Larsen
- Kirurgisk Sektion, Gastroenheden, Hvidovre Hospital, Kettegård Allé 30, 2650 Hvidovre, Denmark.
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Ioannidis O, Cheva A, Paraskevas G, Chatzopoulos S, Kotronis A, Papadimitriou N, Konstantara A, Makrantonakis A, Kakoutis E. Neuroendocrine tumor of the cystic duct. Acta Gastroenterol Belg 2012; 75:357-360. [PMID: 23082709] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Neuroendocrine tumours of the extrahepatic bile ducts are extremely rare with less than 70 cases having been reported in the literature. Neuroendocrine tumours are neoplasms of variable malignant potential that arise from the embryonic neural crest cells. They most commonly occur in young females and usually present with painless jaundice. Preoperative diagnosis is seldom made and neuroendocrine tumours are usually incidentally found during abdominal surgical intervention for other indication. Due to their indolent biological behaviour aggressive surgical treatment is recommended. We present a case of an incidentally discovered neuroendocrine tumour of the cystic duct in a 41 year old woman following laparoscopic cholecystectomy for symptomatic gallbladder microlithiasis. The present case is the 8th case of cystic duct NET and the 63rd of extrahepatic bile duct NET. While a rare location for a NET, it is important to report cases of biliary tract neuroendocrine tumours in order for their pathogenesis and physical history to be clarified.
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Affiliation(s)
- O Ioannidis
- First Surgical Department, General Regional Hospital 'George Papanikolaou', Thessaloniki, Greece.
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Sepe PS, Berzin TM, Sanaka S, Patel N, Sawhney MS, Chuttani R, Pleskow DK. Single-operator cholangioscopy for the extraction of cystic duct stones (with video). Gastrointest Endosc 2012; 75:206-10. [PMID: 22047700 DOI: 10.1016/j.gie.2011.08.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [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: 04/06/2011] [Accepted: 08/14/2011] [Indexed: 01/22/2023]
Affiliation(s)
- Paul S Sepe
- Beth Israel Deaconess Medical Center, Boston, MA, USA
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Wakahara T, Tsukamoto T, Toyokawa A, Iwasaki T, Hamabe Y, Teramura K. [A case of cystic duct metastasis from rectal cancer]. Nihon Shokakibyo Gakkai Zasshi 2011; 108:2023-2029. [PMID: 22139490] [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: 05/31/2023]
Abstract
A 67-year-old man underwent laparoscopic low anterior resection and open medial segmentectomy of the liver for rectal cancer and liver metastasis. During the operation, a cystic duct mass, 1cm in diameter, was found. Therefore cholecystectomy with partial resection of the common bile duct was also performed. The rectal tumor and liver tumor were diagnosed pathologically as moderately differentiated adenocarcinoma. The cystic duct mass was mainly located in the lamina propria and its histological aspects were similar to the rectal cancer. Immunohistochemical staining revealed that rectal, hepatic, and cystic duct lesions were all negative for CK7 but were all positive for CK20. These findings confirmed the diagnosis of rectal cancer with metastases to the liver and the cystic duct. Metastatic cystic duct tumor is extremely rare and has never been reported in the Japanese literature.
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Abue M, Suzuki M, Miyazaki T, Nomura E, Uchimi K, Noguchi T, Suzuki S, Onodera H, Sato M, Ito S, Sato I. [A case of early cystic duct carcinoma concomitant with xanthogranulomatous cholecystitis (XGC)]. Nihon Shokakibyo Gakkai Zasshi 2011; 108:1743-1751. [PMID: 21971149] [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: 05/31/2023]
Abstract
We reported a case of early cystic duct carcinoma concomitant with xanthogranulomatous cholecystitis (XGC). This case was a 72-year-old man in whom thickening of the gallbladder wall was pointed out an abdominal ultrasonography and elevation of the CA19-9 level was detected at a local clinic. Endoscopic ultrasonography and CT demonstrated a mass in the cystic duct. Mapping biopsy using peroral cholangioscopy (POCS) revealed a diagnosis of cystic carcinoma with superficial flat growth, therefore a pylorus-preserving pancreatoduodenectomy was performed. Histopathological diagnosis was well differentiated papillotubular adenocarcinoma with superficial flat spread and the thickening of the gallbladder wall was XGC. A case of early cystic duct carcinoma concomitant with XGC is extremely rare.
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Affiliation(s)
- Makoto Abue
- Department of Gastroenterology, Miyagi Cancer Center.
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Sadowitz B, Azer W, Neulander O. A dilated cystic duct stump as a cause of postcholecystectomy syndrome. Am Surg 2011; 77:E67-E68. [PMID: 21679537] [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: 05/30/2023]
Affiliation(s)
- Benjamin Sadowitz
- Department of Surgery, Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.
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Abstract
BACKGROUND During laparoscopic cholecystectomy, it is necessary to occlude the cystic duct permanently. Traditionally, this has been performed through the application of non-absorbable metal clips. Use of absorbable materials to occlude the cystic duct has been suggested as an alternative for metal clips for various reasons. OBJECTIVES To assess the benefits and harms of the different methods of occlusion of cystic duct in patients undergoing laparoscopic cholecystectomy. SEARCH STRATEGY We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until August 2010. SELECTION CRITERIA We included all randomised clinical trials comparing different methods of occlusion of cystic duct. DATA COLLECTION AND ANALYSIS We collected the data on the characteristics, methodological quality, bile duct injury, bile leaks, operating time, and incidence of recurrent common bile duct stone from each trial. We analysed the data with both the fixed-effect and the random-effects model using RevMan Analysis. For each outcome we calculated the risk ratio (RR) in the presence of more than one trial for the outcome or mean difference (MD) with 95% confidence intervals (CI) based on intention-to-treat analysis. In the presence of only one trial under a dichotomous outcome, we performed the Fisher's exact test. MAIN RESULTS Three trials including 255 patients qualified for this review. In two of the trial, a total of 150 patients were randomised to absorbable clips (n = 75) and non-absorbable clips (n = 75). In the third trial, a total of 105 patients were randomised to absorbable ligatures (n = 53) and non-absorbable clips (n = 52). All three trials were of high risk of bias. There was no difference in the morbidity between the groups. There was statistically significant longer operating time (MD 12.00 minutes, 95% CI 1.59 to 22.41) in the absorbable ligature group than non-absorbable clips. The duration and method of follow-up were not adequate to determine the incidence of long-term complications. AUTHORS' CONCLUSIONS We are unable to determine the benefits and harms of different methods of cystic duct occlusion because of the small sample size, short period of follow-up, and lack of reporting of important outcomes in the included trials. Adequately powered randomised trials with low risk of bias and with long periods of follow-up and assessing all of the important outcomes for patients and professionals are necessary.
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Affiliation(s)
- Kurinchi Selvan Gurusamy
- Department of Surgery, Royal Free Campus, UCL Medical School, 9th Floor, Royal Free Hospital, Pond Street, London, UK, NW3 2QG
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Panpimanmas S, Ratanachuek T, Chantawiboon S. Endoscopic management of cystic duct stump leakage after cholecystectomy. Hepatogastroenterology 2008; 55:1962-1964. [PMID: 19260459] [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: 05/27/2023]
Abstract
BACKGROUND/AIMS Cystic duct stump leakage (CDL) is a rare and serious complication after cholecystectomy. Since laparoscopic cholecystectomy has been gold standard treatment of gallstone disease, this complication is found more frequently. Endoscopic management is now highly recommended and more appropriate than surgical correction, that would be evaluated. METHODOLOGY From January 1994 to December 2004, sixteen consecutive cases of patients with CDL after cholecystectomy were managed by endoscopic retrograde cholangiopancreatography (ERCP) in our unit. Endoscopic sphincterotomy (EST), stone extraction, stenting and nasobiliary tube drainage were selected to manage each patient with appropiate indication. Failed cannulation cases were corrected by open choledochojejunostomy. We also reviewed the time from cholecystectomy to presentation, presenting symptoms, treatment procedures and outcome. RESULTS A total of 16 patients; 9 women, 7 men average age 57.7 years with CDL after cholecystectomy were studied, 12 had undergone laparoscopic, and 4 had open cholecystectomy. Median time of presenting symptoms after cholecystectomy was 10.3 days (range 3-25 days). Symptoms included abdominal distension 100%, pain 87.5%, jaundice 62.5% and fever 37.5%. Diagnostic and therapeutic ERCP was successful in 14 cases comprising EST 2, EST+stone extraction 2, EST+ stone extraction +stent 2, EST+stone extraction + nasobiliary tube 1 and only plastic stent 7. Failed connulation in 2 cases, underwent open choledochojejunostomy. Median follow up time was 18.2 months (range 1-96 months) in 13 cases with no mortality. CONCLUSIONS CDL is a serious complication, more frequently after LC than OC. ERCP with combined endoscopic procedure is the treatment of choice to resolve the bile leakage.
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Kubota K, Kakuta Y, Inayama Y, Yoneda M, Abe Y, Inamori M, Kirikoshi H, Saito S, Nakajima A, Sugimori K, Matuo K, Kazunaga T, Shimada H. Clinicopathologic study of resected cases of primary carcinoma of the cystic duct. Hepatogastroenterology 2008; 55:1174-1178. [PMID: 18795652] [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: 05/26/2023]
Abstract
BACKGROUND/AIMS There have been few reports of primary carcinoma of the cystic duct (CCD) included in advanced cases. The aim of this study was to elucidate the clinical features of resected CCD. METHODOLOGY Six cases of CCD were diagnosed in which the main carcinomatous component arose from the cystic bile duct, even if these carcinomas were accompanied by invasion beyond the cystic duct. Histopathologic findings (i.e., H.E. staining and cell proliferating potency assessed by ki-67 staining) were compared between the main lesion and invasive lesion of the CCD. RESULTS Abdominal ultrasonography revealed swelling of the gallbladder in 3 of the 6 patients, but not in the remaining 3, who were later diagnosed as having adenomyomatosis of the gallbladder, dystelectasis due to the carcinomatous infiltration, and atrophic gallbladder, respectively. On computed tomography, 4 of the 6 cases with nodular-type lesions fulfilling Farrar's criteria, the tumors showed contrast enhancement. Direct cholangiography demonstrated unilateral obstruction of the common bile duct in 4 out of the 6 cases. Intraductal ultrasonography revealed CCD in only 1 of the 6 cases. Advanced CCD shows 2 patterns of invasion; the hepatic hilum pattern and the confluence invasive pattern. The hepatic hilum pattern of invasion tends to be associated with a poorer prognosis. Histopathological study revealed papillary and/or well differentiated adenocarcinoma in the cases where the lesion predominantly involved the cystic duct, whereas those lesions which extended beyond the cystic duct were composed of moderate and/or poorly differentiated tubular adenocarcinoma. The latter was associated with a high cellular proliferative activity as assessed by immunocytochemical examination for ki-67. Invasion of the perineural space was often observed in the cases with advanced CCD. CONCLUSIONS CCD showed the hepatic hilum and/or confluence pattern of invasion when the tumor extended beyond the cystic duct. CCD extending beyond the cystic duct was associated with more aggressive characteristics of the tumors, with perineural infiltration and histopathologic features resembling those of pancreatic cancer. It is concluded that CCDs extending beyond the cystic duct are more aggressive and associated with a poorer prognosis.
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Affiliation(s)
- Kensuke Kubota
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Fukuura 3-9, Kanazawa, Yokohama 236-0004, Japan
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Lam VWT, Ng KKC, Chok KSH, Cheung TT, Wat J, Fan ST, Poon RTP. Safety and efficacy of radiofrequency ablation for periductal hepatocellular carcinoma with intraductal cooling of the central bile duct. J Am Coll Surg 2008; 207:e1-5. [PMID: 18656036 DOI: 10.1016/j.jamcollsurg.2008.03.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Accepted: 03/17/2008] [Indexed: 12/20/2022]
Affiliation(s)
- Vincent Wai-To Lam
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
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Clemente G. Laparoscopic subtotal cholecystectomy without cystic duct ligation (Br J Surg 2007; 94: 1527-1529). Br J Surg 2008; 95:534; author reply 534. [PMID: 18320556 DOI: 10.1002/bjs.6195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Mimidis K, Anagnostoulis S, Iakovidis C, Argyropoulou P. Remarkably elevated serum levels of carbohydrate antigen 19-9 in cystic duct and common bile duct lithiasis. J Gastrointestin Liver Dis 2008; 17:111-112. [PMID: 18392257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Abstract
BACKGROUND Cholecystectomy is made hazardous by distortion of the anatomy of Calot's triangle by acute or chronic inflammation. Laparoscopic subtotal cholecystectomy (LSTC) without cystic duct ligation is an alternative to conversion to open surgery in difficult cases. METHODS This prospective study included all cholecystectomies performed in a district general hospital upper gastrointestinal unit between 2003 and 2005, after the introduction of LSTC. RESULTS Of 889 laparoscopic cholecystectomies, 28 LSTCs without cystic duct ligation were performed in 18 men and ten women of median age 68 years. Median operating time was 90 min and median duration of hospital stay was 3 days. Two temporary bile leaks resolved spontaneously on days 14 and 19. Three patients required endoscopic retrograde cholangiopancreatography, extraction of bile duct stones and stent insertion for persistent leaks. All five bile leaks were expected from peroperative findings. One patient had a myocardial infarction and one developed a subphrenic abscess. There were no deaths. Open conversion rates were reduced from 5.0 per cent in 1997-2002 to 0.3 per cent in 2005 (P < 0.001). CONCLUSION LSTC without cystic duct ligation is an alternative to open conversion when dissection of Calot's triangle is hazardous. Bile leaks are predictable and readily managed.
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Affiliation(s)
- I Sinha
- Department of General Surgery, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK
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Kim WC, Lee DH, Ahn SI, Kim JM. A case of cystic duct carcinoma treated with surgery and adjuvant radiotherapy: a proposal for new classification. J Gastrointestin Liver Dis 2007; 16:437-440. [PMID: 18193129] [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: 05/25/2023]
Abstract
Cystic duct carcinoma is a rare disease. We present the case report of a 63-year-old man with cystic duct adenocarcinoma. In this patient, we performed cholecystectomy and segmental resection of the bile duct with lymph node dissection. A histopathologic examination showed that the cystic duct was obstructed by a solid mass. It also revealed the presence of cystic duct adenocarcinoma with lymph node metastasis, where the tumor involved resection margins. We therefore decided on postoperative adjuvant radiotherapy for the prevention of local failure. The patient had an uneventful course, apart from a liver abscess. Nevertheless, he died with liver metastases 15 months postoperatively. Our case highlights the role of postoperative radiotherapy and the necessity of a new classification system based on the extent of tumor infiltration.
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Affiliation(s)
- Woo Chul Kim
- Department of Radiation Oncology, College of Medicine, Inha University, 7-206, 3-Ga, Shinheung-Dong, Jung-Gu, Incheon, 400-711, South Korea.
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Affiliation(s)
- Juha M Grönroos
- Departments of Surgery and Emergency, University of Turku, Turku, Finland
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Affiliation(s)
- Fumihiko Miura
- Department of Surgery, Teikyo University, School of Medicine 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605 Japan.
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Chedid MF, Chedid AD. Mirizzi syndrome in a patient with anomalous connection of the cystic duct into the right hepatic duct. Int Surg 2007; 92:198-201. [PMID: 18050827] [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: 05/25/2023] Open
Abstract
In 1948, Mirizzi described a syndrome characterized as the obstruction of the common hepatic duct by a stone located in the gallbladder's neck or in the cystic duct. We present a rare case of Mirizzi syndrome resulting from a fistula involving the cystic duct, the neck of the gallbladder, and the right hepatic duct. This finding was possible because the patient had a rare biliary anatomic variation: the insertion of the cystic duct straight in the right hepatic duct. The diagnosis was suggested by abdominal ultrasonography and confirmed by endoscopic retrograde cholangiopancreatography. The surgical approach was performed by means of an open cholecystectomy, common biliary duct exploration using the right hepatic duct and a transduodenal papillotomy, and insertion of a long limb T-tube through the right hepatic duct to drain the common duct. The procedure was successful, and after an 18-month period, the patient is free of symptoms.
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Affiliation(s)
- Marcio F Chedid
- Adult Liver Transplantation Program, Service of General Surgery, Hospital de Clínicas, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Jho DH, Jho DJ, Chejfec G, Ahn M, Ong ES, Espat NJ. Primary biliary B-cell lymphoma of the cystic duct causing obstructive jaundice. Am Surg 2007; 73:508-10. [PMID: 17521008] [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: 05/15/2023]
Abstract
A distinctive case of primary biliary lymphoma occurring in the cystic duct causing extrinsic compression of the porta hepatis in a 48-year-old woman is presented. Imaging studies revealed stricture of the common hepatic duct with a 2.5-cm nonhomogeneous mass at the porta hepatis, mimicking a Klatskin tumor. Exploratory laparotomy revealed a mass in the gallbladder neck with extension into the cystic duct akin to Mirizzi's syndrome. A soft, tan-yellow 1.0-cm mass was removed from the cystic duct, and infiltrating atypical lymphocytic nodules were identified with a final diagnosis of an anaplastic variant of diffuse large B-cell lymphoma.
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Affiliation(s)
- David H Jho
- Department of Surgery, University of Illinois, Chicago, Illinois, USA
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Takahashi S, Homma H, Akiyama T, Mesawa S, Koike K, Hirata K, Kogawa K, Kawano Y, Takada K, Sato T, Niitsu Y. [A case of primary carcinoma of the cystic duct with limy bile]. Nihon Shokakibyo Gakkai Zasshi 2007; 104:394-400. [PMID: 17337877] [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: 05/14/2023]
Abstract
A 78-year-old man had been admitted to a previous hospital because of epigastralgia and a diagnosis of cholecystolithiasis had been made. He had been transferred to our institution for further examination. CT scan and US revealed chronic cholecystitis and gallstone, however, ERC revealed severe obstruction of the cystic duct and EUS revealed dilation of that duct and a solitary mass there. Carcinoma of the cystic duct was diagnosed, and we performed cholecystectomy and resection of the extrahepatic duct with two-field lymphadenectomy. The pathological specimen showed a round flat elevated mass localized in the cystic duct. Histopathologically, the diagnosis was well differentiated tubular adenocarcinoma of the cystic duct with limy bile and tiny gallstone.
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Affiliation(s)
- Sho Takahashi
- Department of Gastroenterology, Sapporo Kyoritsu Hospital
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Ojima H, Yamauchi H, Yamaki E, Idetu A, Hosouchi Y, Nishida Y, Kuwano H. Management of bile leakage caused by clip displacement from cystic duct stumps. Hepatogastroenterology 2007; 54:28-31. [PMID: 17419225] [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: 05/14/2023]
Abstract
BACKGROUND/AIMS Cystic duct leakage (CDL) is one of the most common complications after laparoscopic cholecystectomy (LC). We retrospectively examined 3 patients with CDL that were treated with endoscopic stenting. METHODOLOGY From January 1995 to December 2004, 1127 LCs were performed. CDL occurred in 3 cases and a closed suction drain was inserted in 2 of those 3 cases. RESULTS The duration from LC to endoscopic retrograde cholangiopancreatography (ERCP) was 2 to 4 days, and the patient without the drain experienced the longest waiting time. Hospital stay was almost identical for all 3 cases. There was an immediate improvement after the procedure. CONCLUSIONS It is important to employ accurate technical surgical procedures to prevent complications. ERCP with stent placement and sphincterotomy is an easy and safe diagnostic and therapeutic procedure for CDL, and has a high success rate in resolving leaks.
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Affiliation(s)
- Hitoshi Ojima
- Department of Surgery, Gunma Prefecture Saiseikai-Maebashi Hospital, Gunma, Japan.
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Paganini AM, Guerrieri M, Sarnari J, De Sanctis A, D'Ambrosio G, Lezoche G, Perretta S, Lezoche E. Thirteen years' experience with laparoscopic transcystic common bile duct exploration for stones. Effectiveness and long-term results. Surg Endosc 2006; 21:34-40. [PMID: 17111284 DOI: 10.1007/s00464-005-0286-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [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: 04/19/2005] [Accepted: 04/03/2006] [Indexed: 12/18/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate the effectiveness and long-term results of laparoscopic transcystic common bile duct exploration (TC-CBDE). METHODS Ductal stones were present in 344 of 3212 patients (10.7%) who underwent laparoscopic cholecystectomy (LC). The procedure was completed laparoscopically in 329 patients (95.6%), with TC-CBDE performed in 191 patients (58.1%) who are the object of this study, or with a transverse choledochotomy in 138 cases (41.9%). RESULTS Biliary drainage was employed in 71 of 191 cases (37.2%). Major complications occurred in 10 patients (5.1%), including retained stones in 6 (3.1%). Mortality was nil. No patients were lost to follow-up (median: 118.0 months; range: 17.6-168 months). No signs of bile stasis, no recurrent ductal stones and no biliary stricture were observed. At present 182 patients are alive with no biliary symptoms; 9 have died from unrelated causes. CONCLUSIONS Long-term follow-up after laparoscopic TC-CBDE proved its effectiveness and safety for single-stage management of gallstones and common bile duct stones.
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Affiliation(s)
- A M Paganini
- Clinica di Chirurgia Generale e Metodologia Chirurgica, Università Politecnica delle Marche, Azienda Ospedaliera Umberto I, Via Conca, 60020, Ancona, Italy
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Abstract
sWe describe the management of a cystic duct remnant calculus in a 45-year-old male patient who had undergone a laparoscopic cholecystectomy and re-presented with abdominal pain and jaundice. Magnetic resonance cholangiopancreatography was utilized to confirm the diagnosis of an impacted calculus within the remnant cystic duct along with several small retained common bile duct stones. Four sequential endoscopic procedures successfully removed all retained common bile duct calculi to alleviate the biliary obstruction; however, we were unable to treat the cystic duct remnant calculus endoscopically. The patient finally underwent successful laparoscopic excision of a 2.5-cm cystic duct remnant containing its impacted calculus. It remains unclear if cystic duct remnant calculi may become more prevalent as a cause of postcholecystectomy syndrome in future due to the large numbers of laparoscopic cholecystectomies performed in the past 2 decades.
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Affiliation(s)
- Ying Wei Lum
- Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21224, USA
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Isayama H, Kawabe T, Nakai Y, Tsujino T, Sasahira N, Yamamoto N, Arizumi T, Togawa O, Matsubara S, Ito Y, Sasaki T, Hirano K, Toda N, Komatsu Y, Tada M, Yoshida H, Omata M. Cholecystitis after metallic stent placement in patients with malignant distal biliary obstruction. Clin Gastroenterol Hepatol 2006; 4:1148-53. [PMID: 16904950 DOI: 10.1016/j.cgh.2006.06.004] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.3] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Cholecystitis after metallic stent (MS) placement is an issue requiring attention. From our experience, cholecystitis seemed to occur mainly in patients with tumor involvement to the cystic duct orifice. The aim of the present study was to identify risk factors for cholecystitis in patients treated with covered or uncovered MS. METHODS We analyzed 246 patients who received MS placement (covered MS in 171 and uncovered in 75) between August 1997 and May 2005 for the treatment of unresectable distal malignant biliary obstruction. Causative diseases were as follows: pancreatic cancer in 162, papillary cancer in 10, bile duct cancer in 41, and metastatic nodes in 33 patients. Tumor involvement to orifice of the cystic duct (OCD) was diagnosed based on cholangiography and intraductal ultrasonography. RESULTS Cholecystitis after MS placement was found in 13 patients (5.3%). There was no significant difference in the incidence of cholecystitis between covered (5.8%) and uncovered (4.0%) MS. By univariate analysis, tumor involvement of the OCD, MS placed above the papilla, and stricture located at midportion were associated significantly with cholecystitis. By multivariate analysis, only tumor involvement of the OCD was a risk factor, with an odds ratio of 47.206 (95% confidence interval, 5.84-381.60). CONCLUSIONS Cholecystitis after MS placement is associated with tumor involvement to the orifice of the cystic duct, regardless of the type of stent.
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Affiliation(s)
- Hiroyuki Isayama
- Department of Gastroenterology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
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Affiliation(s)
- Cheng-Maw Ho
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Abstract
The modern era of common bile duct (CBD) surgery started with Mirizzi, who introduced intraoperative cholangiography in 1932. Intraoperative choledoscopy had been developed as an adjunctive to intraoperative cholangiography, which helped to detect CBD stones in an additional 10% to 15% of instances that otherwise would have been missed. Findings have shown choledochoscopy to be an important technique for efficient and effective management of CBD stones. Efforts to treat patients with common duct stones in one session and to avoid the potential complications of endoscopic sphincterotomy resulted in several laparoscopic transcystic CBD (LTCBDE) techniques. The techniques of transcystic stone extraction include lavage, trolling with wire baskets or biliary balloon catheters, cystic duct dilation, biliary endoscopy, and stone retrieval with wire baskets under direct vision and antegrade sphincterotomy, lithotripsy, and catheter techniques. The indications for LTCBDE are filling or equivocal defects at cholangiography, stones smaller than 10 mm, fewer than 9 stones, and possible tumor. The contraindications are stones larger than 1 cm, stones proximal to the cystic duct entrance into the CBD, small friable cystic duct, and 10 or more stones. Experience with LTCBDE shows that the approach is applicable in more than 85% of cases, with a success rate of 85% to 95%. It also is shown to be more cost effective than postoperative endoscopic retrograde cholangiopancreatography. Recent developments in LTCBDE have focused mainly on implementation of robotically assisted surgery and new imaging methods such as magnetic resonance cholangiopancreatography with three-dimensional virtual cholangioscopy and three-dimensional ultrasound. Further technological advances will facilitate the application of laparoscopic approaches to the common duct, which should become the primary strategy for the great majority of patients.
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Affiliation(s)
- S Lyass
- Cedars Sinai Medical Center, Center for Minimally Invasive Surgery, Los Angeles, CA, USA
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Abstract
OBJECTIVE Mirizzi syndrome (MS) is an uncommon presentation of cholelithiasis. This study aims to find the incidence and analyze the outcome of management of this condition at Riyadh Medical Complex (RMC) with particular reference to diagnostic methods and outcome of surgical treatment. METHODS Retrospective study on 17 consecutive patients of MS diagnosed and managed at RMC over ten year period. The records were reviewed for demography, clinical presentation, diagnostic methods, operative procedures, postoperative complication and follow up. RESULTS The incidence of MS syndrome was 0.7% of 2415 cholecystectomies. There was preponderance of Type I variety (58.8%). Ultrasonography was able to diagnose 82% cases. ERCP suggested the diagnosis in all cases and helped further in classifying and management of these patients. All Type I cases were managed with partial cholecystectomy, two underwent laparoscopic surgery. Three Type II patients were managed by partial cholecystectomy alone. Three patients with Type III variety had choledochoplasty whereas one remaining patient with Type IV variety underwent hepatico-jejunostomy. All patients had complete recovery with 17.6% procedure-related morbidity and no hospital mortality. All patients are doing well over a mean follow up 6.5 years. CONCLUSION Preoperative diagnosis of Mirizzi syndrome by ultrasound and ERCP is essential to prevent serious complications during surgery. Partial cholecystectomy is an adequate procedure for Types I & II MS. Choledochoplasty provides an effective surgical repair in Type III cases. Although laparoscopic cholecystectomy in MS may be hazardous, it may still be tried in preoperatively diagnosed type I cases, provided the surgeon is experienced and keeps a low threshold for conversion open surgery.
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Affiliation(s)
- Mohammed H A Al-Akeely
- Department of General Surgery, College of Medicine, King Saud University, P.O. Box 2925, Riyadh, 11461, Kingdom of Saudi Arabia
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Tajiri K, Shimizu Y, Mihara H, Kawanishi Y, Orihara T, Takahashi H, Ishizawa S, Kawai S, Sugiyama T. Cholangiocarcinoma at the cystic duct discovered by lymph node metastases with clear cell transformation. Intern Med 2006; 45:1045-8. [PMID: 17043375 DOI: 10.2169/internalmedicine.45.1608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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] [Indexed: 02/05/2023] Open
Abstract
We encountered a case with cholangiocarcinoma of the cystic duct, which was first manifested by multiple lymph node metastases with clear cell changes resembling clear cell adenocarcinoma (CCC). Because the clear cell changes were not prominent at the primary site, clear cell transformation might have occurred preferentially at the metastatic lesion in this case. Alternatively, tumor cells with clear cell transformation, found at the primary site, might have high metastatic potential. The patient showed thromboembolism and hypercalcemia as paraneoplastic syndromes at the terminal stage as reported in patients with CCC of the ovary. Those complications might be common biological features of CCC.
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Affiliation(s)
- Kazuto Tajiri
- The Third Department of Internal Medicine, Faculty of Medicine, University of Toyama
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Oku T, Wada Y, Waga E, Misu K, Hazama K, Suzuki Y, Fujita M, Nagamachi Y, Maeda M. [A case of mucin-producing cystic duct cancer protruding into the common bile duct]. Nihon Shokakibyo Gakkai Zasshi 2006; 103:44-51. [PMID: 16444985] [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] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Takatomi Oku
- Department of Gastroenterology, Shinnittetsu Muroran General Hospital
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Kunisaki SM, Hertl M, Bodner BE, Cosimi AB. Mirizzi syndrome secondary to an adenoma of the cystic duct. ACTA ACUST UNITED AC 2005; 12:159-62. [PMID: 15868083 DOI: 10.1007/s00534-004-0970-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 06/20/2003] [Accepted: 12/24/2004] [Indexed: 10/25/2022]
Abstract
Bile duct adenomas are uncommon lesions that can cause obstructive jaundice. We report the unusual case of a 54-year-old man who developed Mirizzi syndrome secondary to a bile duct papillary adenoma located in the cystic duct remnant. A case report is presented, together with a review of extrahepatic bile duct adenomas published in the English-language literature, with special attention directed toward the clinical manifestations, locations, and prognosis of these tumors. Bile duct adenomas are very rare tumors. Although cholangiography can detect many of these lesions, few cases were correctly diagnosed preoperatively. Most lesions were located in the distal common bile duct or at the ampulla of Vater. Pathologic examination often revealed foci of carcinoma in situ, dysplasia, or atypia. Local resection was performed in most cases. There were no previous case reports of extrinsic common bile duct obstruction caused by tumors within the cystic duct. We describe here a very rare, acalculous variant of Mirizzi syndrome secondary to a solitary papillary adenoma of the cystic duct. In general, bile duct adenomas are uncommon lesions that are difficult to diagnoses preoperatively. These tumors usually present with jaundice secondary to intraluminal biliary obstruction. These lesions are premalignant and should be managed by complete surgical resection.
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Affiliation(s)
- Shaun M Kunisaki
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, WHT 515, Boston, MA 02114, USA
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Zaima M, Mitsuyoshi A, Komori J, Shinkura N. Segment VI cholangiocholecystostomy for unresectable malignant obstruction at the hepatic hilum. Hepatogastroenterology 2005; 52:1362-3. [PMID: 16201074] [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: 05/04/2023]
Abstract
Anastomosis between the segment VI intrahepatic bile duct and the stump of the cystic duct was done to relieve obstructive jaundice caused by high biliary malignant obstruction. This procedure is considered to be a safe and easy method to provide good palliation in patients with unresectable hepatic hilar carcinoma.
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Affiliation(s)
- Masazumi Zaima
- Department of Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan
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Kubota K, Abe Y, Inamori M, Kawamura H, Kirikoshi H, Kobayashi N, Saito S, Ueno N, Nakajima A. Percutaneous transhepatic gallbladder stenting for recurrent acute acalculous cholecystitis after failed endoscopic attempt. ACTA ACUST UNITED AC 2005; 12:286-9. [PMID: 16133694 DOI: 10.1007/s00534-005-0989-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 02/15/2005] [Accepted: 03/30/2005] [Indexed: 10/25/2022]
Abstract
Endoscopic gallbladder stenting is useful palliative therapy for acute cholecystitis in high-risk patients. Although the success rate of endoscopic gallbladder stenting is 79%-100%, an alternative method has not been reported. We succeeded in employing a method for percutaneous gallbladder stenting (PTGS) and herein describe this new method. A patient with acute acalculous cholecystitis related to ischemic atherosclerotic vascular disease, cholangitis due to Lemmel syndrome, and severe congestive heart failure underwent PTGS through the cystic duct from the gallbladder to the duodenal papilla, because an endoscopic method failed in the treatment of Lemmel syndrome. Because we were unable to place endoscopic transpapillary gallbladder drainage, percutaneous transhepatic gallbladder drainage (PTGBD) was performed and both the cholecystitis and cholangitis ceased. PTGS was performed as an alternative to endoscopic gallbladder stenting. Access to the cystic duct and gallbladder was obtained by the PTGBD route, using a guidewire (0.035-inch diameter) and seeking catheter (6.5 Fr) under fluoroscopic control. A 7-Fr 12-cm double-pigtail biliary polyethylene stent was placed. The patient remained asymptomatic for 3 months after the PTGS until he died, of an acute recurrent myocardial infarction. This new PTGS placement is an alternative treatment for symptomatic gallbladder disease in patients with increased operative risk when the endoscopic method is unsuccessful.
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Affiliation(s)
- Kensuke Kubota
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
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Shim CS, Moon JH, Cho YD, Kim YS, Hong SJ, Kim JO, Cho JY, Kim YS, Lee JS, Lee MS. The role of extracorporeal shock wave lithotripsy combined with endoscopic management of impacted cystic duct stones in patients with high surgical risk. Hepatogastroenterology 2005; 52:1026-9. [PMID: 16001622] [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: 05/03/2023]
Abstract
BACKGROUND/AIMS Cholecystoscopic lithotripsy can be an alternative procedure for the treatment of impacted cystic duct stones in patients who are high risk for surgery. Conventional methods, including electrohydraulic lithotripsy (EHL), occasionally fail due to the inability to access or capture the impacted stones in the narrow, spirally long cystic duct. Using extracorporeal shock wave lithotripsy (ESWL) may be more effective to disintegrate cystic duct stones. The aim of the study is to evaluate the role of ESWL in the endoscopic treatment of impacted cystic duct stones in patients with high operative risk. METHODOLOGY Eleven patients with impacted cystic duct stones who were at high risk for surgery were included in this study. All of them had had a failed initial attempt of percutaneous transhepatic cholecystoscopic lithotripsy (PTCCS-L) followed by percutaneous transhepatic cholecystostomy. Patients underwent ESWL to disintegrate cystic duct stones with endoscopic removal of fragmented stones. RESULTS Complete removal of cystic duct stones was achieved in 9 of 11 patients (81.8%). One of the 9 patients (11.1%) was treated solely with ESWL, but the other 8 patients (88.9%) required cholecystoscopic removal of residual fragmented stones after ESWL. Fragmented stones passing through the cystic duct impacted in ampullary region in 3 patients after ESWL. Two patients required transpapillary removal of stones. CONCLUSIONS Endoscopic stone removal after ESWL for impacted cystic duct stones is a difficult and time-consuming procedure. But, it seems to be a relatively safe alternative to surgery in patients with high surgical risk.
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Affiliation(s)
- Chan Sup Shim
- Institute for Digestive Research, Digestive Disease Center, Soon Chun Hyang University College of Medicine, Seoul, Korea.
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Vyas FL, Nayak S, Perakath B, Pradhan NR. Gallbladder remnant and cystic duct stump calculus as a cause of postcholecystectomy syndrome. Trop Gastroenterol 2005; 26:159-60. [PMID: 16512471] [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] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Frederick L Vyas
- Department of General Surgery Unit 5, Christian Medical College and Hospital, Vellore 632 004.
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