1
|
Cho YJ, Nam SH, Oh E, Luciano MP, Lee C, Shin IH, Schnermann MJ, Cha J, Kim KW. Laparoscopic cholecystectomy in a swine model using a novel near-infrared fluorescent IV dye (BL-760). Lasers Surg Med 2021; 54:305-310. [PMID: 34490931 DOI: 10.1002/lsm.23470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Bile duct injury during laparoscopic cholecystectomy has an incidence rate of 1%-2% and commonly appears under conditions of severe inflammation, adhesion, or unexpected anatomical variations. Despite the difficulties and rising concerns of identifying bile duct during surgeries, surgeons do not have a specific modality to identify bile duct except intraoperative cholangiography. While no biliary-specific fluorescent dye exists for clinical use, our team has previously described the development of a preclinical biliary-specific dye, BL-760. Here, we present our study of laparoscopic cholecystectomy using the fluorescent dye in a swine model. STUDY DESIGN/MATERIALS AND METHODS With an approval from Institutional Animal Care and Use Committee, two 20-25 kg swine underwent laparoscopic abdominal surgery using a Food and Drug Administration-cleared fluorescent laparoscopic system. Images of the liver and gallbladder were taken both before and after intravenous injection of the novel fluorescent dye. The dye was dosed at 60 μg/kg and injected via the ear vein. The amount of time taken to visualize fluorescence in the biliary tract was measured. Fluorescent signal was observed after injection, and target-to-background ratio (TBR) of the biliary tract to surrounding cystic artery and liver parenchyma was measured. RESULTS Biliary tract visualization under fluorescent laparoscopy was achieved within 5 min after the dye injection without any adverse effects. Cystic duct and extrahepatic duct were clearly visualized and identified with TBR values of 2.19 and 2.32, respectively, whereas no fluorescent signal was detected in liver. Cystic duct and artery were successfully ligated by an endoscopic clip applier with the visual assistance of highlighted biliary tract images. Laparoscopic cholecystectomy was completed within 30 min in each case without any complications. CONCLUSIONS BL-760 is a novel preclinical fluorescent dye useful for intraoperative identification and visualization of biliary tract. Such fluorescent dye that is exclusively metabolized by liver and rapidly excreted into biliary tract would be beneficial for all types of hepato-biliary surgeries. With the validation of additional preclinical data, this novel dye has potential to be a valuable tool to prevent any iatrogenic biliary injuries and/or bile leaks during laparoscopic abdominal and liver surgeries.
Collapse
Affiliation(s)
- Yu Jeong Cho
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, District of Columbia, USA.,Department of Surgery, Asan Medical Center, Songpa-Gu, Seoul, South Korea
| | - So-Hyun Nam
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, District of Columbia, USA.,Department of Surgery, Dong-A University College of Medicine, Seo-Gu, Busan, South Korea
| | - Eugene Oh
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, District of Columbia, USA.,Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael P Luciano
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, Maryland, USA
| | - Choonghee Lee
- InTheSmart Co., Center for Medical Innovation Bld., Jongro-gu, Seoul, South Korea
| | - Il Hyung Shin
- InTheSmart Co., Center for Medical Innovation Bld., Jongro-gu, Seoul, South Korea
| | - Martin J Schnermann
- Chemical Biology Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, Maryland, USA
| | - Jaepyeong Cha
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, District of Columbia, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Kwan Woo Kim
- Department of Surgery, Dong-A University College of Medicine, Seo-Gu, Busan, South Korea
| |
Collapse
|
2
|
Marano L, Bartoli A, Polom K, Bellochi R, Spaziani A, Castagnoli G. The unwanted third wheel in the Calot's triangle: Incidence and surgical significance of caterpillar hump of right hepatic artery with a systematic review of the literature. J Minim Access Surg 2019; 15:185-191. [PMID: 29737324 PMCID: PMC6561071 DOI: 10.4103/jmas.jmas_75_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Caterpillar hump of the right hepatic artery is a rare variation increasing the risk of vascular and biliary injuries during hepatobiliary surgery. The aim of this study is to record the cases of the right hepatic artery forming caterpillar hump in a cohort of patients underwent laparoscopic cholecystectomy and to report a review of the literature systematically conducted. Methods: We reviewed clinical and surgical video data of 230 patients with symptomatic cholelithiasis treated with laparoscopic cholecystectomy between January 2016 and August 2017. A systematic literature search in PubMed, Medline, Cochrane and Ovid databases until 30th June 2017 was also performed in accordance with the PRISMA statement. Results: Our institutional data indicated that 1.3% of 230 patients presented caterpillar hump right hepatic artery. The systematic review included 16 studies reporting data from a total of 498 human cadavers and 579 patients submitted to cholecystectomy. The overall proportion of surgical patients with the caterpillar hump right hepatic artery was 6.9%. Conclusions: Variations of the cystic artery are not just an anatomical dissertation, assuming a very crucial role in surgical strategies to avoid uncontrolled vascular lesions. A meticulous knowledge of the hepatobiliary triangle in association with all elements of ‘Culture of Safety in Cholecystectomy’ is mandatory for surgeons facing more than two structures within Calot's triangle.
Collapse
Affiliation(s)
- Luigi Marano
- Department of Surgery, 'San Matteo Degli Infermi Hospital', Spoleto (PG), Italy
| | - Alberto Bartoli
- Department of Surgery, 'San Matteo Degli Infermi Hospital', Spoleto (PG), Italy
| | - Karol Polom
- Department of Surgical Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Raffaele Bellochi
- Department of Surgery, 'San Matteo Degli Infermi Hospital', Spoleto (PG), Italy
| | - Alessandro Spaziani
- Department of Surgery, 'San Matteo Degli Infermi Hospital', Spoleto (PG), Italy
| | | |
Collapse
|
3
|
Hepatic ductoplasty for iatrogenic Bismuth type 2 bile duct stricture: A case report. Int J Surg Case Rep 2018; 51:161-164. [PMID: 30172055 PMCID: PMC6122482 DOI: 10.1016/j.ijscr.2018.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/15/2018] [Indexed: 11/24/2022] Open
Abstract
The article represents recovering treatment of iatrogenic biliary tract injury by laparoscopic cholecystectomy. Biliary tract stricture like Bismuth type 2 successfully treated by hepatic ductoplasty. To emphasize the importance of avoiding biliary stricture is a key to prevent cholangitis and stone recurrences.
Introduction Biliary enteric anastomosis is a well-known biliary reconstruction method. Anastomosis stricture is one of the complications of this procedure that occurs in some patients over the long-term. We report a successful case of hepatic ductoplasty combined with hepaticojejunostomy (H–J) for the treatment of iatrogenic Bismuth type 2 stricture. Presentation of case The patient was a 68-year-woman who had undergone choledochojejunostomy (C–J) 6 years earlier due to bile duct injury after laparoscopic cholecystectomy for cholelithiasis. She complained of recurrent chills and upper back pain. Cholangiography and computed tomography revealed a C–J anastomotic stricture with hepatolithiasis. The diagnosis was reflux cholangitis with hepatolithiasis due to C–J stricture and a fistula between the reconstructed jejunal limb and duodenum. Exploration was performed, and she underwent hepatic ductoplasty with H–J and hepaticolithotripsy. Surgery was performed uneventfully and the patient has remained well subsequently. Discussion and conclusion We propose hepatic ductoplasty as a useful technique for the treatment of selected patients with a C–J stricture or narrow hepatic duct.
Collapse
|
4
|
Retroinfundibular laparoscopic cholecystectomy versus standard laparoscopic cholecystectomy in difficult cases. Int J Surg 2017; 43:75-80. [PMID: 28552812 DOI: 10.1016/j.ijsu.2017.05.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 05/12/2017] [Accepted: 05/21/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy becomes the gold standard surgical procedure for treating gallstones. Standard laparoscopic cholecystectomy (SLC) requires proper dissection of Calot's triangle to achieve the critical view of safety. This may be difficult in certain conditions, resulting in higher incidence of bile duct injury and conversion to open. We aimed to compare the outcomes of laparoscopic cholecystectomy by retroinfundibular (RI) approach to that of SLC, in difficult cases. PATIENTS AND METHODS This study is prospective cohort study, in which 60 patients were operated by SLC and 65 patients by laparoscopic cholecystectomy by RI approach. RESULTS From the total 125 cases, 95 (76%) patients were male and 30 (24%) were female. The mean age was 59.5 ± 5.5 years. The mean operative time in SLC group was 128 ± 17 min VS. 114 ± 10 min in RI group. Conversion to open occurred in 10% in SLC group VS. 1.5% in RI group. Biliary injury occurred in 3.3% in SLC group VS. 0% in RI group. The mean hospital stay in SLC was 3.7 ± 5.3 days VS. 2.1 ± 0.3 days in RI group. CONCLUSION In difficult cholecystectomy, RI approach is feasible and safe alternative to SLC.
Collapse
|
5
|
Hogan NM, Dorcaratto D, Hogan AM, Nasirawan F, McEntee P, Maguire D, Geoghegan J, Traynor O, Winter DC, Hoti E. Iatrogenic common bile duct injuries: Increasing complexity in the laparoscopic era: A prospective cohort study. Int J Surg 2016; 33 Pt A:151-6. [PMID: 27512909 DOI: 10.1016/j.ijsu.2016.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 07/18/2016] [Accepted: 08/04/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE Iatrogenic bile duct injury (BDI) is the most significant associated complication to laparoscopic cholecystectomy (LC). Little is known about the evolution of the pattern of BDI in the era of laparoscopy. The aim of the study is to assess the pattern of post-LC BDIs managed in a tertiary referral centre. METHODS Post-LC BDI referred over two decades were studied. Demographic data, type of BDI (classified using the Strasberg System), clinical symptoms, diagnostic investigations, timing of referral, post-referral management and morbidity were analysed. The pattern of injury, associated vascular injuries rate and their management were compared over two time periods (1992-2004,2005-2014). RESULTS 78 BDIs were referred. During the second time period Strasberg A injuries decreased from 14% to 0 and Strasberg E1increased from 4% to 23%, the rate of associated vascular injury was six time higher (3.6% versus 22.7%), more patients had an attempted repair at the index hospital (16% versus 35%) sand fewer patients could be managed without surgical intervention at the referral hospital (28% versus 4%). CONCLUSION Complexity of referred BDIs and rate of associated vascular injuries have increased over time. These findings led to more patients managed requiring surgical intervention at the referral hospital.
Collapse
Affiliation(s)
- N M Hogan
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D Dorcaratto
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - A M Hogan
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - F Nasirawan
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - P McEntee
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D Maguire
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - J Geoghegan
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - O Traynor
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D C Winter
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - E Hoti
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| |
Collapse
|
6
|
Abstract
UNLABELLED Advances in microsurgery have displayed promising results for the treatment of lymphedema. The use of vascularized lymph node transfers has increased in popularity but incurs the potential risk for donor-site lymphedema. The omentum has been previously described for the treatment of lymphedema but has been overlooked because of presumed high morbidity, including the need for celiotomy and pedicled complications. The authors present a novel technique and early results of the laparoscopic free omental lymphatic flap for the management of lymphedema. The minimally invasive harvest successfully avoids both the previously associated morbidity of this flap and the risk of iatrogenic lymphedema to the donor site. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
Collapse
|
7
|
Murray M, Healy DA, Ferguson J, Bashar K, McHugh S, Clarke Moloney M, Walsh SR. Effect of institutional volume on laparoscopic cholecystectomy outcomes: Systematic review and meta-analysis. World J Meta-Anal 2015; 3:26-35. [DOI: 10.13105/wjma.v3.i1.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/02/2014] [Accepted: 12/31/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To determine whether institutional laparoscopy cholecystectomy (LC) volume affects rates of mortality, conversion to open surgery, bile leakage and bile duct injury (BDI).
METHODS: Eligible studies were prospective or retrospective cohort studies that provided data on outcomes from consecutive LC procedures in single institutions. Relevant outcomes were mortality, conversion to open surgery, bile leakage and BDI. We performed a Medline search and extracted data. A regression analysis using generalized estimating equations were used to determine the influence of annual institutional LC caseload on outcomes. A sensitivity analysis was performed including only those studies that were published after 1995.
RESULTS: Seventy-three cohorts (127404 LC procedures) were included. Average complication rates were 0.06% for mortality, 3.23% for conversion, 0.44% for bile leakage and 0.28% for bile duct injury. Annual institutional caseload did not influence rates of mortality (P = 0.142), bile leakage (P = 0.111) or bile duct injury (P = 0.198) although increasing caseload was associated with reduced incidence of conversion (P = 0.019). Results from the sensitivity analyses were similar.
CONCLUSION: Institutional volume is a determinant of LC complications. It is unclear whether volume is directly linked to complication rates or whether it is an index for protocolised care.
Collapse
|
8
|
Kais H, Hershkovitz Y, Abu-Snina Y, Chikman B, Halevy A. Different setups of laparoscopic cholecystectomy: Conversion and complication rates: A retrospective cohort study. Int J Surg 2014; 12:1258-61. [DOI: 10.1016/j.ijsu.2014.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/21/2014] [Accepted: 10/14/2014] [Indexed: 12/25/2022]
|
9
|
Chun K. Recent classifications of the common bile duct injury. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2014; 18:69-72. [PMID: 26155253 PMCID: PMC4492327 DOI: 10.14701/kjhbps.2014.18.3.69] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 08/11/2014] [Accepted: 08/13/2014] [Indexed: 02/07/2023]
Abstract
Laparoscopic cholecystectomy is now a gold standard treatment modality for gallstone diseases. However, the incidence rate of bile duct injury has not been changed for many years. From initial classification published by Bismuth, there have been many classifications of common bile duct injury. The initial classification, levels and types of bile duct injury, and currently combined vascular injuries are reviewed here.
Collapse
Affiliation(s)
- Kwangsik Chun
- Department of Surgery, Chungnam National University Hospital, Daejeon, Korea
| |
Collapse
|
10
|
Iannelli A, Paineau J, Hamy A, Schneck AS, Schaaf C, Gugenheim J. Primary versus delayed repair for bile duct injuries sustained during cholecystectomy: results of a survey of the Association Francaise de Chirurgie. HPB (Oxford) 2013; 15:611-6. [PMID: 23458568 PMCID: PMC3731582 DOI: 10.1111/hpb.12024] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/28/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bile duct injuries (BDIs) sustained during a cholecystectomy still remain a major surgical problem, and it is still not clear whether the injury should be repaired immediately or a delayed repair is preferred. METHODS A retrospective national French survey was conducted to compare the results of immediate (at time of cholecystectomy), early (within 45 days after a cholecystectomy) and late (beyond 45 days after a cholecystectomy) surgical repair for BDI sustained during a cholecystectomy. RESULTS Forty-seven surgical centres provided 640 cases of bile duct injury sustained during a cholecystectomy of which 543 were analysed for the purpose of the present study. The timing of repair was immediate in 194 cases (35.7%), early in 216 cases (39.8%) and late in 133 cases (24.5%). The type of repair was a suture repair in 157 cases (81%), and a bilio-digestive reconstruction in 37 cases (19%) for immediate repair; a suture repair in 119 cases (55.1%) and a bilio-digestive anastomosis in 96 cases (44.9%) for the early repair; and a bilio-digestive reconstruction in 129 cases (97%) and a suture repair in 4 cases (3%) for late repair. A second procedure was required in 110 cases (56.7%) for immediate repair, 80 cases (40.7%) for early repair (P < 0.05) and in 9 cases (6.8%) for late repair (P < 0.001). CONCLUSION The timing of surgical repair for a bile duct injury sustained during a cholecystectomy influences significantly the rate of a second procedure and a late repair should be preferred option.
Collapse
Affiliation(s)
- Antonio Iannelli
- Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet 2, Centre Hospitalo Universitaire, Université de Nice Sophia AntipolisNice
| | - Jacques Paineau
- Institut de Cancérologie de l'Ouest René Gauducheau Oncologie ChirurgicaleNantes, France
| | - Antoine Hamy
- Service de Chirurgie Digestive et Endocrinienne, Centre Hospitalier et UniversitaireAngers, France
| | - Anne-Sophie Schneck
- Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet 2, Centre Hospitalo Universitaire, Université de Nice Sophia AntipolisNice
| | - Caroline Schaaf
- Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet 2, Centre Hospitalo Universitaire, Université de Nice Sophia AntipolisNice
| | - Jean Gugenheim
- Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet 2, Centre Hospitalo Universitaire, Université de Nice Sophia AntipolisNice
| |
Collapse
|
11
|
Malik AM, Laghari AA, Mallah Q, Hashmi F, Sheikh U, Talpur KAH. [Not Available]. J Minim Access Surg 2013; 4:5-8. [PMID: 19547669 PMCID: PMC2699055 DOI: 10.4103/0972-9941.40990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Accepted: 01/08/2008] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To deteremine the incidence, nature and management of extra-biliary complications of laparoscopic cholecystectomy. MATERIALS AND METHODS This study presents a retrospective analysis of extra-biliary complications occuring during 1046 laparoscopic cholecystectomies performed from August 2003 to December 2006. The study population included all the patients with symptomatic gallstone disease in whom laparoscopic cholecystectomy was performed. The extra-biliary complications were divided into two distinct categories: (i) Procedure related and (ii) Access related. RESULTS The incidence of access-related complications was 3.77% and that of procedure-related complications was 6.02%. Port-site bleeding was troublesome at times and demanded a re-do laparoscopy or conversion. Small bowel laceration occurred in two patients where access was achieved by closed technique. Five cases of duodenal and two of colonic perforations were the major complications encountered during dissection in the area of Calot's triangle. In 21 (2%) patients the procedure was converted to open surgery due to different complications. Biliary complications occurred in 2.6% patients in the current series. CONCLUSION Major extra-biliary complications are as frequent as the biliary complications and can be life-threatening. An early diagnosis is critical to their management.
Collapse
Affiliation(s)
- Arshad M Malik
- Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad, Pakistan
| | | | | | | | | | | |
Collapse
|
12
|
Pulvirenti E, Toro A, Gagner M, Mannino M, Di Carlo I. Increased rate of cholecystectomies performed with doubtful or no indications after laparoscopy introduction: a single center experience. BMC Surg 2013; 13:17. [PMID: 23724992 PMCID: PMC3679744 DOI: 10.1186/1471-2482-13-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 05/22/2013] [Indexed: 12/24/2022] Open
Abstract
Background During recent years laparoscopic cholecystectomy has dramatically increased, sometimes resulting in overtreatment. Aim of this work was to retrospectively analyze all laparoscopic cholecystectomies performed in a single center in order to find the percentage of patients whose surgical treatment may be explained with this general trend, and to speculate about the possible causes. Methods 831 patients who underwent a laparoscopic cholecystectomy from 1999 to 2008 were retrospectively analyzed. Results At discharge, 43.08% of patients were operated on because of at least one previous episode of biliary colic before the one at admission; 14.08% of patients presented with acute lithiasic cholecystitis; 14.68% were operated on because of an increase in bilirubin level; 1.56% were operated on because of a previous episode of jaundice with normal bilirubin at admission; 0.72% had gallbladder adenomas, 0.72% had cholangitis, 0.36% had biliodigestive fistula and one patient (0.12%) had acalculous cholecystitis. By excluding all these patients, 21.18% were operated on without indications. Conclusions The broadening of indications for laparoscopic cholecystectomy is undisputed and can be considered a consequence of new technologies that have been introduced, increased demand from patients, and the need for practice by inexperienced surgeons. If not prevented, this trend could continue indefinitely.
Collapse
Affiliation(s)
- Elia Pulvirenti
- Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Cannizzaro Hospital, Catania, Italy
| | | | | | | | | |
Collapse
|
13
|
Is Monopolar Electrocautery Safe and Effective for Control of the Cystic Artery During Laparoscopic Cholecystectomy? J Laparoendosc Adv Surg Tech A 2012; 22:557-60. [DOI: 10.1089/lap.2011.0507] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
14
|
A novel classification system to address financial impact and referral decisions for bile duct injury in laparoscopic cholecystectomy. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2011; 2011:371245. [PMID: 21912446 PMCID: PMC3170787 DOI: 10.1155/2011/371245] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 06/27/2011] [Accepted: 07/12/2011] [Indexed: 12/20/2022]
Abstract
Purpose. The study was undertaken to evaluate a novel
classification system developed to estimate financial cost of bile
duct injury (BDI) and to aid in decision making for referral.
Study Design. A retrospective review of
patients referred for BDI was performed. Grade I injuries involve the
duct of Luschka or accessory right hepatic ducts, grade II includes
all other biliary injuries, and grade III includes all vasculobiliary
injuries. Groups were compared using standard statistical methods.
Results. There were 14 grade I, 74 grade II,
and 20 grade III injuries. There was a significant difference in the
cost and mortality of grade I ($12,457, 0%), grade II ($46,481, 1.4%),
and grade III ($69,368, 15%,
P = 0.002
and
P = 0.030,
resp.) injuries. Grade II and III injuries were significantly more
likely to require surgical repair (OR 27.7,
P < 0.001).
Conclusion. We have presented a simple
classification system that is able to accurately predict cost and need
for surgical repair.
Collapse
|
15
|
Lau KN, Sindram D, Agee N, Martinie JB, Iannitti DA. Bile duct injury after single incision laparoscopic cholecystectomy. JSLS 2011; 14:587-91. [PMID: 21605529 PMCID: PMC3083056 DOI: 10.4293/108680810x12924466008646] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
This study notes that the development of single-incision laparoscopic surgery is not without risk and that obtaining the critical view in appropriately selected patients is essential for safe single-incision laparoscopic surgery. Background: The advancement and development of laparoscopic cholecystectomy revolutionized surgery and case management. Many procedures are routinely performed laparoscopically. Single incision laparoscopic surgery has been introduced with the hope of further reduction of scarring and possibly procedural pain. With no established technique for this procedure, the safety of single incision laparoscopic cholecystectomy has not been determined. Methods and Results: A 30-year-old man underwent single incision laparoscopic cholecystectomy for symptomatic cholelithiasis at an outside hospital. The operation was uneventful, and the patient was discharged home. The patient returned to the Emergency Department 4 days postoperatively, and a bile duct injury was diagnosed. A percutaneous drain was placed, and the patient was transferred to the Hepato-Pancreato-Biliary (HPB) service of a tertiary care center for definitive care. A delayed repair approach was used to allow the inflammation around the porta to decrease. Six weeks after injury, the patient underwent Roux-en-Y hepaticojejunostomy. The patient did well postoperatively. Conclusion: Although single incision laparoscopic surgery will play a prominent role in the future, its development and application are not without risks as demonstrated from this case. It is imperative that surgeons better define the surgical approach to achieve the critical view and select appropriate patients for single incision laparoscopic cholecystectomy.
Collapse
Affiliation(s)
- Kwan N Lau
- HPB Surgery, Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina 28203, USA
| | | | | | | | | |
Collapse
|
16
|
Santos BF, Hungness ES. Natural orifice translumenal endoscopic surgery: Progress in humans since white paper. World J Gastroenterol 2011; 17:1655-65. [PMID: 21483624 PMCID: PMC3072628 DOI: 10.3748/wjg.v17.i13.1655] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 02/22/2011] [Accepted: 03/01/2011] [Indexed: 02/06/2023] Open
Abstract
Since the first description of the concept of natural orifice translumenal endoscopic surgery (NOTES), a substantial number of clinical NOTES reports have appeared in the literature. This editorial reviews the available human data addressing research questions originally proposed by the white paper, including determining the optimal method of access for NOTES, developing safe methods of lumenal closure, suturing and anastomotic devices, advanced multitasking platforms, addressing the risk of infection, managing complications, addressing challenges with visualization, and training for NOTES procedures. An analysis of the literature reveals that so far transvaginal access and closure appear to be the most feasible techniques for NOTES, with a limited, but growing transgastric, transrectal, and transesophageal NOTES experience in humans. The theoretically increased risk of infection as a result of NOTES procedures has not been substantiated in transvaginal and transgastric procedures so far. Development of suturing and anastomotic devices and advanced platforms for NOTES has progressed slowly, with limited clinical data on their use so far. Data on the optimal management and incidence of intraoperative complications remain sparse, although possible factors contributing to complications are discussed. Finally, this editorial discusses the likely direction of future NOTES development and its possible role in clinical practice.
Collapse
|
17
|
Ruiz Gómez F, Ramia Ángel JM, García-Parreño Jofré J, Figueras J. Lesiones iatrogénicas de la vía biliar. Cir Esp 2010; 88:211-21. [DOI: 10.1016/j.ciresp.2010.03.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 02/21/2010] [Accepted: 03/12/2010] [Indexed: 12/20/2022]
|
18
|
Downing SR, Datoo G, Oyetunji TA, Fullum T, Chang DC, Ahuja N. Asian race/ethnicity as a risk factor for bile duct injury during cholecystectomy. ACTA ACUST UNITED AC 2010; 145:785-7. [PMID: 20713933 DOI: 10.1001/archsurg.2010.131] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Iatrogenic bile duct injury (BDI) is an uncommon but serious complication of cholecystectomy, with identified risk factors of acute cholecystitis, male sex, older age, and aberrant biliary anatomy. The Nationwide Inpatient Sample (1998-2006) was queried for cholecystectomy performed on hospital day 0 or 1. Bile duct injury repair procedure codes were used as a surrogate for BDI. We identified 377,424 patients who underwent cholecystectomy, with 1124 BDIs (0.3%). On multivariate logistic regression analysis, Asian race/ethnicity was a significant risk factor for BDI (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.59-3.23; P < .001). This persisted for laparoscopic (OR, 2.62; 95% CI, 1.28-5.39; P = .009) and open (2.21; 1.59-3.07; P < .001) cholecystectomies. No other race/ethnicity was identified as a risk factor for BDI. We report a new finding that Asian race/ethnicity is a significant risk factor for BDI in laparoscopic and open cholecystectomies.
Collapse
Affiliation(s)
- Stephanie R Downing
- Department of Surgery, The Johns Hopkins University School of Medicine, 1650 Orleans St, Baltimore, MD 21287, USA
| | | | | | | | | | | |
Collapse
|
19
|
Müeller D, Sauerland S, Neugebauer EAM, Immenroth M. Reported effects in randomized controlled trials were compared with those of nonrandomized trials in cholecystectomy. J Clin Epidemiol 2010; 63:1082-90. [PMID: 20346627 DOI: 10.1016/j.jclinepi.2009.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 11/23/2009] [Accepted: 12/14/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Because external validity of randomized controlled trials (RCTs) may be insufficient, the performance of nonrandomized controlled trials (nRCTs) is increasingly debated. RCTs and nRCTs were compared using the example of laparoscopic vs. open cholecystectomy (LC vs. OC). STUDY DESIGN AND SETTING RCTs and nRCTs comparing LC and OC were identified by searching PubMed. To assess internal and external validity of the studies, patient characteristics, relative risks, and mean differences of RCTs and nRCTs were compared by meta-analytic techniques. RESULTS In total, 162 studies were analyzed (136 nRCTs and 26 RCTs). Significant discrepancies between RCT- and nRCT-based results were revealed for 3 of 15 variables: overall complications (P<0.021), wound infections (P<0.014), and length of hospital stay (P<0.005). In RCTs and in nRCTs, length of hospital stay and return to work were significantly reduced when using LC compared with OC. The results of nRCTs were more often heterogeneous among themselves (11 of 15) as compared with RCTs (4 of 15). CONCLUSION The results of RCTs and nRCTs differ significantly in at least 20% of the variables. External validities of RCTs and nRCTs in LC vs. OC appear to be similar. Between-study heterogeneity was larger in nRCTs than in RCTs of cholecystectomy.
Collapse
Affiliation(s)
- Dirk Müeller
- Institute for Research in Operative Medicine, University Witten/Herdecke, Cologne, Germany.
| | | | | | | |
Collapse
|
20
|
|
21
|
Abstract
Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popular and simple classification of IBDI is the Bismuth scale. Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered. Different surgical reconstructions are performed in patients with IBDI. According to the literature, Roux-en-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors. In the opinion of some authors, a more physiological and equally effective type of reconstruction is end-to-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI; the Terblanche scale, based on clinical biliary symptoms, is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life.
Collapse
|
22
|
Bell AK, Zhou M, Schwaitzberg SD, Cao CGL. Using a dynamic training environment to acquire laparoscopic surgery skill. Surg Endosc 2009; 23:2356-63. [PMID: 19263152 DOI: 10.1007/s00464-009-0346-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 11/04/2008] [Accepted: 12/17/2008] [Indexed: 12/15/2022]
Abstract
BACKGROUND Current physical laparoscopic surgical simulators provide training only for static tasks, which do not develop the more advanced hand-eye coordination skills needed to navigate the dynamic surgical environment. A novel dynamic minimally invasive training environment (DynaMITE) was developed to address this need. This study aimed to evaluate further the utility of the system as a training and skill assessment tool. Two studies were performed with a second-generation design. The authors hypothesized that the dynamic task environment would be challenging to novices and would differentiate experienced surgeons from the inexperienced by emphasising the dynamic skills gained through surgical experience. METHODS The participants in the first study were 42 novice and experienced surgeons attending the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2007 Learning Center, whereas the second controlled laboratory study had 16 participants (5 novices and 11 experienced surgeons). The participants performed two tasks: an aiming task and an object manipulation task. Both tasks were positioned on a dynamic platform that moved in five different trajectories. RESULTS The subjective feedback from the surgeons at the SAGES Learning Center was positive. The results from the controlled study showed significant performance deterioration in the fast diagonal task compared with the task of aiming and manipulating in the static environment for both experience groups but no performance differences between the groups. CONCLUSIONS Dynamic tasks are challenging, and surgeons need to be trained specifically for these tasks. The DynaMITE system can provide training benefits for dynamic skill development, even for expert surgeons who may have had no opportunity to gain these skills through their surgical practice.
Collapse
Affiliation(s)
- A K Bell
- Department of Mechanical Engineering, Tufts University, 200 College Avenue, Medford, MA 02155, USA.
| | | | | | | |
Collapse
|
23
|
Treatment of recurrent bile duct stricture after primary reconstruction for laparoscopic cholecystectomy-induced injury. Surg Laparosc Endosc Percutan Tech 2008; 18:445-8; discussion 449. [PMID: 18936662 DOI: 10.1097/sle.0b013e31817a7e47] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Laparoscopic cholecystectomy (LC) has been accepted as a primary treatment modality for various benign gallbladder diseases. However, bile duct injury has occurred in a non-negligible proportion of patients who undergo LC. The outcome of primary reconstruction for LC-induced major bile duct injuries is usually favorable, but a small proportion of patients revealed serious biliary stricture during follow-up. We described the experience on the treatment for such delayed-onset bile duct strictures that occurred in 5 patients. One patient showed biliary strictures 6 months after primary hepaticojejunostomy, which were successfully treated with radiologic intervention. Other 4 patients underwent right lobectomy and redo hepaticojejunostomy 4 to 16 months after primary biliary reconstruction. No recurrent biliary stricture occurred during mean follow-up of 40 months. In conclusion, prolonged surveillance over 5 years seems necessary for the detection of delayed-onset biliary stricture after primary biliary reconstruction. Delayed-onset bile duct stricture should be treated on the case-by-case basis, with radiologic intervention or radical biliary reconstruction combined with liver resection.
Collapse
|
24
|
González Rodríguez FJ, Bustamante Montalvo M, Conde Freire R, Martínez J, Rodríguez Segade F, Varo E. [Management of patients with iatrogenic bile duct injury]. Cir Esp 2008; 84:20-7. [PMID: 18590671 DOI: 10.1016/s0009-739x(08)70599-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The aim of this study is to present an analysis of 30 patients with major bile duct injuries in a single hospital centre. MATERIAL AND METHOD From January 2001 to December 2006, a prospective database was kept of all patients with a bile duct injury (BDI) following laparoscopic cholecystectomy (LC). Patients' charts were reviewed to analyse perioperative surgical management. RESULTS Over 6 years, 30 patients were treated for a major BDI. Patient demographics were not notable for 16 women (53%) and 14 men (47%) with a mean age of 58.9 years. Twenty of them sustained their BDI at another hospital. The mean interval from the time of BDI to referral was 17.4 days. A total of 30 patients underwent definitive biliary reconstruction, including 17 hepaticojejunostomies (56.7%), 8 end-to-end repairs (20%), 2 choledochoduodenostomies (6.7%), 3 liver transplantations (10%), 1 hepatectomy and 1 Whipple (3.3%). There were 2 deaths in the postoperative period (6.7%). Thirteen (43.3%) sustained at least 1 postoperative complication. The most common complications were cholangitis (20%), and intra-abdominal abscess/biloma (23.3%). The mean postoperative length of stay was 17.46 days. CONCLUSIONS Bile duct injury is a serious complication that affects mostly individuals with benign disease. Various subsequent procedures (surgical and/or endoscopic) are almost always necessary for its correction, with a high socioeconomic cost that imposes great suffering on the patients and their relatives. Clearly, all efforts should be made to prevent such accidents.
Collapse
Affiliation(s)
- Francisco Javier González Rodríguez
- Unidad de Trasplante Abdominal, Servicio de Cirugía General, Hospital Clínico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
| | | | | | | | | | | |
Collapse
|
25
|
Malik AM, Laghari AA, Talpur AH, Khan A. Iatrogenic biliary injuries during laparoscopic cholecystectomy. A continuing threat. Int J Surg 2008; 6:392-5. [DOI: 10.1016/j.ijsu.2008.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 07/30/2008] [Indexed: 12/30/2022]
|
26
|
Georgiades CP, Mavromatis TN, Kourlaba GC, Kapiris SA, Bairamides EG, Spyrou AM, Kokkinos CN, Spyratou CS, Ieronymou MI, Diamantopoulos GI. Is inflammation a significant predictor of bile duct injury during laparoscopic cholecystectomy? Surg Endosc 2008; 22:1959-64. [PMID: 18443865 DOI: 10.1007/s00464-008-9943-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Accepted: 03/27/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bile duct injuries (BDI) have been reported to occur more frequently during laparoscopic cholecystectomy (LC) compared to open cholecystectomy (OC). Several studies have demonstrated various potential predisposing factors for BDI. However, there is a controversy as to whether gallbladder inflammation is a significant predictor for BDI. Therefore, out primary aim was to investigate the relationship between inflammation and BDI at LC, and secondarily to present the management and clinical outcome of BDI. METHODS We recorded all consecutive LC performed between 1993 and 2005 in our institution by nine staff surgeons. BDI were classified according to Strasberg's classification. Simple and multivariate logistic regression analysis was performed to evaluate the association between inflammation and BDI occurrence during LC. RESULTS There were 2,184 patients. Among those, 344 had inflammation (16%). The conversion rate was 5% and was higher among male, elder patients, and those with inflammation. The BDI incidence was 0.69% (0.14% for major and 0.55% for minor injuries) and it was significantly higher in those with inflammation compared to those without inflammation (p = 0.01). In particular, the risk for BDI was almost 3.5 times higher in those with inflammation (OR = 3.61, 95% CI 1.27-10.21). Inflammation remained an independent risk factor for BDI even after adjustment for potential confounders. Among patients sustaining injury, one died and two have recurrent cholangitis. No association was observed between clinical outcome and management of BDI, time of diagnosis, sex, and inflammation. CONCLUSION We revealed that inflammation is an independent predictor of BDI occurrence during LC. Therefore, it would be advisable for surgeons to not hesitate to convert a LC to an OC in the presence of inflammation.
Collapse
Affiliation(s)
- Christos P Georgiades
- 3rd Surgical Department and Laparoscopic Unit, Evangelismos General Hospital, Athens, Greece.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Ding YM, Wang B, Wang WX, Wang P, Yan JS. New classification of the anatomic variations of cystic artery during laparoscopic cholecystectomy. World J Gastroenterol 2007; 13:5629-34. [PMID: 17948938 PMCID: PMC4172743 DOI: 10.3748/wjg.v13.i42.5629] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the anatomic variations in the cystic artery by laparoscopy, and to provide a new classification system for the guidance of laparoscopic surgeons.
METHODS: Six hundred patients treated with laparoscopic cholecystectomy from June 2005 to May 2006 were studied retrospectively. The laparoscope of 30˚ (Stryker, American) was applied. Anatomic structures of cystic artery and conditions of Calot's triangle under laparoscope were recorded respectively.
RESULTS: Laparoscopy has revealed there are many anatomic variations of the cystic artery that occur frequently. Based on our experience with 600 laparoscopic cholecystectomies, we present a new classification of anatomic variations of the cystic artery, which can be divided into three groups: (1) Calot's triangle type, found in 513 patients (85.5%); (2) outside Calot's triangle, found in 78 patients (13%); (3) compound type, observed in 9 patients (1.5%).
CONCLUSION: Our classification of the anatomic variations of the cystic artery will be useful for decreasing uncontrollable cystic artery hemorrhage, and avoiding extrahepatic bile duct injury.
Collapse
|
28
|
Watanabe M, Yamazaki K, Tsuchiya M, Otsuka Y, Tamura A, Shimokawa K, Kaneko H, Teramoto T. Use of an opened umbilical vein patch for the reconstruction of the injured biliary tract. ACTA ACUST UNITED AC 2007; 14:270-5. [PMID: 17520202 DOI: 10.1007/s00534-006-1183-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Accepted: 08/11/2006] [Indexed: 12/24/2022]
Abstract
BACKGROUND/PURPOSE When iatrogenic biliary tract injury occurs, there is the risk of complications such as bile leak and biliary stricture, and hepaticojejunostomy is the conventional procedure used for injury repair. However, this procedure can be complicated by retrograde biliary tract infection and the procedure can destroy the normal anatomical structure. METHODS We report here a method of end-to-end biliary tract reconstruction that uses an opened umbilical vein (OUV) patch and two stents to reduce bile leakage and biliary stricture formation following injury to the common bile duct or right main bile duct. The postoperative courses of four patients are reviewed. RESULTS In two of the patients, there was a small amount of postoperative bile drainage (for 3 days in the first patient and 2 days in the second patient). Of the two stents, the first stent was removed 1 month postoperatively, and the second stent at 2 to 3 months postoperatively. Three patients have returned to normal activity without symptoms after 44, 62, and 93 months, respectively. One patient died of a liver tumor recurrence in the fifth postoperative month, without a biliary problem. CONCLUSIONS An OUV patch for end-to-end biliary reconstruction reduced the volume and duration of bile leakage. Further research is needed to accurately evaluate the stenting period so as to reduce its duration.
Collapse
Affiliation(s)
- Masashi Watanabe
- Department of Surgery, Omori Hospital, Toho University School of Medicine, 6-11-1 Omorinishi, Tokyo 143-8541, Japan
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
In the field of visceral surgery, complications requiring reintervention following laparoscopy are currently most likely to be approached with conventional laparotomy. However, relaparoscopy has the theoretical advantage of maintaining the reduced morbidity allowed by the first procedure. Essential to the success of relaparoscopy is a clear understanding of the various specific complications. Should the surgeon decide on relaparoscopy, then prompt action is of central importance. Following laparoscopic cholecystectomy, it is fundamentally technically possible through renewed laparoscopy to treat not only subhepatic abscesses but also smaller lesions of the bile duct, for example from the gall bladder fossa. Revision of complications following fundoplication is technically very demanding and should be performed only by those most experienced in the techniques of laparoscopy. In contrast to interventional drainage, relaparoscopy of abscesses following laparoscopic appendectomy has the theoretical advantage of allowing recognition and treatment of the causes, for example in the case of appendicular stump insufficiency. Relapses very shortly after endoscopic surgery of inguinal herniae result from erroneous technique and may be corrected endoscopically in most cases. Complications following colon surgery have so far been dealt with using open surgery for technical reasons and also for patient safety. Given the uncertainty in the literature, patient safety must be paramount, when deciding on which technique is best to employ, particularly in cases of haemorrhage.
Collapse
Affiliation(s)
- I Leister
- Klinik für Allgemeinchirurgie, Georg-August-Universität Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Deutschland.
| | | |
Collapse
|
30
|
Villeta Plaza R, Landa García JI, Rodríguez Cuéllar E, Alcalde Escribano J, Ruiz López P. [National project for the clinical management of healthcare processes. The surgical treatment of cholelithiasis. Development of a clinical pathway]. Cir Esp 2007; 80:307-25. [PMID: 17192207 DOI: 10.1016/s0009-739x(06)70975-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Because surgical treatment of gallstones is highly prevalent, this topic is particularly suitable for a national study aimed at determining the most important indicators and developing a clinical pathway. OBJECTIVES To analyze the results obtained during the hospital phase of the process. To define the key indicators of the process. To design a clinical pathway for laparoscopic cholecystectomy. PATIENTS AND METHODS A multicenter, prospective, cross-sectional, descriptive study was performed of patients who consecutively underwent surgery for gallstones in 2002. The sample size calculated with data provided by the National Institute of Statistics was 304 patients, which was increased by 45% to compensate for possible losses. Inclusion criteria consisted of elective cholecystectomy for gallstones, without preoperative findings suggestive of common duct stones. A database was designed (Microsoft Access 2000) with 76 variables analyzed in each patient. RESULTS Completed questionnaires were obtained from 37 hospitals with 426 patients. The mean age was 55.69 years, with a predominance of women (68.3%). The most frequent symptom was biliary colic (23%). A total of 20.3% of the patient had prior episodes of cholecystitis and 18% had a history of mild pancreatitis. Diagnosis was given by ultrasonography in 93.2% of the patients. Informed consent was provided by 93.2%. The intervention was performed on an inpatient basis in 96.1% and in the ambulatory setting in the remainder. Antibiotic and antithrombotic prophylaxis was administered in 78.9% and 75.1% of the patients respectively. The laparoscopic approach was used in 84.6%, with a conversion rate of 4.9%. Intraoperative cholangiography was performed in 17.8% of the patients and common duct stones were found in 7 patients. The most frequent complication was surgical wound infection (1.1%). Possible accidental lesion of the biliary tract occurred in 0.7% of the patients and was described as biliary fistula. There were four reinterventions: biliary fistula (1), hemoperitoneum (2) and cause unknown (1). The mean surgical time was 73.17 minutes, with a median of 60 minutes. Postoperative length of stay was 4.75 days in open surgery and 2.67 days in laparoscopic surgery. Ninety-nine percent of the patients were satisfied or highly satisfied with the healthcare received. CONCLUSIONS Analysis of the process and review of the literature identified a series of areas requiring improvement, which were gathered in the clinical pathway developed. These areas consisted of increasing the number of patients with correctly indicated antibiotic and antithrombotic prophylaxis, increasing the percentage of patients providing informed consent and undergoing adequate preoperative tests, limiting intraoperative cholangiography to selected patients, and reducing the number of patients with an overall stay of 3 days.
Collapse
Affiliation(s)
- R Villeta Plaza
- Sección de Gestión de Calidad de la Asociación Española de Cirujanos, Hospital Príncipes de Asturias, Alcalá de Henares, Madrid, España
| | | | | | | | | |
Collapse
|
31
|
Cholecystectomy - When and Why? POLISH JOURNAL OF SURGERY 2007. [DOI: 10.2478/v10035-007-0101-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
32
|
Williams BP, Fischer CP, Adler DG. Aberrant right hepatic sectoral duct injury following laparoscopic cholecystectomy: evaluation and treatment of a diagnostic dilemma. Dig Dis Sci 2006; 51:1773-6. [PMID: 17001514 DOI: 10.1007/s10620-006-9304-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2005] [Accepted: 03/05/2006] [Indexed: 12/09/2022]
Affiliation(s)
- Brian P Williams
- University of Texas, Houston Medical School, Houston, Texas 77030, USA
| | | | | |
Collapse
|
33
|
Milcent M, Santos EG, Bravo Neto GP. Lesão iatrogênica da via biliar principal em colecistectomia videolaparoscópica. Rev Col Bras Cir 2005. [DOI: 10.1590/s0100-69912005000600010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Estudar a incidência, mortalidade e morbidez da lesão iatrogênica da via biliar em um Hospital Universitário onde os pacientes foram operados por vários cirurgiões em diferentes fases de treinamento (residentes e "staffs"). MÉTODO: Estudo retrospectivo de pacientes operados no Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro (HUCFF-UFRJ) no período entre janeiro de 1992 e dezembro de 2003. Foram pesquisadas as lesões da via biliar principal, o tempo de reconhecimento das mesmas (per ou pós operatória) e o tipo de reparo utilizado. RESULTADOS: Foram estudados 1589 pacientes com índice de lesão da via biliar de 0.25%, as quais ocorreram principalmente nos últimos anos do uso da técnica no hospital. CONCLUSÕES: A incidência de lesões da via biliar foi semelhante à da literatura e bastante próxima à da cirurgia convencional, e não esteve diretamente relacionada à curva de aprendizado do cirurgião.
Collapse
|
34
|
Basile A, Macrì A, Bottari A, Lupattelli T, Scuderi G, Famulari C, Certo A. Novel use of a T-tube access to perform an internal/external biliary drainage. Eur Radiol 2005; 15:2200-2. [PMID: 16170558 DOI: 10.1007/s00330-004-2489-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2004] [Revised: 06/21/2004] [Accepted: 08/10/2004] [Indexed: 10/26/2022]
Abstract
We report a case of post-surgical temporary functional stenosis of the sphincter of Oddi and biliary leak in a patient with a previous Billroth II reconstruction who had undergone cholecystectomy, surgical choledochotomy and sphincterotomy for biliary calculi. The patient was treated by creation of an internal/external biliary drainage using the T-tube access with an unreported technique.
Collapse
Affiliation(s)
- Antonio Basile
- Department of Interventional Radiology, Ospedale Ferrarotto, Catania, Italy.
| | | | | | | | | | | | | |
Collapse
|
35
|
Sari YS, Tunali V, Tomaoglu K, Karagöz B, Güneyİ A, KaragöZ İ. Can bile duct injuries be prevented? "A new technique in laparoscopic cholecystectomy". BMC Surg 2005; 5:14. [PMID: 15963227 PMCID: PMC1182383 DOI: 10.1186/1471-2482-5-14] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Accepted: 06/17/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the last decade, laparoscopic cholecystectomy has gained worldwide acceptance and considered to be as "gold standard" in the surgical management of symptomatic cholecystolithiasis. However, the incidence of bile duct injury in laparoscopic cholecystectomy is still two times greater compared to classic open surgery. The development of bile duct injury may result in biliary cirrhosis and increase in mortality rates. The mostly blamed causitive factor is the misidentification of the anatomy, especially by a surgeon who is at the beginning of his learning curve. Biliary tree injuries may be decreased by direct coloration of the cystic duct, ductus choledochus and even the gall bladder. METHODS gall bladder fundus was punctured by Veress needle and all the bile was aspirated. The same amount of fifty percent methylene blue diluted by saline solution was injected into the gall bladder for coloration of biliary tree. The dissection of Calot triangle was much more safely performed after obtention of coloration of the gall bladder, cystic duct and choledocus. RESULTS Between October 2003 and December 2004, overall 46 patients (of which 9 males) with a mean age of 47 (between 24 and 74) underwent laparoscopic cholecystectomy with methylene blue injection technique. The diagnosis of chronic cholecystitis (the thickness of the gall bladder wall was normal) confirmed by pre-operative abdominal ultrasonography in all patients. The diameters of the stones were greater than 1 centimeter in 32 patients and calcula of various sizes being smaller than 1 cm. were documented in 13 cases. One patient was operated for gall bladder polyp (our first case). Successful coloration of the gall bladder, cystic duct and ductus choledochus was possible in 43 patients, whereas only the gall bladder and proximal cystic duct were visualised in 3 cases. In these cases, ductus choledochus visibility was not possible. None of the patients developed bile duct injury. CONCLUSION The number of bile duct injuries related to anatomic misidentification can be decreased and even vanished by using intraoperative methylene blue injection technique into the gall bladder fundus intraoperatively.
Collapse
Affiliation(s)
- Yavuz Selim Sari
- SSK İstanbul Training Hospital Department of General Surgery – Istanbul, Turkey
| | - Vahit Tunali
- SSK İstanbul Training Hospital Department of General Surgery – Istanbul, Turkey
| | - Kamer Tomaoglu
- Saint Georg Hospital Department of General Surgery, Hamburg, Austria
| | - Binnur Karagöz
- SSK İstanbul Training Hospital Department of General Surgery – Istanbul, Turkey
| | - Ayhan Güneyİ
- SSK İstanbul Training Hospital Department of General Surgery – Istanbul, Turkey
| | - İbrahim KaragöZ
- SSK İstanbul Training Hospital Department of General Surgery – Istanbul, Turkey
| |
Collapse
|
36
|
Kohneh Shahri N, Lasnier C, Paineau J. [Bile duct injuries at laparoscopic cholecystectomy: early repair results]. ACTA ACUST UNITED AC 2005; 130:218-23. [PMID: 15847856 DOI: 10.1016/j.anchir.2004.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2004] [Accepted: 12/22/2004] [Indexed: 12/27/2022]
Abstract
STUDY AIM To compare the early repair results in bile duct injuries at laparoscopic cholecystectomy to a later repair and so the early reconstruction by an end-to-end anastomosis to a Roux-en-Y bypass. PATIENTS AND METHOD From 1990 to 2003, twelve patients were treated for bile duct injury, not diagnosed at the time of cholecystectomy and had an early repair within 30 days after the cholecystectomy. They had either a duct to duct anastomosis or a Roux-en-Y bypass at the time of the reconstruction. RESULTS The level of the injury was Bismuth II (N=7), III (N=1), IV (N=2) and V (N=1) referral to Bismuth classification and one isolated right sectoral duct injury. Four patients had an duct to duct anastomosis and eight an hepaticojejunostomy at a median of 15.3 days after cholecystectomy. With one patient lost to follow up, the overall success rate in this series was 81.8% after reconstruction with a mean 40 months follow up. The reconstruction by an end to end anastomosis was successful in 100% of patients (with a mean 31.2 months follow up) and in 71.4% of patients after a Roux-en-Y biliary reconstruction (with a mean 45 months follow up). CONCLUSION Good results may be performed, by an early repair in bile duct injuries at laparoscopic cholecystectomy, either by an duct to duct anastomosis or a Roux-en-Y bypass.
Collapse
Affiliation(s)
- N Kohneh Shahri
- Service de clinique chirurgicale, 1, centre hospitalier universitaire de Nantes, 4409 Nantes cedex 01, France.
| | | | | |
Collapse
|
37
|
Ragozzino A, De Ritis R, Mosca A, Iaccarino V, Imbriaco M. Value of MR Cholangiography in Patients with Iatrogenic Bile Duct Injury After Cholecystectomy. AJR Am J Roentgenol 2004; 183:1567-72. [PMID: 15547192 DOI: 10.2214/ajr.183.6.01831567] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Our aim was to determine the diagnostic role of MR cholangiography in the evaluation of iatrogenic bile duct injuries after cholecystectomy. SUBJECTS AND METHODS Nineteen patients (14 women and five men; mean age, 47 years; age range, 24-75 years) with suspected bile duct injury as a result of laparoscopic cholecystectomy (17 patients) and open cholecystectomy (two patients) underwent MR cholangiography. MR images were evaluated for bile duct discontinuity, presence or absence of biliary dilation, stricture, excision injury, free fluid, and collections. Bile duct excision and stricture were classified according to the Bismuth classification. Final diagnosis was made on the basis of findings at surgery in 15 patients, on percutaneous transhepatic cholangiography (PTC) in one patient, and on endoscopic retrograde cholangiography (ERC) and at clinical follow-up until hospital discharge in the remaining three patients. RESULTS In 16 patients, injury of the bile duct was observed. Two patients had Bismuth type I injury; one patient, type II injury; 11 patients, type III injury; and one patient each, type IV and V injuries. Three patients showed findings suggestive of leakage from the cystic duct remnant, which were confirmed on ERC. CONCLUSION MR cholangiography is an accurate diagnostic technique in the identification of postoperative bile duct injuries. This technique allows exploration above and below the level of obstruction, a resource provided by neither ERC nor PTC, and allows the accurate classification of these injuries, which is essential for treatment planning.
Collapse
Affiliation(s)
- Alfonso Ragozzino
- Department of Radiology, Cardarelli Hospital, Via Pansini 5, Via Manzoni 214/0, Naples 80123, Italy
| | | | | | | | | |
Collapse
|
38
|
Syrakos T, Antonitsis P, Zacharakis E, Takis A, Manousari A, Bakogiannis K, Efthimiopoulos G, Achoulias I, Trikoupi A, Kiskinis D. Small-incision (mini-laparotomy) versus laparoscopic cholecystectomy: a retrospective study in a university hospital. Langenbecks Arch Surg 2004; 389:172-7. [PMID: 15133673 DOI: 10.1007/s00423-004-0481-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2003] [Accepted: 03/10/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Since the introduction of laparoscopic cholecystectomy into general practice in 1990, it has rapidly become the dominant procedure for gallbladder surgery. The aim of this study was to compare the results of the laparoscopic, open and mini-laparotomy approaches to cholecystectomy. PATIENTS AND METHODS Our study covers a period of 6 years. A total of 1,276 patients underwent cholecystectomy for calculous biliary disease. The laparoscopic procedure was applied to 952 (74.6%) patients, while 210 (16.5%) underwent the traditional open cholecystectomy and the remaining 114 (8.9%) patients underwent mini-laparotomy cholecystectomy. RESULTS Thirty-seven patients (3.9%) from the laparoscopic group required conversion to open cholecystectomy. Morbidity was similar in the open and laparoscopic groups (3.8%), while it was significantly lower in the mini-laparotomy group (0.8%). No major bile duct injuries occurred after the open or mini-laparotomy approaches. The median operation time was significantly shorter in the mini-laparotomy group than in the laparoscopic group (46 min vs 61 min). Hospital stay was significantly longer for the open cholecystectomy group (mean value 5.1 days) compared with the laparoscopic and mini-laparotomy groups (mean values 2.5 days and 2.7 days, respectively). Hospital expenses showed a saving of 786 Euro for each patient who underwent the open procedure and 980 Euro for each patient who underwent the mini-laparotomy approach compared with the laparoscopic one. CONCLUSION We believe that commissioners of healthcare should question whether the benefits of laparoscopic cholecystectomy justify the additional cost after the introduction of the mini-laparotomy approach.
Collapse
Affiliation(s)
- Theodoros Syrakos
- A' Surgical Clinic, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Shamiyeh A, Wayand W. Laparoscopic cholecystectomy: early and late complications and their treatment. Langenbecks Arch Surg 2004; 389:164-71. [PMID: 15133671 DOI: 10.1007/s00423-004-0470-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2004] [Accepted: 02/03/2004] [Indexed: 02/07/2023]
Abstract
UNLABELLED Laparoscopic cholecystectomy gained wide acceptance as treatment of choice for gallstone disease and cholecystitis. With this new technique, not only did the new era of minimal invasive surgery begin, but also the spectrum of complications changed. Laparoscopy-related complications such as access injuries and procedure-related problems are discussed in our article. Typical mishaps are reviewed according to the literature. Set-up of the pneumoperitoneum (morbidity up to 0.2%); bleeding-from trocar sites and vascular injury (mortality up to 0.2%); biliary leaks and bile duct injuries are the main topics in this article (still on a level of 0.2%-0.8%). Aetiology, diagnosis and treatment are discussed, and an overview of the most cited classifications of bile duct injuries is summarised graphically. Finally, bowel injuries as a specific complication in laparoscopy are discussed (incidence up to 0.87%). CONCLUSION Careful selection of patients, the knowledge of typical procedure-related complications, and their best treatment are the key points for a safe laparosopic cholecystectomy.
Collapse
Affiliation(s)
- A Shamiyeh
- Ludwig Boltzmann Institute for Operative Laparoscopy and 2nd Surgical Department, Academic Teaching Hospital of Linz, Krankenhausstrasse 9, 4020 Linz, Austria.
| | | |
Collapse
|
40
|
Familiari L, Scaffidi M, Familiari P, Consolo P, Ficano L, Micelic D, Martorana G, Tarantello M. An endoscopic approach to the management of surgical bile duct injuries: nine years' experience. Dig Liver Dis 2003; 35:493-7. [PMID: 12870736 DOI: 10.1016/s1590-8658(03)00223-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The evaluation of the endoscopic treatment of surgical bile duct injuries, especially in the management of post-operative strictures, remains controversial. AIM The aim of this study was to evaluate the feasibility of using endoscopic management from a study of the clinical reports of two of the main endoscopy units in Sicily. PATIENTS AND METHODS A total of 137 consecutive patients were selected. There were 85 simple biliary fistulas: 64 from the cystic duct stump; 19 from the gall bladder bed; and two from intra-hepatic bile ducts. There were 52 biliary lesions: 15 complete transections; 12 incomplete lesions of the common bile duct with six associated strictures; five complete or incomplete sections of the right antero-medial duct; and 20 incomplete strictures (without leak). RESULTS The success rate was 96.3% for simple biliary fistulas. Endoscopic therapy was feasible only in 40.6% of lesions of the common bile duct or the right antero-medial duct (13/32), but with 100% success. In the case of strictures (with or without associated leak), there was a good outcome in 88.2% of patients who completed the therapeutic procedure. CONCLUSIONS Endoscopic management of simple biliary fistulas and incomplete lesions of the common bile duct is the preferred approach. If continued for 12-24 months, with the placement of three or more 10F stents, the management of stenoses is guaranteed to yield good results.
Collapse
Affiliation(s)
- L Familiari
- Digestive Endoscopy Unit, Department of Medicine and Pharmacology, University of Messina, Messina, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Crema E, Silva AA, Lenza RM, de Oliveira CB, Bridi VAU, Martins A. Excluded-loop hepatojejunal anastomosis with use of laparoscopy in late management of iatrogenic ligature of the bile duct. Surg Laparosc Endosc Percutan Tech 2002; 12:110-4. [PMID: 11948297 DOI: 10.1097/00129689-200204000-00007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although the procedures adopted for bile duct surgery are routine, serious complications occasionally occur. This article reports the authors' experience in managing an iatrogenic ligature of the bile duct. The patient in this case had undergone open cholecystectomy and had significant jaundice in the early postoperative period. During the investigation, a complete ligature of the common hepatic duct was discovered. An anastomosis of the common hepatic duct with an excluded jejunum loop was performed with use of laparoscopy. Periodic follow-up continuing until 30 months after surgery showed the patient was asymptomatic, and ultrasonography, percutaneous transhepatic cholangiography, and cholangioresonance findings were normal. We consider the procedure feasible and technically advantageous when done with the assistance of laparoscopy.
Collapse
Affiliation(s)
- Eduardo Crema
- Department of Digestive Surgery, Federal School of Medicine, Uberaba-Minas Gerais, Brazil.
| | | | | | | | | | | |
Collapse
|
42
|
Gharaibeh KI, Ammari F, Al-Heiss H, Al-Jaberi TM, Qasaimeh GR, Bani-Hani K, Al-Natour S. Laparoscopic cholecystectomy for gallstones: a comparison of outcome between acute and chronic cholecystitis. Ann Saudi Med 2001; 21:312-6. [PMID: 17261936 DOI: 10.5144/0256-4947.2001.312] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is now a common method of treating symptomatic gallstones, and it is increasingly being requested by the informed general public. Our aim was to evaluate the role of LC for cholelithiasis and to establish its outcome and the effect of gender on the results. PATIENTS AND METHODS Between September 1994 and June 1999, all patients who underwent LC for cholelithiasis were retrospectively reviewed. They were classified as having acute or chronic cholecystitis (AC or CC). RESULTS There were 791 patients with CC (633 females, 158 males) and 204 patients with AC (124 females, 80 males). Conversion to open cholecystectomy was needed in 0.76% and 11.8% of the patients with CC and AC, respectively (P<0.00). Four percent of the female patients with AC needed conversion as compared to 23.8% in the males (P<0.00). The low conversion rate in CC limited gender comparison. Median operation time in the patients with CC was 53+/-16 minutes as compared to 74.5+/-35.7 minutes in those with AC (P<0.00). Operation time in the male patients with CC and AC was significantly higher than in the female patients, even after excluding the converted cases (P<0.00). Median postoperative stay for patients with CC was 1.33+/-0.9 days as compared to 1.9+/-1.34 days in patients with AC (P<0.00). No statistical significance in the hospital stay was found between males and females (in CC and AC). There was no mortality in the series. There were three bile duct injuries in the patients with CC. In patients with successful LC, gallbladder perforation occurred in 18% and 31% of CC and AC patients, respectively (P<0.003). Missed stones occurred in 1.4% and 3.3% of the patients with successful LC for CC and AC, respectively. Bile collection, which was treated with open drainage, occurred in four patients with CC and one patient with AC. CONCLUSION LC for symptomatic cholelithiasis is safe and feasible; it should be the first choice before resorting to open surgery. In patients with AC as compared to CC, there is an increased conversion rate, longer operation time, longer hospital stay, and higher incidence of gallbladder perforation without an increase in the incidence of bile duct injuries (BDI). Male patients have a longer operation time and higher conversion rate than female patients.
Collapse
Affiliation(s)
- K I Gharaibeh
- Department of Surgery, Princess Basma Teaching Hospital, University of Science and Technology, Irbid, Jordan
| | | | | | | | | | | | | |
Collapse
|
43
|
Plaisier PW, Pauwels MMA, Lange JF. Quality control in laparoscopic cholecystectomy: operation notes, video or photo print? HPB (Oxford) 2001; 3:197-9. [PMID: 18333014 PMCID: PMC2020624 DOI: 10.1080/136518201753242208] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In 1995 the concept of a 'critical view of safety' (CVS) in Calot's triangle was introduced to prevent bile duct injury in laparoscopic cholecystectomy. The aim of this study was to determine the most reliable method for recording CVS. METHODS Operation notes, video images and photo prints from 50 consecutive elective non-converted laparoscopic cholecystectomies were analysed. RESULTS Operation notes alone did not suffice to record CVS. As an adjunct, video proved superior to photo print with regard to quality. Nevertheless, photo prints were practically and logistically much easier to produce than video. Moreover, when good quality images were achieved, photo print recorded CVS more conclusively than video. DISCUSSION Operation notes,video and photo print are complementary, and the combination records CVS conclusively in nearly every case.
Collapse
Affiliation(s)
- PW Plaisier
- Department of Surgery, Medisch Centrum Rijnmond-Zuid (MCRZ)RotterdamThe Netherlands
| | - MMA Pauwels
- Department of Surgery, Medisch Centrum Rijnmond-Zuid (MCRZ)RotterdamThe Netherlands
| | - JF Lange
- Department of Surgery, Medisch Centrum Rijnmond-Zuid (MCRZ)RotterdamThe Netherlands
| |
Collapse
|
44
|
Lesiones quirúrgicas de la vía biliar principal tras colecistectomía laparoscópica: reparación en un hospital local o centro de referencia. Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71885-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
45
|
Johnson SR, Koehler A, Pennington LK, Hanto DW. Long-term results of surgical repair of bile duct injuries following laparoscopic cholecystectomy. Surgery 2000; 128:668-77. [PMID: 11015101 DOI: 10.1067/msy.2000.108422] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is associated with an increased incidence of bile duct injuries when compared with the open surgical technique. Long-term results of repaired injuries and hepatic damage associated with chronic biliary obstruction are lacking. METHODS From Aug 1, 1991 until Dec 1, 1999, there were 27 patients referred for management of complex biliary injuries that occurred during LC. Patients underwent percutaneous transhepatic cholangiography and placement of transhepatic catheters with computed tomography-guided biloma drainage when indicated. On the basis of the cholangiography findings, patients underwent Roux-en-Y hepaticojejunostomy (HJ) and liver biopsy or were treated with nonsurgical interventions. RESULTS Twenty-one of 27 patients (77. 8%) underwent HJ, and 16 of these 21 patients (76.2%) also underwent hepatic biopsy. In 1 patient, a recurrent stricture developed at 20 months after the initial repair; and, in a second patient, an episode of cholangitis developed in the postoperative period with the transhepatic catheters in place. Five of 16 patients (31.2%) demonstrated marked hepatic fibrosis with 4 (25%) of these patients showing evidence of evolving cirrhosis at the time of HJ. CONCLUSIONS In this series with 55 months of follow-up, HJ repair of LC injuries was associated with an initial 95.2% success rate and an ultimate success rate of 100%. Despite this, delayed referral, averaging 12 months, was associated with significant hepatic injury in 5 of 16 (31.3%) patients who underwent biopsy.
Collapse
Affiliation(s)
- S R Johnson
- Department of Surgery, Division of Transplantation and Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | | | | |
Collapse
|
46
|
Abstract
Cholelithiasis is a common disease in the United States associated with significant morbidity. Surgical treatment with cholecystectomy has been increasing with a significant cost to the health care system. Surgical management is not without risk. Cholecystectomy has also been associated with a significant morbidity and mortality in elderly patients. Cholecystectomies are often performed unnecessarily in gallstone patients for nonspecific symptoms. Many patients with nonspecific pain, which may have a psychogenic component, continue to experience similar pain after cholecystectomy. There are problems in determining the symptom status of patients. Patients who believe surgery will relieve symptoms may maximize their symptoms, whereas patients who are reluctant to undergo surgery may minimize their symptoms. Although cholecystectomy is the mainstay of gallstone treatment, bile acid therapy and, if available, ESWL and topical dissolution are nonsurgical treatment alternatives in selected patients. In selected cases, in particular in the elderly and in other patients at increased risk from surgery, nonsurgical management offers lower morbidity and mortality than does operative treatment. The decision for surgical versus nonsurgical management should be based on both objective selection criteria and patient choice.
Collapse
Affiliation(s)
- D E Howard
- Department of Medicine, George Washington University Medical Center, Washington, DC, USA
| | | |
Collapse
|