1
|
Yu T, Li Y, He H, Hou S, Zhang L. Novel per-oral cholangioscopy for treatment of occult accessory hepatic duct stones. Gastroenterol Rep (Oxf) 2023; 11:goad051. [PMID: 37661998 PMCID: PMC10468296 DOI: 10.1093/gastro/goad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/03/2023] [Accepted: 08/10/2023] [Indexed: 09/05/2023] Open
Affiliation(s)
- Tingting Yu
- Department of Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Yaoting Li
- Department of Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Hongfei He
- Department of Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Senlin Hou
- Department of Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| | - Lichao Zhang
- Department of Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, P. R. China
| |
Collapse
|
2
|
Tomita M, Okabe H, Masuda T, Ono A, Kuroda D, Kuroki H, Hirota M, Hibi T, Baba H, Sugita H. A case of accessory hepatic duct entering cystic duct successfully treated by laparoscopic cholecystectomy for cholecystolithiasis. Asian J Endosc Surg 2023. [PMID: 36944530 DOI: 10.1111/ases.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/14/2023] [Accepted: 02/19/2023] [Indexed: 03/23/2023]
Abstract
Although laparoscopic cholecystectomy is a well-established surgical procedure, an accessory hepatic duct (AcHD) entering the cystic duct is poorly understood. A 77-year-old woman with symptomatic cholecystlithiasis was referred to our hospital. Abdominal ultrasonography indicated several small stones in the gall bladder. Magnetic resonance cholangiopancreatography (MRCP) did not reveal an anomalous cystic duct. Dissecting the gall bladder bed at operation, AcHD entering the cystic duct was suspected. Intraoperative cholangiography revealed that B5 branch entered the cystic duct. We ligated the AcHD, and divided it. Laparoscopic cholecystectomy was completed, and the patient was discharged without any complication. A week after the operation, MRCP showed that ventral branch of B5 was dilated. The patient showed no symptom for more than a year. The present case exhibited extremely rare AcHD entering the cystic duct, which was hardly recognized before surgery. It is possible to recognize such anomalous variants with standard laparoscopic approach based on 2018 Tokyo Guidelines and with attention to the possibilities of AcHD entering the cystic duct.
Collapse
Affiliation(s)
- Masahiro Tomita
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
- Department of Pediatric Surgery and Transplantation, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hirohisa Okabe
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Toshiro Masuda
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Asuka Ono
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Daisuke Kuroda
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Hideyuki Kuroki
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Masahiko Hirota
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
- Department of Health and Nutrition, Graduate School of Health Management, Nagasaki International University, Nagasaki, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroki Sugita
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| |
Collapse
|
3
|
Murakami H, Okubo S, Kobayashi M, Akabane M, Matsumura M, Shindoh J, Hashimoto M. Gallbladder cancer concomitant with autosomal dominant polycystic kidney disease: A case report. Clin Case Rep 2022; 10:e6734. [PMID: 36540879 PMCID: PMC9755817 DOI: 10.1002/ccr3.6734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
The case is a 67-year-old female with autosomal dominant polycystic kidney disease who was followed up regularly. CT scan showed a mural nodule growing over the past 4 years inside the hypodense region surrounded by hepatic cysts. Surgery was performed and the pathological diagnosis was StageI gallbladder cancer.
Collapse
Affiliation(s)
- Hisashi Murakami
- Department of Gastroenterological SurgeryToranomon HospitalTokyoJapan
| | - Satoshi Okubo
- Department of Gastroenterological SurgeryToranomon HospitalTokyoJapan
| | | | - Miho Akabane
- Department of Gastroenterological SurgeryToranomon HospitalTokyoJapan
| | - Masaru Matsumura
- Department of Gastroenterological SurgeryToranomon HospitalTokyoJapan
| | - Junichi Shindoh
- Department of Gastroenterological SurgeryToranomon HospitalTokyoJapan
| | - Masaji Hashimoto
- Department of Gastroenterological SurgeryToranomon HospitalTokyoJapan
| |
Collapse
|
4
|
Li X, Duan R, He Y, Qin J, Liu R, Dai S, Zhou J, Zeng X, Duan J, Gao P, Yang X, Li C. Application of three-dimensional visualization technology in the anatomical variations of hilar bile ducts in Chinese population. Front Surg 2022; 9:934183. [PMID: 35983555 PMCID: PMC9379322 DOI: 10.3389/fsurg.2022.934183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022] Open
Abstract
This study aimed to establish three-dimensional models of the biliary tract of Chinese people using the Hisense computer-aided surgery (CAS) system and to explore the branching patterns and variation types of the biliary system under the study of 3D reconstruction of the biliary tract. Three-dimensional models of the biliary tract were reconstructed in 50 patients using the Hisense CAS system. The branching patterns of intrahepatic bile ducts were observed. The biliary tract was classified according to the confluence of the right posterior sectoral duct (RPSD), right anterior sectoral duct (RASD) and left hepatic duct (LHD), and the presence or absence of accessory hepatic ducts. The 3D models of the bile ducts were successfully reconstructed in 50 Chinese patients. The branching patterns of the bile ducts were classified into seven types. The anatomy of the bile ducts was typical in 54% of cases (n = 27), showed triple confluence in 10% (n = 5), and crossover anomaly in 14% (n = 7), which means anomalous drainage of the RPSD into the LHD, anomalous drainage of the RPSD into the common hepatic duct (CHD) in 10% (n = 5), anomalous drainage of the RPSD into the cystic duct (CD) in 2% (n = 1), absence of left main hepatic duct in 1% (n = 1), presence of accessory duct in 8% (n = 4). Among them, there were three cases of accessory hepatic ducts coexisting with other variation types. By using the Hisense CAS system to establish 3D models of the biliary tract of the Chinese people, we established the branching model of the second-order bile ducts, which has important value for the classification of the biliary system and its variation types.
Collapse
|
5
|
Chikamori F, Ueta K, Iwabu J, Sharma N. Modified and dynamic intraoperativecholangiography during laparoscopic cholecystectomy in two patients with aberrant right posterior hepatic duct. Radiol Case Rep 2022; 17:1843-1847. [PMID: 35401891 PMCID: PMC8990060 DOI: 10.1016/j.radcr.2022.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022] Open
Abstract
Aberrant right posterior hepatic duct (ARPHD) is one of the anatomical anomalies of the bile duct. It is a risk factor for bile duct injury during laparoscopic cholecystectomy (LC). ARPHD can be diagnosed before surgery by magnetic resonance cholangiopancreatography or drip infusion cholangiographic-computed tomography. However, it is not easy to identify ARPHD during LC. Classic intraoperative cholangiography (IOC) procedure that does not lead to bile duct injury avoidance needs to be modified. In modified IOC, cannulation is performed from the infundibulum or neck of the gallbladder. We reported a modified and dynamic IOC procedure that can identify ARPHD safely and precisely during LC. The modified IOC provided direct evidence of no injury to ARPHD in 2 cases.
Collapse
Affiliation(s)
- Fumio Chikamori
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan
- Corresponding author.
| | - Koji Ueta
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan
| | - Jun Iwabu
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562, Japan
| | - Niranjan Sharma
- Adv Train Gastroint & Organ Transp Surgery, Dunedin, New Zealand
| |
Collapse
|
6
|
Zhao Y, Tao H, Liu Y, Sha G, Yi X, Qin Q, Jin D, He C, Wu X, Zhou Q. Effectiveness and Clinical Value of Laparoscopic Cholecystectomy and Cholangiography in the Diagnosis of Biliary Calculi. Front Surg 2022; 9:880266. [PMID: 35574533 PMCID: PMC9091961 DOI: 10.3389/fsurg.2022.880266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/01/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the effectiveness and clinical value of cholangiography in the diagnosis of bile duct stones in laparoscopic cholecystectomy. Methods 200 patients who underwent laparoscopic cholecystectomy in our hospital from January 2017 to January 2019 were randomly divided into research group and control group, with 100 cases in each group. The research group underwent choledochotomy and exploration with the help of choledochoscope, while the control group underwent cholangiography to diagnose bile duct stones. The cure rate, residual stone rate, complication rate, intraoperative bleeding, hospital stay and patient satisfaction were compared between the two groups. Results in the control group, 9 cases were converted to laparotomy, 20 cases of common bile duct stones, 10 cases of bile duct injury and 6 cases of common bile duct variation. In the research group, there were 2 cases of conversion to laparotomy, 12 cases of common bile duct stones, 2 cases of bile duct injury and 4 cases of common bile duct variation. The cure rate of the researchgroup was higher than that of the control group, There was significant difference between the two groups (P < 0.05). The residual amount of stones in the research group was lower than that in the control group, and there was significant difference between the two groups (P < 0.05). The incidence of postoperative complications in the research group was lower than that in the control group, and there was significant difference between the two groups (P < 0.05). The patient satisfaction in the research group was higher than that in the control group, and there was significant difference between the two groups (P < 0.05). The intraoperative blood output of the research group was lower than that of the observation group, and there was significant difference between the two groups (P < 0.05). Conclusion cholangiography is an effective method for the diagnosis of bile duct stones in laparoscopic cholecystectomy. Clarifying the variation and anatomical structure of bile duct is helpful to improve the surgical cure rate, reduce the residual rate of postoperative stones and the incidence of complications, reduce the amount of intraoperative bleeding, shorten the hospital stay, and promote the postoperative rehabilitation of patients.
Collapse
Affiliation(s)
- Yunqing Zhao
- Department of General Surgery, Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital), Wuhan, China
| | - Hongbo Tao
- Department of Anesthesiology, Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital), Wuhan, China
| | - Yanqin Liu
- Operating Room, Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital), Wuhan, China
- *Correspondence: Yanqin Liu
| | - Gen Sha
- Operating Room, Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital), Wuhan, China
- Gen Sha
| | - Xianyun Yi
- Operating Room, Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital), Wuhan, China
| | - Qin Qin
- Operating Room, Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital), Wuhan, China
| | - Dong Jin
- Operating Room, Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital), Wuhan, China
| | - Chengjie He
- Operating Room, Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital), Wuhan, China
| | - Xianghong Wu
- Operating Room, Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital), Wuhan, China
| | - Qing Zhou
- Operating Room, Wuhan Wudong Hospital (Wuhan Second Psychiatric Hospital), Wuhan, China
| |
Collapse
|
7
|
Nassar AHM, Ng HJ. Risk identification and technical modifications reduce the incidence of post-cholecystectomy bile leakage: analysis of 5675 laparoscopic cholecystectomies. Langenbecks Arch Surg 2021; 407:213-223. [PMID: 34436660 PMCID: PMC8847250 DOI: 10.1007/s00423-021-02264-z] [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: 01/22/2021] [Accepted: 07/01/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE The main sources of post-cholecystectomy bile leakage (PCBL) not involving major duct injuries are the cystic duct and subvesical/hepatocystic ducts. Of the many studies on the diagnosis and management of PCBL, few addressed measures to avoid this serious complication. The aim of this study was to examine the causes and mechanisms leading to PCBL and to evaluate the effects of specific preventative strategies. METHODS A prospectively maintained database of 5675 consecutive laparoscopic cholecystectomies was analysed. Risk factors for post-cholecystectomy bile leakage were identified and documented and technical modifications and strategies were adopted to prevent this complication. The incidence, causes and management of patients who suffered bile leaks were studied and their preoperative characteristics, operative data and postoperative outcomes were compared with patients where potential risks were identified and PCBL avoided and with the rest of the series. RESULTS Twenty-five patients (0.4%) had PCBL (7 expected and less than half requiring reintervention): 11 from cystic ducts (0.2%), 3 from subvesical ducts (0.05%) and 11 from unconfirmed sources (0.2%). The incidence of cystic duct leakage was significantly lower with ties (0.15%) than with clips (0.7%). Fifty-two percent had difficulty grades IV or V, 36% had empyema or acute cholecystitis and 16% had contracted gallbladders. Twelve patients required 17 reinterventions before PCBL resolved; 7 percutaneous drainage, 6 ERCP and 4 relaparoscopy. The median hospital stay was 17 days with no mortality. Hepatocystic ducts were encountered in 72 patients (1.3%) and were secured with loops (54.2%), ties (25%) or sutures (20.8%) with no PCBL. Eighteen sectoral ducts were identified and secured. CONCLUSION Ligation of the cystic duct reduces the incidence of PCBL resulting from dislodged endoclips. Careful blunt dissection in the proper anatomical planes avoiding direct or thermal injury to subvesical and sectoral ducts and a policy of actively searching for hepatocystic ducts during gallbladder separation to identify and secure them can reduce bile leakage from such ducts.
Collapse
Affiliation(s)
- Ahmad H M Nassar
- Laparoscopic Biliary Surgery Service, University Hospital Monklands, Lanarkshire, Airdrie, Scotland, ML6 0JS, UK.
| | | |
Collapse
|
8
|
Tanaka T, Nakada T, Ito T, Kominami R, Sonomura T, Kagaya M, Kawai K, Honma S. Topographical relationship between the accessory hepatic duct and the hepatic artery system. Anat Sci Int 2020; 96:112-118. [PMID: 32914370 DOI: 10.1007/s12565-020-00568-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
Hepatic biliary injury is one of the most common complications in cholecystectomy and is frequently accompanied by arterial injuries. Because there are several anatomical variations of the hepatic ducts, including the accessory hepatic ducts (AHDs), it is important to consider not only the anatomical position of the hepatic ducts but also those of the AHDs in cholecystectomy. However, the topographical relationships between the AHDs and the hepatic arteries are still poorly understood. In the present study we show that AHDs were observed in 7 out of 59 (11.9%) of the cadavers. There was a single AHD in the 6 out of the 7 cadavers and double AHDs in one. In these cases, the right AHDs emerged from the anterior medial segment of the liver piercing the parenchyma, while the left AHDs emerged directly from the anterior part of the caudate lobe. The right AHDs ran anterior to the right hepatic artery, while the left AHDs ran posterior to the hepatic arteries. The topographical relationship between the AHD and the hepatic artery system was thus reversed in the cases of the right and the left AHDs.
Collapse
Affiliation(s)
- Takashi Tanaka
- Department of Anatomy II, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
| | - Takayuki Nakada
- Anatomy Center, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
| | - Tetsufumi Ito
- Department of Anatomy II, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
| | - Rieko Kominami
- Department of Anatomy II, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
| | - Takahiro Sonomura
- Department of Anatomy, School of Dentistry, Asahi University, 1851 Hozumi, Mizuho, Gifu, 501-0296, Japan
| | - Miyuki Kagaya
- Department of Anatomy II, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
| | - Katsushi Kawai
- Department of Anatomy II, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
| | - Satoru Honma
- Department of Anatomy II, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan.
| |
Collapse
|
9
|
Narita K, Nakamura Y, Higaki T, Akagi M, Honda Y, Awai K. Deep learning reconstruction of drip-infusion cholangiography acquired with ultra-high-resolution computed tomography. Abdom Radiol (NY) 2020; 45:2698-2704. [PMID: 32248261 DOI: 10.1007/s00261-020-02508-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Deep learning reconstruction (DLR) introduces deep convolutional neural networks into the reconstruction flow. We examined the clinical applicability of drip-infusion cholangiography (DIC) acquired on an ultra-high-resolution CT (U-HRCT) scanner reconstructed with DLR in comparison to hybrid and model-based iterative reconstruction (hybrid-IR, MBIR). METHODS This retrospective, single-institution study included 30 patients seen between January 2018 and November 2019. A radiologist recorded the standard deviation of attenuation in the paraspinal muscle as the image noise and calculated the contrast-to-noise ratio (CNR) in the common bile duct. The overall visual image quality of the bile duct on thick-slab maximum intensity projections was assessed by two other radiologists and graded on a 5-point confidence scale ranging from 1 (not delineated) to 5 (clearly delineated). The difference among hybrid-IR, MBIR, and DLR images was compared. RESULTS The image noise was significantly lower on DLR than hybrid-IR and MBIR images and the CNR and the overall visual image quality of the bile duct were significantly higher on DLR than on hybrid-IR and MBIR images (all: p < 0.001). CONCLUSION DLR resulted in significant quantitative and qualitative improvement of DIC acquired with U-HRCT.
Collapse
Affiliation(s)
- Keigo Narita
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yuko Nakamura
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Toru Higaki
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Motonori Akagi
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yukiko Honda
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazuo Awai
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| |
Collapse
|
10
|
Ojo AS, Pollard A. Risk of Gallstone Formation in Aberrant Extrahepatic Biliary Tract Anatomy: A Review of Literature. Cureus 2020; 12:e10009. [PMID: 32864277 PMCID: PMC7449616 DOI: 10.7759/cureus.10009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The age-long mnemonic of '5Fs' (fat, female, fertile, forty, and fair) has traditionally been used in medical school instructions to describe the risk factors for gallstone disease. However, evidence suggests that aberrant extrahepatic biliary tract (EHBT) anatomy may contribute significantly to the risk of gallstone disease. This review explores the anatomy and embryological bases of EHBT variations as well as the prevalence of these variations. Also, we discuss the risk factors for gallstone formation in the relationship between gallstone disease and aberrant EHBT anatomy.
Collapse
|
11
|
Kurahashi S, Komatsu S, Matsumura T, Fukami Y, Arikawa T, Saito T, Osawa T, Uchino T, Kato S, Suzuki K, Toda Y, Kaneko K, Sano T. A novel classification of aberrant right hepatic ducts ensures a critical view of safety in laparoscopic cholecystectomy. Surg Endosc 2020; 34:2904-2910. [PMID: 32377838 DOI: 10.1007/s00464-020-07610-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/28/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Based on the spatial relationship of an aberrant right hepatic duct (ARHD) with the cystic duct and gallbladder neck, we propose a practical classification to evaluate the specific form predisposing to injury in laparoscopic cholecystectomy (LC). METHODS We retrospectively investigated the preoperative images (mostly magnetic resonance cholangiopancreatography) and clinical outcomes of 721 consecutive patients who underwent LC at our institute from 2015 to 2018. We defined the high-risk ARHD as follows: Type A: communicating with the cystic duct and Type B: running along the gallbladder neck or adjacent to the infundibulum (the minimal distance from the ARHD < 5 mm), regardless of the confluence pattern in the biliary tree. Other ARHDs were considered to be of low risk. RESULTS A high-risk ARHD was identified in 16 cases (2.2%): four (0.6%) with Type A anatomy and 12 (1.7%) with Type B. The remaining ARHD cases (n = 34, 4.7%) were categorized as low risk. There were no significant differences in the operative outcomes (operative time, blood loss, hospital stay) between the high- and low- risk groups. Subtotal cholecystectomy was applied in four cases (25%) in the high-risk group, a significantly higher percentage than the low-risk group (n = 1, 2.9%). In all patients with high-risk ARHD, LC was completed safely without bile duct injury or conversion to laparotomy. CONCLUSIONS Our simple classification of high-risk ARHD can highlight the variants located close to the dissecting site to achieve a critical view of safety and may contribute to avoiding inadvertent damage of an ARHD in LC.
Collapse
Affiliation(s)
- Shintaro Kurahashi
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shunichiro Komatsu
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Tatsuki Matsumura
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yasuyuki Fukami
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takashi Arikawa
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takuya Saito
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takaaki Osawa
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tairin Uchino
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shoko Kato
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kenta Suzuki
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yoko Toda
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kenitiro Kaneko
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tsuyoshi Sano
- Department of Gastroenterological Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| |
Collapse
|
12
|
Nakazawa A, Akamatsu N, Miyata Y, Komagome M, Maki A, Arita J, Ishizawa T, Kaneko J, Beck Y, Hasegawa K. Usefulness of preoperative drip infusion cholangiography with computed tomography for predicting surgical difficulty during laparoscopic cholecystectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:315-323. [PMID: 31971340 DOI: 10.1002/jhbp.718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/24/2019] [Accepted: 01/16/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Drip infusion cholangiography with computed tomography (DIC-CT) is a major preoperative modality used for patients undergoing laparoscopic cholecystectomy (LC). METHODS This study included 218 patients for whom preoperative DIC-CT images were obtained prior to undergoing LC. The association between gallbladder (GB) opacification in DIC-CT and the operative time was assessed. RESULTS The GB opacification on the DIC-CT images was classified as follows: Grade 0, homogeneous opacification; Grade 1, heterogeneous opacification; Grade 2, only cystic duct can be identified; and Grade 3, no opacification. Images obtained for the 218 patients showed 41 (18.8%) with Grade 0, 91 (41.7%) with Grade 1, 54 (24.8%) with Grade 2, and 32 (14.7%) with Grade 3. The operative time and intraoperative blood loss were significantly longer and larger, respectively, in cases classified as Grade 2 or 3 (GB negative) compared with cases classified as Grade 0 or 1 (GB positive). We created an LC difficulty score based on the following variables that were significant independent predictors of increased operative time: GB negativity in DIC-CT (P = .002, 2 points), GB wall thickness (P = .002, 2 points), body mass index (P = .015, 1 point), preoperative alkaline phosphatase value (P = .018, 1 point), and preoperative C-reactive protein value (P = .04, 1 point). The LC difficulty score (Grade A, score 0-2; Grade B, score 3-5; and Grade C, score 6-7) was significantly associated with a prolonged operative time. CONCLUSION Drip infusion cholangiography with computed tomography is useful for predicting the surgical difficulty of LC.
Collapse
Affiliation(s)
- Akiko Nakazawa
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Hepato-biliary-pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Nobuhisa Akamatsu
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoichi Miyata
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Hepato-biliary-pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Masahiko Komagome
- Department of Hepato-biliary-pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Akira Maki
- Department of Hepato-biliary-pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Junichi Arita
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeaki Ishizawa
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junichi Kaneko
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshifumi Beck
- Department of Hepato-biliary-pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
13
|
Matsubara H, Satoh S, Fukugaki A, Kinjo Y. Single-incision laparoscopic cholecystectomy with the right accessory hepatic duct diagnosed preoperatively: A case report. J Minim Access Surg 2019; 16:80-82. [PMID: 31571670 PMCID: PMC6945336 DOI: 10.4103/jmas.jmas_285_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Accessory hepatic duct or gallbladder duplication is considered to be a risk factor for bile duct injuries and open conversion during laparoscopic cholecystectomy (LC). A 32-year-old woman with epigastric pain was referred to our department. Gallstone disease in the gallbladder was diagnosed by ultrasonography and magnetic resonance cholangiopancreatography. The involvement of an accessory hepatic duct was suspected during endoscopic retrograde cholangiography. Drip infusion cholangiography with computed tomography showed that the cystic duct merged with the accessory right hepatic duct. Single-incision LC (SILC) was successfully performed without bile duct injury. The operative time and intraoperative blood loss were 145 min and 1 mL, respectively. The patient was discharged 3 days' postoperatively, without complications. The involvement of the accessory right hepatic duct is a rare anomaly and is considered to be a risk factor for bile duct injuries. However, obtaining pre-operative images enabled us to perform SILC successfully.
Collapse
Affiliation(s)
| | - Seiji Satoh
- Department of Surgery, Himeji Medical Center, Himeji, Hyogo, Japan
| | - Atsushi Fukugaki
- Department of Surgery, Himeji Medical Center, Himeji, Hyogo, Japan
| | - Yousuke Kinjo
- Department of Surgery, Himeji Medical Center, Himeji, Hyogo, Japan
| |
Collapse
|
14
|
Garg S, Kumar H, Sahni D, Yadav TD, Aggarwal A, Gupta T. Rare anatomic variations of the right hepatic biliary system. Surg Radiol Anat 2019; 41:1087-1092. [PMID: 31115596 DOI: 10.1007/s00276-019-02260-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/17/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE To report rare and clinically significant anatomic variations in the biliary drainage of right hepatic lobe. METHODS Unique variations in the extra- and intrahepatic biliary drainage of right hepatic lobe were observed in 6 cadaveric livers during dissection on 100 formalin-fixed en bloc cadaveric livers. RESULTS There was presence of aberrant drainage of right segmental and sectorial ducts in four cases and of accessory right posterior sectorial duct in two cases. CONCLUSIONS We encountered some extensively complicated biliary drainage of right hepatic lobe, unsuccessful recognition of which can lead to serious biliary complications during hepatobiliary surgeries and biliary interventions.
Collapse
Affiliation(s)
- Shallu Garg
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Hemanth Kumar
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daisy Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - T D Yadav
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjali Aggarwal
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Tulika Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| |
Collapse
|
15
|
Edo H, Sekiguchi R, Edo N, Kajiyama A, Nagamoto M, Gomi T. Evaluation of biliary anatomy in the caudate lobe using drip infusion cholangiography-computed tomography. Abdom Radiol (NY) 2019; 44:886-893. [PMID: 30448918 DOI: 10.1007/s00261-018-1825-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE This study aimed to retrospectively evaluate the caudate branches (CBs), which are bile ducts originating from the caudate lobe (CL), using drip infusion cholangiography with computed tomography (DIC-CT). METHODS The confluence patterns of CBs were evaluated in 185 adult patients undergoing DIC-CT. The following bile duct features were evaluated: (a) number of depicted CBs; (b) identification of the caudate portion from which the CBs were derived; (c) identification of the confluence site of a CB; and (d) whether there was a difference in the confluence site of the CBs depending on the position of the right posterior hepatic duct (RPHD) and the portal vein (PV). RESULTS DIC-CT enabled detection of a total of 640 bile ducts from the CL in 185 patients, and the total number of CBs from the Spiegel lobe (SP), the paracaval portion, and the caudate process (CP) were 347 (54.2%), 112 (17.5%), and 181 (28.2%), respectively. In the SP, over 60% of CBs joined the left hepatic duct system (LHDS). The positional relationship between the RPHD and the PV was divided into a supra-portal course (n = 168) and an infra-portal course (n = 17). The number of CBs joining the LHDS was significantly different between a supra-portal course and an infra-portal course (p = 0.0484). CONCLUSION CBs were depicted by DIC-CT in 98.9% of the subjects, and a detailed evaluation was possible. The number of CBs joining the LHDS was associated with the position of the RPHD and the PV.
Collapse
Affiliation(s)
- Hiromi Edo
- Department of Radiology, Toho University Ohashi Medical Center, 2-22-36 Ohashi Meguroku, Tokyo, Japan.
| | - Ryuzo Sekiguchi
- Department of Radiology, Toho University Ohashi Medical Center, 2-22-36 Ohashi Meguroku, Tokyo, Japan
| | - Naoki Edo
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Akiko Kajiyama
- Department of Radiology, Toho University Ohashi Medical Center, 2-22-36 Ohashi Meguroku, Tokyo, Japan
| | - Masashi Nagamoto
- Department of Radiology, Toho University Ohashi Medical Center, 2-22-36 Ohashi Meguroku, Tokyo, Japan
| | - Tatsuya Gomi
- Department of Radiology, Toho University Ohashi Medical Center, 2-22-36 Ohashi Meguroku, Tokyo, Japan
| |
Collapse
|
16
|
Manesis K, Nikou E, Zaravinos S, Bouboulis P, Oikonomou C, Kalliouris DN, Filippou D, Skandalakis P. A case of a right accessory hepatic duct diagnosed during a Whipple procedure. Int J Surg Case Rep 2018; 51:210-212. [PMID: 30193206 PMCID: PMC6126193 DOI: 10.1016/j.ijscr.2018.08.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/11/2018] [Accepted: 08/14/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Although anatomic variations of the bile tract are relatively common and can be present in about 28% of patients, existence of an accessory right hepatic duct that confluence on the common bile duct is quite rare. PRESENTATION OF CASE We present a rare case of a caucasian 78-years-old patient, with accessory right hepatic duct which was diagnosed intraoperatively. The patient was submitted to Whipple procedure due to a mass in the head of pancreas. Intraoperatively, an accessory right hepatic duct that merged with the common bile duct was found, and a double bilio-intestinal anastomosis was performed. DISCUSSION Definition of accessory hepatic duct, requires the existence of a main right hepatic duct, otherwise the definition of "accessory" is inconclusive. In our case the accessory right hepatic duct drained the posterior segments of the right hepatic lobe. CONCLUSION A detailed mapping of the biliary tree is essential in patients that will undergo major interventions of the hepatobiliary system. Common and rare variations of the biliary tree should be known prior to any intervention to avoid intraoperative difficulties or complications.
Collapse
Affiliation(s)
- Konstantinos Manesis
- 2nd Department of General Surgery, 417 Army Share Fund Hospital, Athens, Greece; Department of Anatomy and Surgical Anatony, Medical School, National and Kapodestrian University of Athens, Athens, Greece.
| | - Efstathios Nikou
- 2nd Department of General Surgery, 417 Army Share Fund Hospital, Athens, Greece
| | - Spiridon Zaravinos
- 2nd Department of General Surgery, 417 Army Share Fund Hospital, Athens, Greece
| | - Petros Bouboulis
- 2nd Department of General Surgery, 417 Army Share Fund Hospital, Athens, Greece; Department of Anatomy and Surgical Anatony, Medical School, National and Kapodestrian University of Athens, Athens, Greece
| | - Christianna Oikonomou
- 1st Department of Surgery, 417 Army Share Fund Hospital, Athens, Greece; Department of Anatomy and Surgical Anatony, Medical School, National and Kapodestrian University of Athens, Athens, Greece
| | - Dimitrios N Kalliouris
- 2nd Department of General Surgery, 417 Army Share Fund Hospital, Athens, Greece; Department of Anatomy and Surgical Anatony, Medical School, National and Kapodestrian University of Athens, Athens, Greece
| | - Dimitrios Filippou
- Department of Anatomy and Surgical Anatony, Medical School, National and Kapodestrian University of Athens, Athens, Greece
| | - Panagiotis Skandalakis
- Department of Anatomy and Surgical Anatony, Medical School, National and Kapodestrian University of Athens, Athens, Greece
| |
Collapse
|