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Khorasanizadeh F, Azizi N, Cannella R, Brancatelli G. An exploration of radiological signs in post-intervention liver complications. Eur J Radiol 2024; 180:111668. [PMID: 39180784 DOI: 10.1016/j.ejrad.2024.111668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/28/2024] [Accepted: 08/02/2024] [Indexed: 08/26/2024]
Abstract
The advent and progression of radiological techniques in the past few decades have revolutionized the diagnostic and therapeutic landscape for liver diseases. These minimally invasive interventions, ranging from biopsies to complex therapeutic procedures like transjugular intrahepatic portosystemic shunt placement and transarterial embolization, offer substantial benefits for the treatment of patients with liver diseases. They provide accurate tissue diagnosis, allow real-time visualization, and render targeted treatment for hepatic lesions with enhanced precision. Despite their advantages, these procedures are not without risks, with the potential for complications that can significantly impact patient outcomes. It is imperative for radiologists to recognize the signs of these complications promptly to mitigate further health deterioration. Ultrasound, CT, and MRI are widely utilized examinations for monitoring the complications. This article presents an overarching review of the most commonly encountered hepatobiliary complications post-radiological interventions, emphasizing their imaging characteristics to improve patient post-procedure management.
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Affiliation(s)
- Faezeh Khorasanizadeh
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Narges Azizi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Science, Tehran, Iran
| | - Roberto Cannella
- Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy.
| | - Giuseppe Brancatelli
- Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
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2
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Marinato V, Phillips A, Giuliano L, Cascella T, Greco G, Lanocita R. The role of CEUS in the management of biloma. J Ultrasound 2024; 27:745-749. [PMID: 38329714 PMCID: PMC11333771 DOI: 10.1007/s40477-023-00849-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/20/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND A biloma refers to an abnormal, well-defined accumulation of bile outside the biliary tree within the abdomen, which can be either intra- or extra-hepatic in nature. It can result from traumatic or iatrogenic causes, leading to a disruption in the biliary system. Without prompt diagnosis and appropriate management, it can result in significant morbidity and mortality. While magnetic resonance cholangiopancreatography (MRCP) is the typical diagnostic method, there are instances where it may not provide conclusive results. CASE PRESENTATION We present the case of a 72-year-old woman who underwent an hepatic resection of the seventh segment after recurrence of hepatocellular carcinoma (HCC). During the ultrasound (US) follow-up, she developed a peri-hepatic collection which proved to be a biloma continuously refurnished by the biliary tree. Neither the MRCP nor the percutaneous transhepatic cholangiography (PTC) were able to clearly detect the exact site of the bile leak. While awaiting the Endoscopic Retrograde Cholangio-Pancreatography (ERCP), a Contrast-Enhanced Ultrasound (CEUS) was conducted administering the contrast agent directly through the percutaneous drainage catheter placed in the biloma. This revealed the presence of contrast flow from the collection to a peripheral right bile duct, confirming the intra-hepatic leak communication. CONCLUSIONS This case demonstrates that Contrast-Enhanced Ultrasound (CEUS) presents a straightforward, secure, and precise approach to detect biliary leakage responsible for the formation of a biloma. Additionally, the adoption of CEUS offers the dual benefit of minimizing radiation exposure for the patient and obviating the requirement for anesthesia. In summary, CEUS emerges as a compelling alternative to conventional diagnostic methods for effectively managing a biloma.
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Affiliation(s)
- Valentina Marinato
- IRCCS Fondazione Nazionale Tumori di Milano, Milan, Italy
- Radiology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Alice Phillips
- IRCCS Fondazione Nazionale Tumori di Milano, Milan, Italy
- Radiology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Leonardo Giuliano
- IRCCS Fondazione Nazionale Tumori di Milano, Milan, Italy
- Radiology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Tommaso Cascella
- IRCCS Fondazione Nazionale Tumori di Milano, Milan, Italy
- Radiology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Giorgio Greco
- IRCCS Fondazione Nazionale Tumori di Milano, Milan, Italy
- Radiology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Rodolfo Lanocita
- IRCCS Fondazione Nazionale Tumori di Milano, Milan, Italy.
- Radiology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
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3
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Fried GM, Ortenzi M, Dayan D, Nizri E, Mirkin Y, Maril S, Asselmann D, Wolf T. Surgical Intelligence Can Lead to Higher Adoption of Best Practices in Minimally Invasive Surgery. Ann Surg 2024; 280:525-534. [PMID: 38842169 DOI: 10.1097/sla.0000000000006377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
OBJECTIVE To examine the use of surgical intelligence for automatically monitoring critical view of safety (CVS) in laparoscopic cholecystectomy (LC) in a real-world quality initiative. BACKGROUND Surgical intelligence encompasses routine, artificial intelligence-based capture and analysis of surgical video, and connection of derived data with patient and outcomes data. These capabilities are applied to continuously assess and improve surgical quality and efficiency in real-world settings. METHODS Laparoscopic cholecystectomies conducted at 2 general surgery departments between December 2022 and August 2023 were routinely captured by a surgical intelligence platform, which identified and continuously presented CVS adoption, surgery duration, complexity, and negative events. In March 2023, the departments launched a quality initiative aiming for 75% CVS adoption. RESULTS Two hundred seventy-nine procedures were performed during the study. Adoption increased from 39.2% in the 3 preintervention months to 69.2% in the final 3 months ( P < 0.001). Monthly adoption rose from 33.3% to 75.7%. Visualization of the cystic duct and artery accounted for most of the improvement; the other 2 components had high adoption throughout. Procedures with full CVS were shorter ( P = 0.007) and had fewer events ( P = 0.011) than those without. OR time decreased following intervention ( P = 0.033). CONCLUSIONS Surgical intelligence facilitated a steady increase in CVS adoption, reaching the goal within 6 months. Low initial adoption stemmed from a single CVS component, and increased adoption was associated with improved OR efficiency. Real-world use of surgical intelligence can uncover new insights, modify surgeon behavior, and support best practices to improve surgical quality and efficiency.
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Affiliation(s)
- Gerald M Fried
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Monica Ortenzi
- Department of Research and Development, Theator Inc., Palo Alto, CA
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy
| | - Danit Dayan
- Department of General Surgery, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Nizri
- Department of General Surgery, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Mirkin
- Department of Research and Development, Theator Inc., Palo Alto, CA
| | - Sari Maril
- Department of Research and Development, Theator Inc., Palo Alto, CA
| | - Dotan Asselmann
- Department of Research and Development, Theator Inc., Palo Alto, CA
| | - Tamir Wolf
- Department of Research and Development, Theator Inc., Palo Alto, CA
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4
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Tan JR, Lunevicius R. Cholecystoappendiceal fistula associated with xanthogranulomatous cholecystitis. BMJ Case Rep 2024; 17:e260954. [PMID: 39209744 DOI: 10.1136/bcr-2024-260954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Xanthogranulomatous cholecystitis is a rare chronic inflammatory disease of the gallbladder associated with complications such as perforation, dense adhesions and fistulation. We present a case of a female patient in her 20s who presented with three episodes of recurrent cholecystitis over 3 months. Her medical history included an endoscopic retrograde cholangiopancreatography for obstructive jaundice due to choledocholithiasis. As there was no possibility of performing an urgent cholecystectomy during her initial admission, she was listed for an elective operation. Laparoscopic inspection revealed a pericholecystic mass involving the omentum, transverse colon, duodenum and liver and findings suspicious of a cholecystoappendiceal fistula. Laparoscopic cholecystectomy and appendicectomy were performed. Early index admission laparoscopic cholecystectomy should be performed in patients with acute cholecystitis to prevent higher grades of operative difficulty and associated complications. This case presentation-cholecystoappendiceal fistula associated with xanthogranulomatous cholecystitis-emphasises the necessity of complying with national guidelines in managing acute calculous cholecystitis.
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Affiliation(s)
- Jay Roe Tan
- Department of General Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Raimundas Lunevicius
- Department of General Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Vincenzi P, Mocchegiani F, Nicolini D, Benedetti Cacciaguerra A, Gaudenzi D, Vivarelli M. Bile Duct Injuries after Cholecystectomy: An Individual Patient Data Systematic Review. J Clin Med 2024; 13:4837. [PMID: 39200979 PMCID: PMC11355347 DOI: 10.3390/jcm13164837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/22/2024] [Accepted: 08/09/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Post-cholecystectomy bile duct injuries (BDIs) represent a challenging complication, with negative impacts on clinical outcomes. Several surgical and endoscopic/interventional radiologist (IR) approaches have been proposed to manage these damages, though with high failure rates. This individual patient data (IPD) systematic review analyzes the potential risk factors for failure after treatment interventions for BDIs, both surgical and endoscopic/IR. Methods: An extensive literature search was conducted on MEDLINE and Scopus for relevant articles published in English on the management of BDIs after cholecystectomy, between 1 January 2010 and 31 December 2023. Our series of BDIs was included. BDIs were always categorized according to the Strasberg's classification. The composite primary endpoints evaluated were the failure of treatment interventions, defined as patient death or the requirement of any other procedure, whatever surgical and/or endoscopic/IR, after the primary treatment. Results: A total of 342 cases were retrieved from our literature analysis, including our series of 19 patients. Among these, three groups were identified: "upfront surgery", "upfront endoscopy and/or IR" and "no upfront treatment", consisting of 224, 109 and 9 patients, respectively. After eliminating the third group, treatment intervention failure was observed overall in 34.2% (114/333) of patients, of whom 80.7% (92/114) and 19.3% (22/114) in the "upfront surgery" and in the "upfront endoscopy/IR" groups, respectively. At multivariable analysis, injury type D and E, and repair in a non-specialized center represented independent predictors of treatment failure in both groups, whereas laparoscopic cholecystectomy (LC) converted to open and immediate attempt of surgical repair exclusively in the first group. Conclusions: Significant treatment failure rates are responsible for remarkable negative effects on immediate and longer-term clinical outcomes of post-cholecystectomy BDIs. Understanding the important risk factors for this outcome may better guide the most appropriate therapeutical approach and improve clinical decisions in case this serious complication occurs.
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Affiliation(s)
- Paolo Vincenzi
- Division of HPB and Abdominal Transplant Surgery, Department of Gastroenterology and Transplants, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (P.V.); (D.N.); (D.G.)
| | - Federico Mocchegiani
- Division of HPB and Abdominal Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy; (A.B.C.); (M.V.)
| | - Daniele Nicolini
- Division of HPB and Abdominal Transplant Surgery, Department of Gastroenterology and Transplants, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (P.V.); (D.N.); (D.G.)
| | - Andrea Benedetti Cacciaguerra
- Division of HPB and Abdominal Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy; (A.B.C.); (M.V.)
| | - Diletta Gaudenzi
- Division of HPB and Abdominal Transplant Surgery, Department of Gastroenterology and Transplants, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy; (P.V.); (D.N.); (D.G.)
| | - Marco Vivarelli
- Division of HPB and Abdominal Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy; (A.B.C.); (M.V.)
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Etherington MS, Handzel R, Ongchin M, Choudry MH, Tohme ST, Paniccia A, Lee KK, Zureikat A, Geller DA. Remnant completion cholecystectomy is on the rise: Don't three-putt it. HPB (Oxford) 2024; 26:1072-1074. [PMID: 38735816 DOI: 10.1016/j.hpb.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024]
Affiliation(s)
- Mark S Etherington
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Robert Handzel
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Melanie Ongchin
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - M Haroon Choudry
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Samer T Tohme
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alessandro Paniccia
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kenneth K Lee
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Amer Zureikat
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David A Geller
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Hlyan NP, Alsadoun L, Hassan MMU, Cheema MJ, Ali A, Shehryar A, Rehman A, Fareed MU. The Influence of Obesity on Cholecystectomy Outcomes: A Systematic Review of Laparoscopic and Open Approaches. Cureus 2024; 16:e66171. [PMID: 39233975 PMCID: PMC11372850 DOI: 10.7759/cureus.66171] [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] [Accepted: 08/04/2024] [Indexed: 09/06/2024] Open
Abstract
This systematic review evaluates the impact of obesity on the outcomes of laparoscopic versus open cholecystectomy, analyzing data from five key studies. The review explores differences in operative times, complication rates, conversion rates, and recovery times among obese patients undergoing these surgical procedures. The findings indicate that while laparoscopic cholecystectomy in obese patients tends to require longer operative times, it does not significantly increase complication rates compared to open cholecystectomy. However, the risk of conversion to open surgery is modestly elevated. The review highlights the necessity for surgical guidelines to adapt to the challenges posed by obesity, recommending advanced training and innovative technologies to improve surgical outcomes. Limitations such as study design heterogeneity and variability in defining obesity underscore the need for further research. This review contributes to optimizing surgical care strategies and improving patient outcomes in the growing demographic of obese surgical patients.
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Affiliation(s)
| | - Lara Alsadoun
- Trauma and Orthopaedics, Chelsea and Westminster Hospital, London, GBR
| | | | | | - Asghar Ali
- General Surgery, Sir Ganga Ram Hospital, Lahore, PAK
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8
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Harrison E, Kathir Kamarajah S. Global evaluation and outcomes of cholecystectomy: protocol for a multicentre, international, prospective cohort study (GlobalSurg 4). BMJ Open 2024; 14:e079599. [PMID: 39059804 PMCID: PMC11287069 DOI: 10.1136/bmjopen-2023-079599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 06/17/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Cholecystectomy is one of the most common operations performed worldwide. Although laparoscopic surgery has been the 'gold-standard' approach for this operation, there is a paucity of global evidence around the variations of safe provision of cholecystectomy, including low-income and middle-income countries. This international collaborative study will allow contemporaneous data collection on the quality of cholecystectomies using measures covering infrastructure, care processes and outcomes, with the primary aim define the global variation in compliance with preoperative, intraoperative and postoperative audit standards. METHODS AND ANALYSIS Global Evaluation of Cholecystectomy Knowledge and Outcomes is a prospective, international, multicentre, observational cohort study delivered by the GlobalSurg Collaborative. Consecutive patients undergoing cholecystectomy between 31 July 2023 and 19 November 2023 will be recruited, with follow-up at 30 days and 1-year postoperatively. The study will be undertaken at any hospital providing emergency or elective surgical services for biliary disease. The primary endpoint of this study is compliance with preoperative, intraoperative and postoperative audit standards. Secondary outcomes include rates of 30-day complications, achievement of critical view of safety and rates of gallbladder cancer. ETHICS AND DISSEMINATION This project will not affect clinical practice and has been classified as clinical audit following research ethics review at University Hospital Birmingham NHS Trust. The protocol will be disseminated through the international GlobalSurg and CovidSurg network. TRIAL REGISTRATION NUMBER NCT06223061.
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Affiliation(s)
- Ewen Harrison
- University of Edinburgh Western General Hospital, Edinburgh, UK
| | - Sivesh Kathir Kamarajah
- NIHR Global Health Research Unit on Global Surgery, Institute of Applied Health Research, Birmingham, UK
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9
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R K K, Ravipati C, Ramakrishnan KK, Ramaswami S, Natarajan P. Comparative Efficacy of Magnetic Resonance Cholangiopancreatography vs. Percutaneous Transhepatic Cholangiography With Percutaneous Transhepatic Biliary Drainage Stenting in Evaluating Obstructive Jaundice: A Prospective Study in South India. Cureus 2024; 16:e65241. [PMID: 39184628 PMCID: PMC11343331 DOI: 10.7759/cureus.65241] [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: 05/15/2024] [Accepted: 07/23/2024] [Indexed: 08/27/2024] Open
Abstract
Introduction Obstructive jaundice due to proximal biliary obstruction presents significant diagnostic and therapeutic challenges. Accurate and timely diagnosis is essential for effective management. Objective/aim This study aimed to evaluate and compare the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) and percutaneous transhepatic cholangiography (PTC) along with percutaneous transhepatic biliary drainage (PTBD) stenting in obstructive jaundice, while also incorporating the comparison of ultrasonography (USG) and computed tomography (CT) findings. Materials and methods A prospective study was conducted at a tertiary healthcare center in South India from January 2020 to June 2022. Comprehensive diagnostic evaluations were performed using USG, contrast-enhanced computed tomography (CECT), MRCP, and PTC. The diagnostic outcomes from USG and CECT were initially assessed, followed by MRCP for every patient. These results were then compared with PTC, focusing on identifying the causes and levels of biliary obstruction. Results Fifty patients with suspected obstructive jaundice were included in the study. The study predominantly involved patients aged between the fourth and eighth decades (80%). Choledocholithiasis was identified as the leading cause (30%). MRCP demonstrated superior sensitivity in identifying both the cause (80%) and level (88%) of obstruction. It was particularly effective in detecting hilar masses with 100% sensitivity. Conversely, PTC, while less sensitive in detection, offered the advantage of simultaneous therapeutic intervention through stenting, with a sensitivity rate of 93% in detecting hilar masses. Conclusion MRCP outperforms PTC in diagnostic sensitivity for obstructive jaundice caused by proximal biliary obstruction. However, the advantage of PTC lies in its capacity for immediate therapeutic intervention via stent placement, addressing both diagnostic and treatment needs.
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Affiliation(s)
- Karpagam R K
- Department of Radiology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Chakradhar Ravipati
- Department of Radiology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Karthik Krishna Ramakrishnan
- Department of Radiology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Sukumar Ramaswami
- Department of Radiology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Paarthipan Natarajan
- Department of Radiology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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10
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Schertz PJ, Mao CA, Derrick KD, Galar F, Ortiz CB, Walker JA, Lopera JE. Biliary Leaks: Multidisciplinary Approach to Diagnosis and Treatment. Radiographics 2024; 44:e230155. [PMID: 38935550 DOI: 10.1148/rg.230155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Bile leaks arise from various causes such as trauma, complications after hepatobiliary surgery, and intrahepatic malignancies or their associated liver-directed treatments. Bile leaks can result in significant morbidity and mortality. Delayed diagnosis is not uncommon due to nonspecific manifestations; therefore, a high clinical suspicion is needed. A multidisciplinary approach for treatment of biliary leaks with prompt referral to tertiary care centers with experienced hepatobiliary surgeons, advanced endoscopists, and interventional radiologists is needed to address these challenging complications. Management of biliary leaks can range from conservative management to open surgical repair. Minimally invasive procedures play a crucial role in biliary leak treatment, and the interventional radiologist can help guide appropriate management on the basis of a clear understanding of the pathophysiology of biliary leaks and a current knowledge of the armamentarium of treatment options. In most cases, a simple diversion of bile to decompress the biliary system may prove effective. However, persistent and high-output biliary leaks require delineation of the source with tailored treatment options to control the leak. This may be done by additional diversions, occluding the source, reestablishing connections, or using a combination of therapies to bridge to more definitive surgical interventions. The authors describe the different treatment options and emphasize the role of interventional radiology. ©RSNA, 2024.
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Affiliation(s)
- Philip J Schertz
- From the Department of Radiology, University of Texas at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229
| | - Christopher A Mao
- From the Department of Radiology, University of Texas at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229
| | - Kade D Derrick
- From the Department of Radiology, University of Texas at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229
| | - Federico Galar
- From the Department of Radiology, University of Texas at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229
| | - Carlos B Ortiz
- From the Department of Radiology, University of Texas at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229
| | - John A Walker
- From the Department of Radiology, University of Texas at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229
| | - Jorge E Lopera
- From the Department of Radiology, University of Texas at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229
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11
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Kazi IA, Siddiqui MA, Thimmappa ND, Abdelaziz A, Gaballah AH, Davis R, Kimchi E, Hammoud G, Syed KA, Nasrullah A. Post-operative complications of cholecystectomy: what the radiologist needs to know. Abdom Radiol (NY) 2024:10.1007/s00261-024-04387-5. [PMID: 38940909 DOI: 10.1007/s00261-024-04387-5] [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: 03/31/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 06/29/2024]
Abstract
Cholecystectomy is one of the most performed surgical procedures. The safety of this surgery notwithstanding, the sheer volume of operations results in a notable incidence of post-cholecystectomy complications. Early and accurate diagnosis of such complications is essential for timely and effective management. Imaging techniques are critical for this purpose, aiding in distinguishing between expected postsurgical changes and true complications. This review highlights current knowledge on the indications for cholecystectomy, pertinent surgical anatomy and surgical technique, and the recognition of anatomical variants that may complicate surgery. The article also outlines the roles of various imaging modalities in identifying complications, the spectrum of possible postsurgical anatomical changes, and the implications of such findings. Furthermore, we explore the array of complications that can arise post-cholecystectomy, such as biliary system injuries, gallstone-related issues, vascular complications, and the formation of postsurgical collections. Radiologists should be adept at identifying normal and abnormal postoperative findings to guide patient management effectively.
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Affiliation(s)
- Irfan Amir Kazi
- Department of Radiology, University Hospital, University of Missouri, 1 Hospital Drive, Columbia, MO, 65212, USA.
| | - M Azfar Siddiqui
- Department of Radiology, University of Missouri, Columbia, MO, USA
| | | | - Amr Abdelaziz
- Department of Radiology, University of Missouri, Columbia, MO, USA
| | - Ayman H Gaballah
- Department of Radiology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Ryan Davis
- Department of Radiology, University of Missouri, Columbia, MO, USA
| | - Eric Kimchi
- Department of Surgical Oncology, University of Missouri, Columbia, MO, USA
| | - Ghassan Hammoud
- Department of Gastroenterology, University of Missouri, Columbia, MO, USA
| | - Kazi A Syed
- Medical Student, Kansas City University College of Osteopathic Medicine, Kansas, MO, USA
| | - Ayesha Nasrullah
- Department of Radiology, University of Missouri, Columbia, MO, USA
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12
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Fernicola A, Palomba G, Capuano M, De Palma GD, Aprea G. Artificial intelligence applied to laparoscopic cholecystectomy: what is the next step? A narrative review. Updates Surg 2024:10.1007/s13304-024-01892-6. [PMID: 38839723 DOI: 10.1007/s13304-024-01892-6] [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: 04/10/2024] [Accepted: 05/18/2024] [Indexed: 06/07/2024]
Abstract
Artificial Intelligence (AI) is playing an increasing role in several fields of medicine. AI is also used during laparoscopic cholecystectomy (LC) surgeries. In the literature, there is no review that groups together the various fields of application of AI applied to LC. The aim of this review is to describe the use of AI in these contexts. We performed a narrative literature review by searching PubMed, Web of Science, Scopus and Embase for all studies on AI applied to LC, published from January 01, 2010, to December 30, 2023. Our focus was on randomized controlled trials (RCTs), meta-analysis, systematic reviews, and observational studies, dealing with large cohorts of patients. We then gathered further relevant studies from the reference list of the selected publications. Based on the studies reviewed, it emerges that AI could strongly improve surgical efficiency and accuracy during LC. Future prospects include speeding up, implementing, and improving the automaticity with which AI recognizes, differentiates and classifies the phases of the surgical intervention and the anatomic structures that are safe and those at risk.
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Affiliation(s)
- Agostino Fernicola
- Division of Endoscopic Surgery, Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy.
| | - Giuseppe Palomba
- Division of Endoscopic Surgery, Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Marianna Capuano
- Division of Endoscopic Surgery, Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Giovanni Domenico De Palma
- Division of Endoscopic Surgery, Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy
| | - Giovanni Aprea
- Division of Endoscopic Surgery, Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Pansini 5, 80131, Naples, Italy
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Edergren Å, Sandblom G, Franko M, Agustsson T, Cengiz Y, Jaafar G. Safety of cholecystectomy performed by surgeons who prefer fundus first versus surgeons who prefer a standard laparoscopic approach. Surg Open Sci 2024; 19:141-145. [PMID: 38706518 PMCID: PMC11066465 DOI: 10.1016/j.sopen.2024.04.004] [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: 04/11/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024] Open
Abstract
Background An alternative method to standard laparoscopic cholecystectomy (SLC) is the "fundus first" method (FFLC). Concerns have been raised that FFLC can lead to misinterpretation of important anatomical structures, thus causing complications of a more serious kind than SLC. Comparisons between the methods are complicated by the fact that FFLC is often used as a rescue procedure in complicated cases. To avoid confounding related to this we conducted a population-based study with comparisons on the surgeon level. Method In GallRiks, the Swedish registry for Gallbladder surgery, we stratified all cholecystectomies performed 2006-2020 in three groups: surgeries carried out by surgeons that uses FFLC in <20 % of the cases (N = 150,119), in 20-79 % of the cases (N = 10,212) and in 80 % or more of the cases (N = 3176). We compared the groups with logistic regression, adjusting for sex, age, surgical experience, year of surgery and history of acute cholecystitis. All surgical complications (bleeding, gallbladder perforation, visceral perforation, infection, and bile duct injury) were included as outcome. A separate analysis was done with regards to operation time. Results No difference in incidence of all surgical complications or bile duct injury were seen between groups. The rates of bleeding (OR 0.34 [0.14-0.86]) and gallbladder perforation (OR 0.61 [0.45-0.82]) were significantly lower in the "fundus first > 80% group" and the operative time was shorter (OR 0.76 [0.69-0.83]). Conclusion In this study including >160,000 cholecystectomies, both methods was found to be equally safe. Key message During laparoscopic cholecystectomy, the standard method of dissection and fundus first dissection are equally safe surgical techniques. Surgeons need to learn both methods to be able to use the one most appropriate for each individual case.
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Affiliation(s)
- Åsa Edergren
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute & Department of Surgery, Södersjukhuset, Sjukhusbacken 10, 11883 Stockholm, Sweden
| | - Gabriel Sandblom
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute & Department of Surgery, Södersjukhuset, Sjukhusbacken 10, 11883 Stockholm, Sweden
| | - Mikael Franko
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Sjukhusbacken 10, 11883 Stockholm, Sweden
| | - Thorhallur Agustsson
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute & Department of Surgery, Södersjukhuset, Sjukhusbacken 10, 11883 Stockholm, Sweden
| | - Yucel Cengiz
- Department of Surgical and Perioperative Sciences, Umeå University, 90185 Umeå, Sweden
| | - Gona Jaafar
- Department of Clinical Sciences, Intervention and Technology, Karolinska Institute & Department of Emergency Care, Karolinska University Hospital, Ana Futura, Alfred Nobels Allé 8, 141 52 Huddinge, Sweden
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Barbaro A, Paredes SR, Tran S, Kaur H, Arayne AA, Senaratne J. Cholecystectomy in the red centre: a review of the surgical outcomes in Central Australia in a five-year period. ANZ J Surg 2024; 94:1122-1126. [PMID: 38682428 DOI: 10.1111/ans.19017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/26/2024] [Accepted: 04/18/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Despite the high rates of cholecystectomy in Australia, there is minimal literature regarding the outcomes of cholecystectomy in rural Central Australia within the Northern Territory. This study aims to better characterize the outcomes for patients undergoing cholecystectomy in Central Australia and review clinical and patient characteristics, which may affect outcomes. METHOD A retrospective case-control study was performed using data obtained from medical records for all patients undergoing cholecystectomy at Alice Springs Hospital in the Northern Territory from January 2018 until December 2022. Patient characteristics were gathered, and key outcomes examined included: inpatient mortality and 30-day mortality, bile duct injury, bile leak, return to theatre, conversion to open, duration of procedure, length of stay, and up-transfer to a tertiary referral centre. RESULTS A total of 466 patients were included in this study. Majority of the patients were female and there was a large portion of Indigenous Australians (56%). There were no inpatient mortalities, or 30-day mortalities recorded. There were two bile leaks and/or bile duct injuries (0.4%) and two unplanned returned to theatres (0.4%). Indigenous Australians were more likely to require an emergency operation and had a longer median length of stay (P < 0.001). CONCLUSION Cholecystectomy can be performed safely and to a high standard in Central Australia. Surgeons in Central Australia must appreciate the nuances in the management of patients who come from a significantly different socioeconomic background, with complex medical conditions when compared to metropolitan centres.
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Affiliation(s)
- Antonio Barbaro
- Department of Surgery, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- Department of Surgery, University of Adelaide, Adelaide, South Australia, Australia
| | - Steven Ronald Paredes
- Department of Surgery, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- School of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Steven Tran
- Department of Surgery, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Harleen Kaur
- Department of Surgery, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- Department of Surgery, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | | | - Jayantha Senaratne
- Department of Surgery, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
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15
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Patel M, Tranter-Entwistle I, Sirimanna P, Hugh TJ. 3D visualization systems improve operator efficiency during difficult laparoscopic cholecystectomy: a retrospective blinded review of surgical videos. ANZ J Surg 2024; 94:1114-1121. [PMID: 38486432 DOI: 10.1111/ans.18949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/29/2024] [Accepted: 03/06/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND 3D visualization systems in laparoscopic surgery have been proposed to improve manual task handling compared to 2D, however, few studies have compared the intra-operative efficacy in laparoscopic cholecystectomy (LC). The aim of this study is to determine if there is a benefit in intra-operative efficiency when using a 3D visualization system in difficult LC compared to traditional 2D visualization systems. METHODS Retrospective analysis of 'difficult' LCs (Grades 3 or 4) was completed. The assessor was blinded as all cases were recorded and viewed in 2D only. Variables collected included time to complete steps, missed hook diathermy attempts, failed grasp attempts, missed clip attempts and preparation steps for intra-operative cholangiogram (IOC). Multiple linear regression was undertaken for time variables, Poisson regression or negative binomial regression was completed for continuous variables. RESULTS Fifty-two operative videos of 'difficult' LC were reviewed. 3D systems were associated with reduced operative times, although this was not statistically significant (CI: -2.93-14.93, P-value = 0.183). Dissection of the anterior fold to achieve the critical view of safety was significantly faster by 3.55 min (CI: 1.215-9.206, P-value = 0.002), and with considerably fewer errors when using 3D systems. Fewer IOC preparation errors were observed with a 3D system compared with a 2D system. CONCLUSIONS 3D systems appear to enhance operator efficiency, allowing faster completion of critical steps with fewer errors. This pilot study underscores the utility of video annotation for intra-operative assessment and suggests that, in larger multi-centre studies, 3D systems may demonstrate superior intra-operative efficiency over 2D systems during a 'difficult' LC.
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Affiliation(s)
- Meet Patel
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Northern Beaches Hospital, Frenches Forrest, New South Wales, Australia
| | | | - Pramudith Sirimanna
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Thomas J Hugh
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, St Leonards, New South Wales, Australia
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Ünal E, Çiftçi TT, Akinci D, Parlak E. Magnets in action: role of interventional radiologists in magnetic compression anastomosis procedures. Insights Imaging 2024; 15:128. [PMID: 38816640 PMCID: PMC11139847 DOI: 10.1186/s13244-024-01705-9] [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: 02/03/2024] [Accepted: 04/08/2024] [Indexed: 06/01/2024] Open
Abstract
Obstructions encountered in biliary, gastrointestinal, and urinary tracts are increasing in number due to successful percutaneous and endoscopic organ-saving procedures. Although functional recovery is established to an extent, failure of traversing an obstruction may end up necessitating invasive surgical procedures. Multidisciplinary collaboration may traverse the limitations of each individual approach, therefore creating the perfect intervention for the patient. Magnetic compression anastomosis is a minimally invasive procedure that can provide a great outcome in select cases with biliary, gastrointestinal, or urinary tract obstructions. CRITICAL RELEVANCE STATEMENT: In this article, various applications of magnetic compression anastomosis are reviewed with illustrative cases of esophageal, biliary, colonic, and urinary obstructions that cannot be traversed with a wire. This method will expand the spectrum of interventions performed in the IR unit. KEY POINTS: Magnets can enable wire access beyond an impassable obstruction. Magnets can create anatomical and non-anatomical anastomosis at an occlusion. Magnetic compression anastomosis is a minimally invasive procedure that can provide great outcomes.
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Affiliation(s)
- Emre Ünal
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Türkmen Turan Çiftçi
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Devrim Akinci
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Erkan Parlak
- Department of Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Lopez-Lopez V, Kuemmerli C, Maupoey J, López-Andujar R, Lladó L, Mils K, Müller P, Valdivieso A, Garcés-Albir M, Sabater L, Cacciaguerra AB, Vivarelli M, Valladares LD, Pérez SA, Flores B, Brusadin R, Conesa AL, Cortijo SM, Paterna S, Serrablo A, Toop FHW, Oldhafer K, Sánchez-Cabús S, Gil AG, Masía JAG, Loinaz C, Lucena JL, Pastor P, Garcia-Zamora C, Calero A, Valiente J, Minguillon A, Rotellar F, Alcazar C, Aguilo J, Cutillas J, Ruiperez-Valiente JA, Ramírez P, Petrowsky H, Ramia JM, Robles-Campos R. Textbook outcome in patients with biliary duct injury during cholecystectomy. J Gastrointest Surg 2024; 28:725-730. [PMID: 38480039 DOI: 10.1016/j.gassur.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/11/2024] [Accepted: 02/17/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Iatrogenic bile duct injury (BDI) during cholecystectomy is associated with a complex and heterogeneous management owing to the burden of morbidity until their definitive treatment. This study aimed to define the textbook outcomes (TOs) after BDI with the purpose to indicate the ideal treatment and to improve it management. METHODS We collected data from patients with an BDI between 1990 and 2022 from 27 hospitals. TO was defined as a successful conservative treatment of the iatrogenic BDI or only minor complications after BDI or patients in whom the first repair resolves the iatrogenic BDI without complications or with minor complications. RESULTS We included 808 patients and a total of 394 patients (46.9%) achieved TO. Overall complications in TO and non-TO groups were 11.9% and 86%, respectively (P < .001). Major complications and mortality in the non-TO group were 57.4% and 9.2%, respectively. The use of end-to-end bile duct anastomosis repair was higher in the non-TO group (23.1 vs 7.8, P < .001). Factors associated with achieving a TO were injury in a specialized center (adjusted odds ratio [aOR], 4.01; 95% CI, 2.68-5.99; P < .001), transfer for a first repair (aOR, 5.72; 95% CI, 3.51-9.34; P < .001), conservative management (aOR, 5.00; 95% CI, 1.63-15.36; P = .005), or surgical management (aOR, 2.45; 95% CI, 1.50-4.00; P < .001). CONCLUSION TO largely depends on where the BDI is managed and the type of injury. It allows hepatobiliary centers to identify domains of improvement of perioperative management of patients with BDI.
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Affiliation(s)
- Victor Lopez-Lopez
- Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, Murcian Institute of Biosanitary Research (IMIB), Murcia, Spain.
| | - Christoph Kuemmerli
- Department of Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland
| | - Javier Maupoey
- Department of Hepatobiliary Surgery and Transplants, Hospital Universitario La Fe, Valencia, Spain
| | - Rafael López-Andujar
- Department of Hepatobiliary Surgery and Transplants, Hospital Universitario La Fe, Valencia, Spain
| | - Laura Lladó
- Department of Hepatobiliary Surgery and Liver Transplant Unit, Hospital Universitari Bellvitge, University of Barcelona, Barcelona, Spain
| | - Kristel Mils
- Department of Hepatobiliary Surgery and Liver Transplant Unit, Hospital Universitari Bellvitge, University of Barcelona, Barcelona, Spain
| | - Philip Müller
- Department of Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland; Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Andres Valdivieso
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, Bilbao, Spain
| | - Marina Garcés-Albir
- Department of Surgery, Hospital Clínico, University of Valencia, Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Luis Sabater
- Department of Surgery, Hospital Clínico, University of Valencia, Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Andrea Benedetti Cacciaguerra
- Department of Experimental and Clinical Medicine, Hepatobiliary and Abdominal Transplantation Surgery, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Marco Vivarelli
- Department of Experimental and Clinical Medicine, Hepatobiliary and Abdominal Transplantation Surgery, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Luis Díez Valladares
- Department of Surgery, Hepatopancreatobiliary Unit, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Benito Flores
- Department of Surgery, Morales University Hospital, Madrid, Spain
| | - Roberto Brusadin
- Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, Murcian Institute of Biosanitary Research (IMIB), Murcia, Spain
| | - Asunción López Conesa
- Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, Murcian Institute of Biosanitary Research (IMIB), Murcia, Spain
| | | | - Sandra Paterna
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - Alejando Serrablo
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Karl Oldhafer
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asklepios Hospital Barmbek, Germany
| | - Santiago Sánchez-Cabús
- Hepatobiliopancreatic Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio González Gil
- Department of Surgery, Los Arcos del Mar Menor University Hospital, Murcia, Spain
| | | | - Carmelo Loinaz
- Department of General Surgery, Digestive Tract and Abdominal Organ Transplantation, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Jose Luis Lucena
- Department of Surgery, Puerta del Hierro University Hospital, Madrid, Spain
| | - Patricia Pastor
- Department of Surgery, Reina Sofía University Hospital, Murcia, Spain
| | | | - Alicia Calero
- Department of General Surgery, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain
| | - Juan Valiente
- Department of General Surgery, Hellin Hospital, Albacete, Spain
| | | | - Fernando Rotellar
- Institute of Health Research of Navarra (IDISNA), Pamplona, Spain; HPB and Liver Transplant Unit, Abdominal and General Surgery, Clinica Universidad de Navarra, Pamplona, Spain
| | - Cándido Alcazar
- Department of Surgery, University Hospital of Alicante, and Universidad Miguel Hernandez, ISABIAL, Alicante, Spain
| | - Javier Aguilo
- Department of General Surgery, Hospital Lluís Alcanyís Hospital, Xàtiva, Valencia, Spain
| | - Jose Cutillas
- Department of General Surgery, Hospital Francesc de Borja, Gandía, Valencia, Spain
| | | | - Pablo Ramírez
- Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, Murcian Institute of Biosanitary Research (IMIB), Murcia, Spain
| | - Henrik Petrowsky
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Jose Manuel Ramia
- Department of Surgery, University Hospital of Alicante, and Universidad Miguel Hernandez, ISABIAL, Alicante, Spain
| | - Ricardo Robles-Campos
- Department of Surgery and Transplantation, Virgen de la Arrixaca Clinic and University Hospital, Murcian Institute of Biosanitary Research (IMIB), Murcia, Spain
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Badgery H, Zhou Y, Bailey J, Brotchie P, Chong L, Croagh D, Page M, Davey CE, Read M. Using neural networks to autonomously assess adequacy in intraoperative cholangiograms. Surg Endosc 2024; 38:2734-2745. [PMID: 38561583 PMCID: PMC11078812 DOI: 10.1007/s00464-024-10768-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/22/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Intraoperative cholangiography (IOC) is a contrast-enhanced X-ray acquired during laparoscopic cholecystectomy. IOC images the biliary tree whereby filling defects, anatomical anomalies and duct injuries can be identified. In Australia, IOC are performed in over 81% of cholecystectomies compared with 20 to 30% internationally (Welfare AIoHa in Australian Atlas of Healthcare Variation, 2017). In this study, we aim to train artificial intelligence (AI) algorithms to interpret anatomy and recognise abnormalities in IOC images. This has potential utility in (a) intraoperative safety mechanisms to limit the risk of missed ductal injury or stone, (b) surgical training and coaching, and (c) auditing of cholangiogram quality. METHODOLOGY Semantic segmentation masks were applied to a dataset of 1000 cholangiograms with 10 classes. Classes corresponded to anatomy, filling defects and the cholangiogram catheter instrument. Segmentation masks were applied by a surgical trainee and reviewed by a radiologist. Two convolutional neural networks (CNNs), DeeplabV3+ and U-Net, were trained and validated using 900 (90%) labelled frames. Testing was conducted on 100 (10%) hold-out frames. CNN generated segmentation class masks were compared with ground truth segmentation masks to evaluate performance according to a pixel-wise comparison. RESULTS The trained CNNs recognised all classes.. U-Net and DeeplabV3+ achieved a mean F1 of 0.64 and 0.70 respectively in class segmentation, excluding the background class. The presence of individual classes was correctly recognised in over 80% of cases. Given the limited local dataset, these results provide proof of concept in the development of an accurate and clinically useful tool to aid in the interpretation and quality control of intraoperative cholangiograms. CONCLUSION Our results demonstrate that a CNN can be trained to identify anatomical structures in IOC images. Future performance can be improved with the use of larger, more diverse training datasets. Implementation of this technology may provide cholangiogram quality control and improve intraoperative detection of ductal injuries or ductal injuries.
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Affiliation(s)
- Henry Badgery
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia.
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Melbourne, VIC, 3065, Australia.
| | - Yuning Zhou
- Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia
- Graeme Clark Institute for Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - James Bailey
- School of Computing and Information Systems, The University of Melbourne, Parkville, Australia
| | - Peter Brotchie
- Department of Radiology, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Lynn Chong
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Melbourne, VIC, 3065, Australia
| | - Daniel Croagh
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
- Department of Surgery, Monash Health, Melbourne, Australia
| | - Mark Page
- Department of Radiology, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Catherine E Davey
- Department of Biomedical Engineering, The University of Melbourne, Parkville, Australia
- Graeme Clark Institute for Biomedical Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Matthew Read
- Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
- Department of Surgery, The University of Melbourne, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Melbourne, VIC, 3065, Australia
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Cadili L, Streith L, Segedi M, Hayashi AH. Management of complex acute biliary disease for the general surgeon: A narrative review. Am J Surg 2024; 231:46-54. [PMID: 36990834 DOI: 10.1016/j.amjsurg.2023.03.020] [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: 11/10/2022] [Revised: 02/26/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023]
Abstract
Acute gallbladder diseases are a common surgical emergency faced by General Surgeons that can sometimes be quite challenging. These complex biliary diseases require multifaceted and expeditious care, optimized based on hospital facility and operating room (OR) resources and the expertise of the surgical team. Effective management of biliary emergencies requires two foundational principles: achieving source control while mitigating the risk of injury to the biliary tree and its blood supply. This review article highlights salient literature on seven complex biliary diseases: acute cholecystitis, cholangitis, Mirizzi syndrome, gallstone ileus with cholecystoenteric fistula, gallstone pancreatitis, gall bladder cancer, and post-cholecystectomy bile leak.
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Affiliation(s)
- Lina Cadili
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Lucas Streith
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Maja Segedi
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada; Hepatopancreatobiliary and Liver Transplant Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Allen H Hayashi
- Division of General Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada; Division of General Surgery, Island Health Authority, Victoria, British Columbia, Canada
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20
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Olmedo NB, Dos Santos JS, Junior JE. The Frequency of Anatomical Variants of the Bile Ducts: A Review Based on a Single Classification as Support for Cholangiographic Examinations. Cureus 2024; 16:e58905. [PMID: 38800324 PMCID: PMC11118781 DOI: 10.7759/cureus.58905] [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] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Complications arising from hepatobiliary surgery can have adverse effects on both the quality of life and the survival of patients. Magnetic resonance cholangiography (MRC) techniques are highly effective at revealing anatomical variants of the bile ducts and thus play a vital role in minimizing the occurrence of complications. The aims of this review are threefold: to ascertain the classifications utilized for categorizing anatomical variants of the bile ducts, to present the reported results on the prevalence of these anatomical variants, and to explore the diagnostic modalities employed to visualize these anatomical variants and associated complications during surgical procedures. A review of the literature was carried out using the Cochrane Library database and the PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), and Google Scholar platforms. We conducted a comprehensive review of relevant studies to categorize the different anatomical variants according to the Huang classification. According to the Huang classification, our study showed type A1, 60.44%; type A2, 11.76%; type A3, 11.73%; type A4, 5.47%; type A5, 0.26%; and type B, which was identified in insignificant numbers (0.16%) or does not appear; additionally, variants that do not fit into the Huang classification have also been identified (10.18%). The Huang classification serves as an invaluable presurgical guide, aiding in the strategic planning of biliary interventions and effectively reducing the risk of iatrogenic complications, morbidity, mortality, and postoperative length of stay. MRC is still considered the noninvasive gold standard method for evaluating the bile ducts and their anatomical variations.
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Affiliation(s)
- Norman B Olmedo
- Department of Imaging and Radiology, College of Medical Sciences, Central University of Ecuador, Quito, ECU
| | - José Sebastião Dos Santos
- Department of Surgery and Anatomy, Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, BRA
| | - Jorge Elías Junior
- Department of Medical Imaging, Hematology, and Oncology, Ribeirão Medical School, University of São Paulo, Ribeirão Preto, BRA
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Meira-Júnior JD, Ramos-Aranda J, Carrillo-Vidales J, Velásquez-Coria ER, Mercado MA, Dominguez-Rosado I. BILE DUCT INJURY REPAIR IN A PATIENT WITH SITUS INVERSUS TOTALIS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2024; 37:e1795. [PMID: 38511812 PMCID: PMC10949928 DOI: 10.1590/0102-672020240002e1795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 11/30/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND Bile duct injury (BDI) causes significant sequelae for the patient in terms of morbidity, mortality, and long-term quality of life, and should be managed in centers with expertise. Anatomical variants may contribute to a higher risk of BDI during cholecystectomy. AIMS To report a case of bile duct injury in a patient with situs inversus totalis. METHODS A 42-year-old female patient with a previous history of situs inversus totalis and a BDI was initially operated on simultaneously to the lesion ten years ago by a non-specialized surgeon. She was referred to a specialized center due to recurrent episodes of cholangitis and a cholestatic laboratory pattern. Cholangioresonance revealed a severe anastomotic stricture. Due to her young age and recurrent cholangitis, she was submitted to a redo hepaticojejunostomy with the Hepp-Couinaud technique. To the best of our knowledge, this is the first report of BDI repair in a patient with situs inversus totalis. RESULTS The previous hepaticojejunostomy was undone and remade with the Hepp-Couinaud technique high in the hilar plate with a wide opening in the hepatic confluence of the bile ducts towards the left hepatic duct. The previous Roux limb was maintained. Postoperative recovery was uneventful, the drain was removed on the seventh post-operative day, and the patient is now asymptomatic, with normal bilirubin and canalicular enzymes, and no further episodes of cholestasis or cholangitis. CONCLUSIONS Anatomical variants may increase the difficulty of both cholecystectomy and BDI repair. BDI repair should be performed in a specialized center by formal hepato-pancreato-biliary surgeons to assure a safe perioperative management and a good long-term outcome.
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Affiliation(s)
- José Donizeti Meira-Júnior
- Universidade de São Paulo, Digestive Surgery Division, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Javier Ramos-Aranda
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Hepatopancreatobiliary Surgery Division, Mexico City, Mexico
| | - Javier Carrillo-Vidales
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Hepatopancreatobiliary Surgery Division, Mexico City, Mexico
| | - Erik Rodrigo Velásquez-Coria
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Hepatopancreatobiliary Surgery Division, Mexico City, Mexico
| | - Miguel Angel Mercado
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Hepatopancreatobiliary Surgery Division, Mexico City, Mexico
| | - Ismael Dominguez-Rosado
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Hepatopancreatobiliary Surgery Division, Mexico City, Mexico
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22
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Jain D, Malage S, Singh A, Ghosh N, Rahul R, Sharma S, Kumar A, Singh RK, Behari A, Kumar A, Saxena R. Post Cholecystectomy Bile Duct Injury in an Acute Setting: Categorization, Triaging, and Management Algorithm. Cureus 2024; 16:e55828. [PMID: 38590499 PMCID: PMC10999900 DOI: 10.7759/cureus.55828] [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] [Accepted: 03/08/2024] [Indexed: 04/10/2024] Open
Abstract
Background Postcholecystectomy bile duct injury (BDI) is a management challenge with significant morbidity, mortality, and effects on long-term quality of life. Early referral to a specialized hepatobiliary center and appropriate early management are crucial to improving outcomes and overall quality of life. In this retrospective analysis, we examined patients who were managed at our center over the past 10 years and proposed a triage and management algorithm for BDI in acute settings. Methods Patients referred to our center with BDI from January 2011 to December 2020 were reviewed retrospectively. The primary objective of initial management is to control sepsis and minimize BDI-related morbidity and mortality. All the patients were resuscitated with intravenous fluid, antibiotics (preferably culture-based), correction of electrolyte deficiencies, and organ support if required. A triage module and management algorithm were framed based on our experience. All the patients were triaged based on the presence or absence of bile leaks. Each group was further subdivided into red, yellow, and green zones (depending on the presence of sepsis, organ failure, and associated injuries), and the results were analyzed as per the proposed algorithm. Results One hundred twenty-eight patients with acute BDI were referred to us during the study period, and 116 patients had BDI with a bile leak and 12 patients were without a bile leak. Out of bile leak patients, 106 patients (91.38%) had sepsis with or without organ failure (red and yellow zone) and required invasive intervention in the form of PCD insertion (n=99, 85.34%) and/or laparotomy, lavage, and drainage (n=7, 6.03%). Another 10 patients (8.62%) had controlled external biliary fistula (green zone), of which four were managed with antibiotics, four underwent endoscopic retrograde cholangiopancreatography stenting, and only two (1.7%) patients could undergo Roux-en-Y hepaticojejunostomy upfront due to late referral. Among patients with BDI without bile leaks, nine (75%) had cholangitis (red and yellow zones). Out of these, five required PTBD along with antibiotics and four were managed with antibiotics alone. Only three (25%) patients in this group could undergo definitive repair without any restriction on the timing of referral and were sepsis-free at presentation (green zone). A total of nine patients had a vascular injury, and four of them required digital subtraction angiography and coil embolization. There were three (2.34%) mortalities; all were in the red zone of rest and had successful initial management. In total, five patients were managed with early repair in the acute setting, and the rest underwent definitive intervention at subsequent admissions after being converted to green zone patients with initial management. Conclusion The presented categorization, triaging, and management algorithm provides optimum insight to understand the severity, simplify these complex scenarios, expedite the decision-making process, and thus enhance patient outcomes in early acute settings following BDI.
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Affiliation(s)
- Divya Jain
- Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Somanath Malage
- Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Ashish Singh
- Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Nalinikanta Ghosh
- Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Rahul Rahul
- Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Supriya Sharma
- Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Ashok Kumar
- Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Rajneesh K Singh
- Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Anu Behari
- Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Ashok Kumar
- Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Rajan Saxena
- Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
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23
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Vitiello A, Spagnuolo M, Persico M, Peltrini R, Berardi G, Calabrese P, De Werra C, Rescigno C, Troisi R, Pilone V. Biliary Leak from Ducts of Luschka: Systematic Review of the Literature. SURGERIES 2024; 5:63-72. [DOI: 10.3390/surgeries5010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2024] Open
Abstract
Injury to the Luschka ducts (LDs), also named “subvesicular” ducts, is an under-reported cause of biliary leak following laparoscopic cholecystectomy (LC). A systematic literature search according to PRISMA guidelines was conducted in PubMed, EMBASE and Cochrane Library including all publications that described a bile leak from an LD. A total of 136 articles were retrieved from the searched databases. After the removal of duplicates and non-eligible papers, 48 studies reporting 231 leaks were included: 20 (41.6%) case reports, 2 (4.3%) comparative studies, 7 (14.9%) meeting abstracts and 19 (40.4%) retrospective cohort articles. The rate of LD leak ranges from 0.05% to 1.9%, but injury to a duct of Luschka was the second most common cause of biliary leakage in all the cohort studies (5.5% to 41%). In 21 (43.7%) cases, the leak was successfully treated with a sphincterotomy through Endoscopic Retrograde Cholangiopancreatography (ERCP) plus or minus stenting, and in 12 (25%), re-laparoscopy was necessary.
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Affiliation(s)
- Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”—Via S. Pansini 5, 80131 Naples, Italy
| | - Maria Spagnuolo
- Public Health Department, Naples “Federico II” University, AOU “Federico II”—Via S. Pansini 5, 80131 Naples, Italy
| | - Marcello Persico
- Public Health Department, Naples “Federico II” University, AOU “Federico II”—Via S. Pansini 5, 80131 Naples, Italy
| | - Roberto Peltrini
- Public Health Department, Naples “Federico II” University, AOU “Federico II”—Via S. Pansini 5, 80131 Naples, Italy
| | - Giovanna Berardi
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”—Via S. Pansini 5, 80131 Naples, Italy
| | - Pietro Calabrese
- Public Health Department, Naples “Federico II” University, AOU “Federico II”—Via S. Pansini 5, 80131 Naples, Italy
| | - Carlo De Werra
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”—Via S. Pansini 5, 80131 Naples, Italy
| | - Carmela Rescigno
- Presidio Ospedaliero Santa Maria Incoronata dell’Olmo di Cava de’ Tirreni, Azienda Ospedaliera Integrata con l’Università, Via de Marinis, 84131 Cava dei Tirreni, Italy
| | - Roberto Troisi
- Clinical Medicine and Surgery Department, Naples “Federico II” University, AOU “Federico II”—Via S. Pansini 5, 80131 Naples, Italy
| | - Vincenzo Pilone
- Public Health Department, Naples “Federico II” University, AOU “Federico II”—Via S. Pansini 5, 80131 Naples, Italy
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24
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Stoica PL, Serban D, Bratu DG, Serboiu CS, Costea DO, Tribus LC, Alius C, Dumitrescu D, Dascalu AM, Tudor C, Simion L, Tudosie MS, Comandasu M, Popa AC, Cristea BM. Predictive Factors for Difficult Laparoscopic Cholecystectomies in Acute Cholecystitis. Diagnostics (Basel) 2024; 14:346. [PMID: 38337862 PMCID: PMC10855974 DOI: 10.3390/diagnostics14030346] [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: 01/10/2024] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024] Open
Abstract
Laparoscopic cholecystectomy (LC) is the gold standard treatment in acute cholecystitis. However, one in six cases is expected to be difficult due to intense inflammation and suspected adherence to and involvement of adjacent important structures, which may predispose patients to higher risk of vascular and biliary injuries. In this study, we aimed to identify the preoperative parameters with predictive value for surgical difficulties. A retrospective study of 255 patients with acute cholecystitis admitted in emergency was performed between 2019 and 2023. Patients in the difficult laparoscopic cholecystectomy (DLC) group experienced more complications compared to the normal LC group (33.3% vs. 15.3%, p < 0.001). Age (p = 0.009), male sex (p = 0.03), diabetes (p = 0.02), delayed presentation (p = 0.03), fever (p = 0.004), and a positive Murphy sign (p = 0.007) were more frequently encountered in the DLC group. Total leukocytes, neutrophils, and the neutrophil-to-lymphocyte ratio (NLR) were significantly higher in the DLC group (p < 0.001, p = 0.001, p = 0.001 respectively). The Tongyoo score (AUC ROC of 0.856) and a multivariate model based on serum fibrinogen, thickness of the gallbladder wall, and transverse diameter of the gallbladder (AUC ROC of 0.802) showed a superior predictive power when compared to independent parameters. The predictive factors for DLC should be assessed preoperatively to optimize the therapeutic decision.
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Affiliation(s)
- Paul Lorin Stoica
- Doctoral School, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania;
| | - Dragos Serban
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.S.S.); (C.A.); (D.D.); (A.M.D.); (C.T.); (L.S.); (M.S.T.); (B.M.C.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania;
| | - Dan Georgian Bratu
- Faculty of Medicine, University Lucian Blaga Sibiu, 550169 Sibiu, Romania
- Department of Surgery, Emergency County Hospital Sibiu, 550245 Sibiu, Romania
| | - Crenguta Sorina Serboiu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.S.S.); (C.A.); (D.D.); (A.M.D.); (C.T.); (L.S.); (M.S.T.); (B.M.C.)
| | - Daniel Ovidiu Costea
- Faculty of Medicine, Ovidius University Constanta, 900470 Constanta, Romania
- General Surgery Department, Emergency County Hospital Constanta, 900591 Constanta, Romania
| | - Laura Carina Tribus
- Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania;
- Department of Internal Medicine, Ilfov Emergency Clinic Hospital Bucharest, 022104 Bucharest, Romania
| | - Catalin Alius
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.S.S.); (C.A.); (D.D.); (A.M.D.); (C.T.); (L.S.); (M.S.T.); (B.M.C.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania;
| | - Dan Dumitrescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.S.S.); (C.A.); (D.D.); (A.M.D.); (C.T.); (L.S.); (M.S.T.); (B.M.C.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania;
| | - Ana Maria Dascalu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.S.S.); (C.A.); (D.D.); (A.M.D.); (C.T.); (L.S.); (M.S.T.); (B.M.C.)
| | - Corneliu Tudor
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.S.S.); (C.A.); (D.D.); (A.M.D.); (C.T.); (L.S.); (M.S.T.); (B.M.C.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania;
| | - Laurentiu Simion
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.S.S.); (C.A.); (D.D.); (A.M.D.); (C.T.); (L.S.); (M.S.T.); (B.M.C.)
- Department of Surgical Oncology, Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Mihail Silviu Tudosie
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.S.S.); (C.A.); (D.D.); (A.M.D.); (C.T.); (L.S.); (M.S.T.); (B.M.C.)
| | - Meda Comandasu
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania;
| | - Alexandru Cosmin Popa
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.S.S.); (C.A.); (D.D.); (A.M.D.); (C.T.); (L.S.); (M.S.T.); (B.M.C.)
- Department of General Surgery, Colentina Clinic Hospital, 020125 Bucharest, Romania
| | - Bogdan Mihai Cristea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.S.S.); (C.A.); (D.D.); (A.M.D.); (C.T.); (L.S.); (M.S.T.); (B.M.C.)
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Symeonidis S, Mantzoros I, Anestiadou E, Ioannidis O, Christidis P, Bitsianis S, Zapsalis K, Karastergiou T, Athanasiou D, Apostolidis S, Angelopoulos S. Biliary Anatomy Visualization and Surgeon Satisfaction Using Standard Cholangiography versus Indocyanine Green Fluorescent Cholangiography during Elective Laparoscopic Cholecystectomy: A Randomized Controlled Trial. J Clin Med 2024; 13:864. [PMID: 38337557 PMCID: PMC10856121 DOI: 10.3390/jcm13030864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Intraoperative biliary anatomy recognition is crucial for safety during laparoscopic cholecystectomy, since iatrogenic bile duct injuries represent a fatal complication, occurring in up to 0.9% of patients. Indocyanine green fluorescence cholangiography (ICG-FC) is a safe and cost-effective procedure for achieving a critical view of safety and recognizing early biliary injuries. The aim of this study is to compare the perioperative outcomes, usefulness and safety of standard intraoperative cholangiography (IOC) with ICG-FC with intravenous ICG. Methods: Between 1 June 2021 and 31 December 2022, 160 patients undergoing elective LC were randomized into two equal groups: Group A (standard IOC) and group B (ICG-FC with intravenous ICG). Results: No significant difference was found between the two groups regarding demographics, surgery indication or surgery duration. No significant difference was found regarding the visualization of critical biliary structures. However, the surgeon satisfaction and cholangiography duration presented significant differences in favor of ICG-FC. Regarding the inflammatory response, a significant difference between the two groups was found only in postoperative WBC levels. Hepatic and renal function test results were not significantly different between the two groups on the first postoperative day, except for direct bilirubin. No statistically significant difference was noted regarding 30-day postoperative complications, while none of the complications noted included bile duct injury events. Conclusions: ICG-FC presents equivalent results to IOC regarding extrahepatic biliary visualization and postoperative complications. However, more studies need to be performed in order to standardize the optimal dose, timing and mode of administration.
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Affiliation(s)
- Savvas Symeonidis
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Ioannis Mantzoros
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Elissavet Anestiadou
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Orestis Ioannidis
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Panagiotis Christidis
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Stefanos Bitsianis
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Konstantinos Zapsalis
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Trigona Karastergiou
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Dimitra Athanasiou
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
| | - Stylianos Apostolidis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Stamatios Angelopoulos
- 4th Department of General Surgery, Aristotle University of Thessaloniki, General Hospital of Thessaloniki “G. Papanikolaou”, 54124 Thessaloniki, Greece; (S.S.); (I.M.); (E.A.); (P.C.); (S.B.); (K.Z.); (T.K.); (D.A.); (S.A.)
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26
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Aburayya BI, Obeidat LR, Kitana FI, Al Khatib O, Romman S, Hamed OH. Complete Common Bile Duct Injury after Laparoscopic Cholecystectomy in Situs Inversus Totalis: A Case Report, Review of the Literature and Illustrative Case Video. Int J Surg Case Rep 2024; 115:109265. [PMID: 38244377 PMCID: PMC10831892 DOI: 10.1016/j.ijscr.2024.109265] [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: 11/27/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Situs Inversus Totalis (SIT) is a rare condition characterized by the transposition of internal organs. Given the anatomical variations in SIT, surgeons must exercise extreme caution when performing laparoscopic cholecystectomy to avoid iatrogenic bile duct injury. Despite the high difficulty index associated with laparoscopic cholecystectomy in SIT, there is only one case report of common bile duct (CBD) injury in the English-language literature. CASE PRESENTATION A 41-year-old female patient, known to have Kartagener syndrome, underwent laparoscopic cholecystectomy for acute cholecystitis and was discharged home on post-operative day one. However, on post-operative day five, the patient presented to the emergency room with abdominal pain, fever, and jaundice. Laboratory tests revealed leukocytosis and hyperbilirubinemia. Radiological images revealed complete occlusion of the CBD. A delayed approach was chosen, and six weeks after her initial operation, a hepaticojejunostomy was performed. CLINICAL DISCUSSION Laparoscopic cholecystectomy is the standard operative procedure for gallbladder disease. The unique anatomy of SIT increases the risk of CBD injury during laparoscopic cholecystectomy. Surgeons are required to perform a mirror-image procedure and adhere to the basic principles of safe laparoscopic cholecystectomy in SIT. This is only the second reported case of CBD injury in SIT patients. CONCLUSION Laparoscopic cholecystectomy in SIT presents a significant challenge. In patients with SIT, preventing CBD injury is the best approach, and referral to an experienced hepato-pancreato-biliary (HPB) surgeon is recommended. A delayed approach to CBD injuries in SIT allows thorough planning and understanding of the complex anatomical variations in these patients.
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Affiliation(s)
- Bahaa I Aburayya
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | | | | | | | - Saleh Romman
- Specialty Hospital, Jaber Ibn Hayyan St, Amman, Jordan
| | - Osama H Hamed
- Arab Medical Center, Jabal Amman, 5th Circle, Amman 11181, Jordan.
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27
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Zidan MHED, Seif-Eldeen M, Ghazal AA, Refaie M. Post-cholecystectomy bile duct injuries: a retrospective cohort study. BMC Surg 2024; 24:8. [PMID: 38172774 PMCID: PMC10765830 DOI: 10.1186/s12893-023-02301-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Bile duct injury (BDI) is still a major worrisome complication that is feared by all surgeons undergoing cholecystectomy. The overall incidence of biliary duct injuries falls between 0.2 and 1.3%. BDI classification remains an important method to define the type of injury conducted for investigation and management. Recently, a Consensus has been taken to define BDI using the ATOM classification. Early management brings better results than delayed management. The current perspective in biliary surgery is the laparoscopic role in diagnosing and managing BDI. Diagnostic laparoscopy has been conducted in various entities for diagnostic and therapeutic measures in minor and major BDIs. METHODS 35 cases with iatrogenic BDI following cholecystectomy (after both open and laparoscopic approaches) both happened in or were referred to Alexandria Main University Hospital surgical department from January 2019 till May 2022 and were analyzed retrospectively. Patients were classified according to the ATOM classification. Management options undertaken were mentioned and compared to the timing of diagnosis, and the morbidity and mortality rates (using the Clavien-Dindo classification). RESULTS 35 patients with BDI after both laparoscopic cholecystectomy (LC) (54.3%), and Open cholecystectomy (OC) (45.7%) (20% were converted and 25.7% were Open from the start) were classified according to ATOM classification. 45.7% were main bile duct injuries (MBDI), and 54.3% were non-main bile duct injuries (NMBDI), where only one case 2.9% was associated with vasculobiliary injury (VBI). 28% (n = 10) of the cases were diagnosed intraoperatively (Ei), 62.9% were diagnosed early postoperatively (Ep), and 8.6% were diagnosed in the late postoperative period (L). LC was associated with 84.2% of the NMBDI, and only 18.8% of the MBDI, compared to OC which was associated with 81.3% of the MBDI, and 15.8% of the NMBDI. By the Clavien-Dindo classification, 68.6% fell into Class IIIb, 20% into Class I, 5.7% into Class V (mortality rate), 2.9% into Class IIIa, and 2.9% into Class IV. The Clavien-Dindo classification and the patient's injury (type and time of detection) were compared to investigation and management options. CONCLUSION Management options should be defined individually according to the mode of presentation, the timing of detection of injury, and the type of injury. Early detection and management are associated with lower morbidity and mortality. Diagnostic Laparoscopy was associated with lower morbidity and better outcomes. A proper Reporting checklist should be designed to help improve the identification of injury types.
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Affiliation(s)
- Mohamed Hossam El-Din Zidan
- Faculty of Medicine, Alexandria University, Alexandria, Egypt.
- Alexandria Main University Hospital, Alexandria University, Alexandria, Egypt.
| | - Mostafa Seif-Eldeen
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Alexandria Main University Hospital, Alexandria University, Alexandria, Egypt
| | - Abdelhamid A Ghazal
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Alexandria Main University Hospital, Alexandria University, Alexandria, Egypt
| | - Mustafa Refaie
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Alexandria Main University Hospital, Alexandria University, Alexandria, Egypt
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28
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Hughes DL, Elmasry M, Wilson I, El Kafsi J. Evaluating the evidence for a liver shrinkage diet for obese patients prior to laparoscopic cholecystectomy: A systematic review and meta-analysis. J Minim Access Surg 2024; 20:1-6. [PMID: 38240381 PMCID: PMC10898636 DOI: 10.4103/jmas.jmas_142_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/11/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The role of a very low-calorie diet (VLCD) before cholecystectomy in obese patients is unclear. This study evaluated whether VLCD could be used as a risk mitigation strategy for this high-risk patient cohort. PATIENTS AND METHODS A systematic review and meta-analysis was performed (PROSPERO ID CRD42022374610). The primary outcome was to determine the impact of pre-operative VLCD on the operative findings and ease of dissection during laparoscopic cholecystectomy (LC). RESULTS Two studies were included with a total of 84 patients. VLCD was associated with a significantly easier Calot's dissection (MD: -0.58 (95% confidence interval [CI] [ -1.03, -0.13], P = 0.01) and was associated with a significantly higher rate of pre-operative weight loss (MD; 2.92 (95% CI [2.23, 3.62], P = 0.00001). CONCLUSIONS The published evidence regarding VLCD before cholecystectomy in obese patients is limited. After acknowledging the limitations of the data, VLCD is associated with a significantly higher rate of weight loss preoperatively and directly impacts the ease of intraoperative dissection of Calot's triangle. Routine use of VLCD should be considered for all obese patients undergoing elective LC.
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Affiliation(s)
- Daniel Llwyd Hughes
- Department of UGI Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, England, UK
| | - Mohamed Elmasry
- Department of HPB Surgery, Churchill Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Iain Wilson
- Department of UGI Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, England, UK
| | - Jihène El Kafsi
- Department of UGI Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, England, UK
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Emara MH, Ahmed MH, Radwan MI, Emara EH, Basheer M, Ali A, Elfert AA. Post-cholecystectomy iatrogenic bile duct injuries: Emerging role for endoscopic management. World J Gastrointest Surg 2023; 15:2709-2718. [PMID: 38222007 PMCID: PMC10784825 DOI: 10.4240/wjgs.v15.i12.2709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/26/2023] [Accepted: 11/24/2023] [Indexed: 12/27/2023] Open
Abstract
Post-cholecystectomy iatrogenic bile duct injuries (IBDIs), are not uncommon and although the frequency of IBDIs vary across the literature, the rates following the procedure of laparoscopic cholecystectomy are much higher than open cholecystectomy. These injuries caries a great burden on the patients, physicians and the health care systems and sometime are life-threatening. IBDIs are associated with different manifestations that are not limited to abdominal pain, bile leaks from the surgical drains, peritonitis with fever and sometimes jaundice. Such injuries if not witnessed during the surgery, can be diagnosed by combining clinical manifestations, biochemical tests and imaging techniques. Among such techniques abdominal US is usually the first choice while Magnetic Resonance Cholangio-Pancreatography seems the most appropriate. Surgical approach was the ideal approach for such cases, however the introduction of Endoscopic Retrograde Cholangio-Pancreatography (ERCP) was a paradigm shift in the management of such injuries due to accepted success rates, lower cost and lower rates of associated morbidity and mortality. However, the literature lacks consensus for the optimal timing of ERCP intervention in the management of IBDIs. ERCP management of IBDIs can be tailored according to the nature of the underlying injury. For the subgroup of patients with complete bile duct ligation and lost ductal continuity, transfer to surgery is indicated without delay. Those patients will not benefit from endoscopy and hence should not do unnecessary ERCP. For low-flow leaks e.g. gallbladder bed leaks, conservative management for 1-2 wk prior to ERCP is advised, in contrary to high-flow leaks e.g. cystic duct leaks and stricture lesions in whom early ERCP is encouraged. Sphincterotomy plus stenting is the ideal management line for cases of IBDIs. Interventional radiologic techniques are promising options especially for cases of failed endoscopic repair and also for cases with altered anatomy. Future studies will solve many unsolved issues in the management of IBDIs.
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Affiliation(s)
- Mohamed H Emara
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mohammed Hussien Ahmed
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mohamed I Radwan
- Department of Tropical Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Emad Hassan Emara
- Department of Diagnostic and Interventional Radiology, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Magdy Basheer
- Department of Surgery, Mansoura University, Mansours 44176, Egypt
| | - Ahmed Ali
- Department of Emergency, Hargeisa Group Hospital, Hargeisa 1235, Somalia
| | - Asem Ahmed Elfert
- Department of Tropical Medicine, Tanta University, Tanta 33120, Egypt
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Wang Y, Chen XP. Comparison of the effects of ampulla-guided realignment and conventional gallbladder triangle anatomy in difficult laparoscopic cholecystectomy. Langenbecks Arch Surg 2023; 409:17. [PMID: 38147122 DOI: 10.1007/s00423-023-03205-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/12/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To compare the effects of ampulla-guided realignment and conventional gallbladder triangle anatomy in difficult laparoscopic cholecystectomy (DLC). METHODS From June 2021 to August 2022, data from 100 patients undergoing DLC at Nanjing Hospital of Traditional Chinese Medicine were analyzed retrospectively. Patients were divided into two groups: the experimental group (LC with the ampulla-guided realignment) and the control group (conventional LC with triangular gallbladder anatomy), with 50 patients per group. The intraoperative blood loss, operation time, postoperative drainage tube indwelling time, hospitalization time, bile duct injury rate, operation conversion rate, and incidence of postoperative complications were recorded and compared between the two groups. The pain response and daily activities of the patients in the two groups were evaluated 48 h after the operation. RESULTS The amount of intraoperative blood loss, postoperative drainage tube indwelling time, hospital stay, operation conversion rate, pain degree at 24 and 48 h after operation, bile duct injury incidence, and total postoperative complication rate were shorter or lower in the experimental group than those in the control group (p < 0.05). The Barthel index scores of both groups were higher 48 h after the operation than before the operation, and the experimental group was higher than the control group (p < 0.05). CONCLUSION The ampulla-guided alignment in DLC surgery was more beneficial in promoting postoperative recovery, reducing postoperative pain response, reducing the incidence of postoperative complications, and reducing bile duct injury.
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Affiliation(s)
- Yong Wang
- Department of General Surgery, PuKou Branch of Nanjing Hospital of Traditional Chinese Medicine, Nanjing, 211800, China
| | - Xiao-Peng Chen
- Department of Hepatobiliary Surgery, Yijishan Hospital, Wannan Medical College, Wuhu, 241004, China.
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Marti Romero L, Boix Clemente C, Alemany Perez G, Martinez Escapa V. Nonoperative repair of complete transection of the common bile duct using single-operator cholangioscopy. Endoscopy 2023; 55:E53-E54. [PMID: 36138527 PMCID: PMC9829542 DOI: 10.1055/a-1930-6050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Kawamura M, Endo Y, Fujinaga A, Orimoto H, Amano S, Kawasaki T, Kawano Y, Masuda T, Hirashita T, Kimura M, Ejima A, Matsunobu Y, Shinozuka K, Tokuyasu T, Inomata M. Development of an artificial intelligence system for real-time intraoperative assessment of the Critical View of Safety in laparoscopic cholecystectomy. Surg Endosc 2023; 37:8755-8763. [PMID: 37567981 DOI: 10.1007/s00464-023-10328-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND The Critical View of Safety (CVS) was proposed in 1995 to prevent bile duct injury during laparoscopic cholecystectomy (LC). The achievement of CVS was evaluated subjectively. This study aimed to develop an artificial intelligence (AI) system to evaluate CVS scores in LC. MATERIALS AND METHODS AI software was developed to evaluate the achievement of CVS using an algorithm for image classification based on a deep convolutional neural network. Short clips of hepatocystic triangle dissection were converted from 72 LC videos, and 23,793 images were labeled for training data. The learning models were examined using metrics commonly used in machine learning. RESULTS The mean values of precision, recall, F-measure, specificity, and overall accuracy for all the criteria of the best model were 0.971, 0.737, 0.832, 0.966, and 0.834, respectively. It took approximately 6 fps to obtain scores for a single image. CONCLUSIONS Using the AI system, we successfully evaluated the achievement of the CVS criteria using still images and videos of hepatocystic triangle dissection in LC. This encourages surgeons to be aware of CVS and is expected to improve surgical safety.
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Affiliation(s)
- Masahiro Kawamura
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan.
| | - Yuichi Endo
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Atsuro Fujinaga
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Hiroki Orimoto
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Shota Amano
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Takahide Kawasaki
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Yoko Kawano
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Takashi Masuda
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Teijiro Hirashita
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Misako Kimura
- Department of Information System and Engineering, Faculty of Information Engineering, Fukuoka Institute of Technology, Fukuoka, Japan
| | - Aika Ejima
- Department of Information System and Engineering, Faculty of Information Engineering, Fukuoka Institute of Technology, Fukuoka, Japan
| | - Yusuke Matsunobu
- Department of Information System and Engineering, Faculty of Information Engineering, Fukuoka Institute of Technology, Fukuoka, Japan
| | - Ken'ichi Shinozuka
- Department of Information System and Engineering, Faculty of Information Engineering, Fukuoka Institute of Technology, Fukuoka, Japan
| | - Tatsushi Tokuyasu
- Department of Information System and Engineering, Faculty of Information Engineering, Fukuoka Institute of Technology, Fukuoka, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Oita, Japan
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Tokuda S, Fujita A, Takagi A, Kanemoto H, Oba N. Repair of Bile Duct Injury Using Indocyanine Green Following Laparoscopic Cholecystectomy. Cureus 2023; 15:e49312. [PMID: 38143614 PMCID: PMC10749145 DOI: 10.7759/cureus.49312] [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] [Accepted: 11/23/2023] [Indexed: 12/26/2023] Open
Abstract
Bile duct injury (BDI) is a potential complication that may arise during cholecystectomy and continues to occur with a certain frequency in the present day. Numerous reports have been published regarding the utilization of indocyanine green (ICG) for the prevention of biliary injury, and we feel that the importance of ICG is being recognized. In this context, we present a case wherein a BDI occurred following cholecystectomy, and ICG was employed for the safe repair of the biliary tract.
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Affiliation(s)
- Satoshi Tokuda
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, JPN
| | - Akitsugu Fujita
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, JPN
| | - Akihiko Takagi
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, JPN
| | - Hideyuki Kanemoto
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, JPN
| | - Noriyuki Oba
- Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, JPN
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Cheewatanakornkul S, Yolsuriyanwong K, Wangkulangkul P, Bualoy P, Sakolprakaikit K. Propensity score-matched comparison of safety outcomes between high-risk and low-risk patients towards early hospital discharge after laparoscopic cholecystectomy. Ann Med Surg (Lond) 2023; 85:5337-5343. [PMID: 37915678 PMCID: PMC10617936 DOI: 10.1097/ms9.0000000000001300] [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: 07/12/2023] [Accepted: 09/04/2023] [Indexed: 11/03/2023] Open
Abstract
Background Laparoscopic cholecystectomy (LC), a common treatment for symptomatic gallstones, has demonstrated safety in low-risk patients. However, existing data are scarce regarding the safety of LC in high-risk patients and the feasibility of early hospital discharge. Materials and methods This retrospective study included 2296 patients diagnosed with symptomatic gallstones who underwent LC at a tertiary care centre from January 2009 through December 2019. The authors employed propensity score matching to mitigate bias between groups. Statistical significance was set at P less than 0.05. Results The median age of the patients was 56 years (range 46-67), with a mean BMI of 25.2±4.3 kg/m2. Patients were classified as: American Society of Anesthesiologists (ASA) I (19.7%), II (68.3%), III (12.0%), and IV (0%). ASA I-II included low surgical risk patients (88%) and ASA III-IV comprised high-risk patients (12%). The LC-related 30-day reoperative rate was 0.2% and the readmission rate was 0.87%. Nine patients (0.4%) sustained major bile duct injuries, resulting in a conversion rate of 2.4%. The postoperative mortality rate was 0.04%, and the mean hospitalization time was 3.5 days. Patients in the high-risk group with a history of acute cholecystitis exhibited greater estimated blood loss, longer operative times, and were significantly more likely to be in the longer-stay group. Conclusion These findings suggest that LC can be conducted safely on high-risk patients, and early hospital discharge is achievable. However, specific factors, such as a history of acute cholecystitis, may result in prolonged hospitalization owing to increased blood loss and longer operative times.
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Affiliation(s)
| | | | | | - Praisuda Bualoy
- Department of Surgical Nursing, Faculty of Nursing, Prince of Songkla University, Songkhla, Thailand
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Marichez A, Fernandez B, Belaroussi Y, Mauriac P, Julien C, Subtil C, Lapuyade B, Adam JP, Laurent C, Chiche L. Waiting for bile duct dilation before repair of bile duct injury: a worthwhile strategy? Langenbecks Arch Surg 2023; 408:409. [PMID: 37848704 DOI: 10.1007/s00423-023-03139-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Hepaticojejunostomy (HJ) is the gold standard procedure for repairing major bile duct injury (BDI). Dilation status of the BD before repair has not been assessed as a risk factor for anastomotic stricture. METHOD This retrospective single-centre study was performed on a population of 87 patients with BDI repaired by HJ between 2007 and 2021. Dilation status was assessed preoperatively, and dilation was defined as the presence of visible peripheral intrahepatic BDs with remaining BD diameter > 8 mm. The short- and long-term outcomes of HJ were assessed according to preoperative dilation status. RESULTS Before final repair, the BDs were dilated (dBD) in 56.3% of patients and not dilated (ND) in 43.7%. Patients with ND at the time of repair had more severe BDI injury than those with dBD (94.7% vs. 77.6%, p = 0.026). The rate of preoperative cholangitis was lower in patients with ND than in those with dBD (10.5% vs. 44.9%, p = 0.001). The rate of short-term morbidity after HJ was 33.3% (ND vs. dBD: 38.8% vs. 26.3%, p = 0.32). Long-term anastomotic stricture rate was 5.7% with a mean follow-up period of 61.3 months. There were no differences in long-term biliary complications according to dilation status (ND vs. dBD: 12.2% vs. 10.5%, p = 1). CONCLUSION Dilation status of the BD before HJ for BDI seemed to have no impact on short- or long-term outcomes. Both surgical and radiological external biliary drainages after BDI appear to be acceptable options to reduce cholangitis before repair without increasing risk for long-term anastomotic stricture.
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Affiliation(s)
- Arthur Marichez
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France.
- Inserm UMR 1312 - Team 3 "Liver Cancers and Tumoral Invasion", Bordeaux Institute of Oncology, University of Bordeaux, Bordeaux, France.
| | - Benjamin Fernandez
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France
| | - Yaniss Belaroussi
- Inserm, Bordeaux Population Health Research Center, ISPED, Bordeaux, France
| | - Paul Mauriac
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France
| | - Céline Julien
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France
| | - Clément Subtil
- Digestive Endoscopy Unit, Haut Lévêque Hospital, CHU de Bordeaux, Bordeaux, France
| | - Bruno Lapuyade
- Department of Digestive Interventional Radiology, Haut Lévêque Hospital, CHU de Bordeaux, Bordeaux, France
| | - Jean-Philippe Adam
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France
| | - Christophe Laurent
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France
| | - Laurence Chiche
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, CHU de Bordeaux, 1 Avenue de Magellan, 33 600, Pessac, France
- Inserm UMR 1312 - Team 3 "Liver Cancers and Tumoral Invasion", Bordeaux Institute of Oncology, University of Bordeaux, Bordeaux, France
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Reinsoo A, Kirsimägi Ü, Kibuspuu L, Košeleva K, Lepner U, Talving P. Bile duct injuries during laparoscopic cholecystectomies: an 11-year population-based study. Eur J Trauma Emerg Surg 2023; 49:2269-2276. [PMID: 36462050 DOI: 10.1007/s00068-022-02190-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/27/2022] [Indexed: 12/07/2022]
Abstract
PURPOSE Iatrogenic bile duct injuries (BDI) following laparoscopic cholecystectomy (LC) result in major morbidity and incidental mortality. There is a lack of unselected population-based cross-sectional studies on the incidence, management, and outcomes of BDI. We hypothesised that due to improved imaging capabilities and collective laparoscopic experience, BDI incidence will decrease over the study period and compare favourably with contemporary literature. METHODS After IRB approval, all cholecystectomies performed at national public healthcare facilities between 2008 and 2018 were retrospectively reviewed. BDIs were classified according to the Strasberg classification. The follow-up period ranged from 36 to 156 months. RESULTS A total of 241 BDIs of 29,739 laparoscopic cholecystectomies (LC) resulted in overall, minor, and major BDI incidence rates of 0.81%, 0.68%, and 0.13%, respectively. No significant decline in the BDIs was noted during the study period. Drainage in 66 (42.6%) and cases ERCP stent placement in 65 (41.9%) cases were equally used in Strasberg A lesions. Suture over T-tube in 20 (42.6%) and ERCP stenting in 19 (40.4%) cases were used in Strasberg D lesions. Roux-en-Y hepatojejunostomy (RYHJ) was performed in 30 (88.9%) of Strasberg E lesions. There were 27 (11.2%) patients with long-term bile duct strictures after BDI management. The overall mortality rate of BDIs and subsequent complications was 4.6%. CONCLUSIONS The annual incidence of iatrogenic bile duct injury over an 11-years' time after laparoscopic cholecystectomy did not decline significantly. We noted an overall BDI incidence of 0.81% comprising of 0.68% minor and 0.13% of major lesions. The management of injuries met contemporary guidelines with comparable outcomes.
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Affiliation(s)
- Arvo Reinsoo
- Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Centre, Sütiste Tee 19, Tallinn, Estonia.
- Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.
| | - Ülle Kirsimägi
- Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Liis Kibuspuu
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | | | - Urmas Lepner
- Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Peep Talving
- Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Centre, Sütiste Tee 19, Tallinn, Estonia
- Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
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Marchegiani F, Conticchio M, Zadoroznyj A, Inchingolo R, Memeo R, De'angelis N. Detection and management of bile duct injury during cholecystectomy. Minerva Surg 2023; 78:545-557. [PMID: 36883937 DOI: 10.23736/s2724-5691.23.09866-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Cholecystectomy represents one of the most performed surgical procedures. Bile duct injuries (BDIs) are a dangerous complication of this intervention. With the advent of the laparoscopy, the rate of BDIs showed a growing trend that was partially justified by the learning curve of this technique. EVIDENCE ACQUISITION A literature search was conducted on Embase, Medline, and Cochrane databases to identify studies published up to October 2022 that analyzed the intraoperative detection and management of BDIs diagnosed during cholecystectomy. EVIDENCE SYNTHESIS According to the literature, approximately 25% of BDIs is diagnosed during the laparoscopic cholecystectomy. In the clinical suspicion of BDI, an intraoperative cholangiography is performed to confirm it. Complimentary technology, such as near-infrared cholangiography, can be also adopted. Intraoperative ultrasound represents a useful tool to furtherly define the biliary and the vascular anatomy. The proper classification of the type of BDI allows to identify the correct treatment. When a good expertise in hepato-pancreato-biliary surgery is available, a direct repair is performed with good outcomes both in case of simple and complex lesions. When the local resources are limited or there is a lack of dedicated surgical experience, patient referral to a reference center shows better outcomes. In particular, complex vasculo-biliary injuries require a highly specialized treatment. The key elements to transfer the patients are a good documentation of the injury, a proper drainage of the abdomen, and an antibiotic therapy. CONCLUSIONS BDI management requires a proper diagnostic process and prompt treatment to reduce the morbidity and mortality of this feared complication occurring during cholecystectomy.
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Affiliation(s)
- Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France
| | - Maria Conticchio
- Unit of Hepato-Pancreato-Biliary Surgery, F. Miulli General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Alizée Zadoroznyj
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France
| | - Riccardo Inchingolo
- Unit of Interventional Radiology, F. Miulli General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreato-Biliary Surgery, F. Miulli General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Nicola De'angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France -
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Fernandez Trokhimtchouk T, Flores LF, Morillo Cox Á, Otanez ES, Negrete JR, Ayala AV. Unusual Anatomic Variant of the Biliary Tree. Cureus 2023; 15:e47206. [PMID: 38021781 PMCID: PMC10653010 DOI: 10.7759/cureus.47206] [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] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Accurate identification of anatomical variations in the biliary tree is crucial in hepatobiliary surgeries, including the widely performed laparoscopic cholecystectomy. Coexisting anomalies, though rare, present challenges for surgeons. This case study follows a 43-year-old female post-sleeve gastrectomy, diagnosed with mild gallstone pancreatitis and choledocholithiasis, who underwent early cholecystectomy. Intraoperatively, a 3 mm aberrant right hepatic duct and three 1 mm subvesicular ducts were identified. Recognizing these variants is pivotal for surgical success. Utilizing preoperative imaging, intraoperative vigilance, and advanced techniques like cholangiography are essential in preventing complications. Continuous education and collaborative experiences among surgical teams are integral in enhancing patient safety in these complex procedures.
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Affiliation(s)
| | - Luis F Flores
- General Surgery, Universidad Internacional del Ecuador, Quito, ECU
| | | | | | - Jose R Negrete
- General Surgery, Universidad Internacional del Ecuador, Quito, ECU
| | - Andrés V Ayala
- General Surgery, Universidad Internacional del Ecuador, Quito, ECU
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Bickel A, Lagrissi R, Jerushalmi J, Sbeit W, Weiss M, Shiller M, Ganam S, Kakiashvili E. The Role of Hepatobiliary Scintigraphy as the Initial Investigative Modality for Significant Bile Leak following Laparoscopic Cholecystectomy. Dig Surg 2023; 40:178-186. [PMID: 37748452 DOI: 10.1159/000533794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/23/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION Currently, the rate of bile duct injury and leak following laparoscopic cholecystectomy (LC) is still higher than for open surgery. Diverse investigative algorithms were suggested for bile leak, shifting from hepatobiliary scintigraphy (HBS) toward invasive and more sophisticated means. We aimed to analyze the use of biliary scan as the initial modality to investigate significant bile leak in the drain following LC, attempting to avoid potential unnecessary invasive means when the scan demonstrate fair passage of nuclear substance to the intestine, without leak. METHODS We have conducted a prospective non-randomized study, mandating hepatobiliary scintigraphy first, for asymptomatic patients harboring drain in the gallbladder fossa, leaking more than 50 mL/day following LC. Analysis was done based on medical data from the surgical, gastroenterology, and the nuclear medicine departments. RESULTS Among 3,124 patients undergoing LC, significant bile leak in the drain was seen in 67 subjects, of whom we started with HBS in 50 patients, presenting our study group. In 27 of whom, biliary scan was the only investigative modality, showing fair passage of the nuclear isotope to the duodenum and absence of leak in the majority. The leak stopped spontaneously within a mean of 3.6 days, and convalescence as well as outpatient clinic follow-up was uneventful. In 23 patients, biliary scan that was interpreted as abnormal was followed by endoscopic retrograde cholangio-pancreatography (ERCP). However, ERCP did not demonstrate any bile leak in 13 subjects. In 17 patients, ERCP was used initially, without biliary scan, suggesting the possibility of avoiding invasive modalities in 7 patients. CONCLUSIONS Based on a negative predictive value of 91%, we suggest that in cases of asymptomatic significant bile leak through a drain following LC, a normal HBS as the initial modality can safely decrease the rate of using invasive modalities.
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Affiliation(s)
- Amitai Bickel
- Departments of Surgery A, Galilee Medical Center, The Azrieli Faculty of Medicine, Bar-Ilan University, Nahariya, Israel
| | - Ron Lagrissi
- Departments of Surgery A, Galilee Medical Center, The Azrieli Faculty of Medicine, Bar-Ilan University, Nahariya, Israel
| | - Jacqueline Jerushalmi
- Nuclear Medicine Institute, Galilee Medical Center, The Azrieli Faculty of Medicine, Bar-Ilan University, Nahariya, Israel
| | - Wisam Sbeit
- Department of Gastroenterology, Galilee Medical Center, The Azrieli Faculty of Medicine, Bar-Ilan University, Nahariya, Israel
| | - Michael Weiss
- Departments of Surgery A, Galilee Medical Center, The Azrieli Faculty of Medicine, Bar-Ilan University, Nahariya, Israel
| | - Moshe Shiller
- Department of Gastroenterology, Galilee Medical Center, The Azrieli Faculty of Medicine, Bar-Ilan University, Nahariya, Israel
| | - Samer Ganam
- Departments of Surgery A, Galilee Medical Center, The Azrieli Faculty of Medicine, Bar-Ilan University, Nahariya, Israel
| | - Eli Kakiashvili
- Departments of Surgery A, Galilee Medical Center, The Azrieli Faculty of Medicine, Bar-Ilan University, Nahariya, Israel
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Hristov B, Doykov D, Stanchev D, Kraev K, Uchikov P, Kostov G, Valova S, Tilkiyan E, Doykova K, Doykov M. Hepatico-Duodenal Fistula Following Iatrogenic Strasberg Type E4 Bile Duct Injury: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1621. [PMID: 37763740 PMCID: PMC10537085 DOI: 10.3390/medicina59091621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Gallstone disease (GSD) is among the most common disorders worldwide. Gallstones are established in up to 15% of the general population. Laparoscopic cholecystectomy (LC) has become the "gold standard" for treatment of GSD but is associated with a higher rate of certain complications, namely, bile duct injury (BDI). Biliary fistulas (BF) are a common presentation of BDI (44.1% of all patients); however, they are mainly external. Post-cholecystectomy internal BF are exceedingly rare. CASE REPORT a 33-year Caucasian female was admitted with suspected BDI after LC. Strasberg type E4 BDI was established on endoscopic retrograde cholangiopancreatography (ERCP). Urgent laparotomy established biliary peritonitis. Delayed surgical reconstruction was planned and temporary external biliary drains were positioned in the right and left hepatic ducts. During follow-up, displacement of the drains occurred with subsequent evacuation of bile through the external fistula, which resolved spontaneously, without clinical and biochemical evidence of biliary obstruction or cholangitis. ERCP established bilio-duodenal fistula between the left hepatic duct (LHD) and duodenum, with a stricture at the level of the LHD. Endoscopic management was chosen with staged dilation and stenting of the fistulous tract over 18 months until fistula maturation and stricture resolution. One year after stent extraction, the patient remains symptom free. DISCUSSION Management of post-cholecystectomy BDI is challenging. The optimal approach is determined by the level and extent of ductal lesion defined according to different classifications (Strasberg, Bismuth, Hannover). Type E BDI are managed mainly surgically with a delayed surgical approach generally deemed preferable. Only three cases of choledocho-duodenal fistulas following LC BDI currently exist in the literature. Management is controversial, with expectant approach, surgical treatment (biliary reconstruction), or liver transplantation being described. Endoscopic treatment has not been described; however, in the current paper, it proved to be successful. More reports or larger case series are needed to confirm its applicability and effectiveness, especially in the long term.
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Affiliation(s)
- Bozhidar Hristov
- Section "Gastroenterology", Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Gastroenterology Clinic, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Daniel Doykov
- Section "Gastroenterology", Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Gastroenterology Clinic, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Desislav Stanchev
- Section "Gastroenterology", Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Gastroenterology Clinic, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Krasimir Kraev
- Department of Propedeutics of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Rheumatology Clinic, St. George University Hospital, 6000 Plovdiv, Bulgaria
| | - Petar Uchikov
- Department of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Second Department of Surgery, St. George University Hospital, 4000 Plovdiv, Bulgaria
| | - Gancho Kostov
- Department of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Department of Surgery, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Siyana Valova
- Section "Nephrology", Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Clinic of Nephrology, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Eduard Tilkiyan
- Section "Nephrology", Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Clinic of Nephrology, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Katya Doykova
- Department of Diagnostic Imaging, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Department of Diagnostic Imaging, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Mladen Doykov
- Department of Urology and General Medicine, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Clinic of Urology, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
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Mayer P, Christmann PY, Venkatasamy A, Uhl G, Vuola S, Heroin L, Habersetzer F. Post-cholecystectomy biliary leakage mimicking a neoplastic lesion: contribution of cholangioscopy in diagnosis and endoscopic treatment. Endosc Int Open 2023; 11:E885-E887. [PMID: 37810902 PMCID: PMC10558258 DOI: 10.1055/a-2160-5462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/04/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- Pierre Mayer
- Gastroenterology & Hepatology, CHU de Strasbourg, Strasbourg, France
- Digestive Endoscopy, IHU Strasbourg, Strasbourg, France
| | - Pierre-Yves Christmann
- Gastroenterology & Hepatology, CHU de Strasbourg, Strasbourg, France
- Digestive Endoscopy, IHU Strasbourg, Strasbourg, France
| | - Aina Venkatasamy
- Department of Radiology, IHU Strasbourg, Strasbourg, France
- INSERM UMR_S 1113 IRFAC, Université de Strasbourg, Strasbourg, France
- Radiology, University Hospital Freiburg Department of Radiology, Freiburg, Germany
| | - Georges Uhl
- Gastroenterology and Hepatology, Les Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Sebastian Vuola
- Gastroenterology & Hepatology, CHU de Strasbourg, Strasbourg, France
- Digestive Endoscopy, IHU Strasbourg, Strasbourg, France
| | - Lucile Heroin
- Gastroenterology & Hepatology, CHU de Strasbourg, Strasbourg, France
- Digestive Endoscopy, IHU Strasbourg, Strasbourg, France
| | - François Habersetzer
- Gastroenterology & Hepatology, CHU de Strasbourg, Strasbourg, France
- Digestive Endoscopy, IHU Strasbourg, Strasbourg, France
- Inserm U1110, Université de Strasbourg, Strasbourg, France
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Sobocki J, Pędziwiatr M, Bigda J, Hołówko W, Major P, Mitura K, Myśliwiec P, Nowosad M, Obcowska-Hamerska A, Orłowski M, Proczko-Stepaniak M, Szeliga J, Wallner G, Zawadzki M, Banasiewicz T, Budzyński A, Dziki A, Grąt M, Jackowski M, Kielan W, Matyja A, Paśnik K, Richter P, Szczepanik A, Szura M, Tarnowski W, Zieniewicz K. The Association of Polish Surgeons (APS) clinical guidelines for the use of laparoscopy in the management of abdominal emergencies. Part I. Wideochir Inne Tech Maloinwazyjne 2023; 18:187-212. [PMID: 37680734 PMCID: PMC10481450 DOI: 10.5114/wiitm.2023.127877] [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: 03/13/2023] [Accepted: 04/27/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction Over the past three decades, almost every type of abdominal surgery has been performed and refined using the laparoscopic technique. Surgeons are applying it for more procedures, which not so long ago were performed only in the classical way. The position of laparoscopic surgery is therefore well established, and in many operations it is currently the recommended and dominant method. Aim The aim of the preparation of these guidelines was to concisely summarize the current knowledge on laparoscopy in acute abdominal diseases for the purposes of the continuous training of surgeons and to create a reference for opinions. Material and methods The development of these recommendations is based on a review of the available literature from the PubMed, Medline, EMBASE and Cochrane Library databases from 1985 to 2022, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. Recommendations were formulated in a directive form and evaluated by a group of experts using the Delphi method. Results and conclusions There are 63 recommendations divided into 12 sections: diagnostic laparoscopy, perforated ulcer, acute pancreatitis, incarcerated hernia, acute cholecystitis, acute appendicitis, acute mesenteric ischemia, abdominal trauma, bowel obstruction, diverticulitis, laparoscopy in pregnancy, and postoperative complications requiring emergency surgery. Each recommendation was supported by scientific evidence and supplemented with expert comments. The guidelines were created on the initiative of the Videosurgery Chapter of the Association of Polish Surgeons and are recommended by the national consultant in the field of general surgery. The first part of the guidelines covers 5 sections and the following challenges for surgical practice: diagnostic laparoscopy, perforated ulcer, acute pancreatitis, incarcerated hernia and acute cholecystitis. Contraindications for laparoscopy and the ERAS program are discussed.
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Affiliation(s)
- Jacek Sobocki
- Chair and Department of General Surgery and Clinical Nutrition, Medical Center of Postgraduate Education Warsaw, Warsaw, Poland
| | - Michał Pędziwiatr
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Justyna Bigda
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
| | - Wacław Hołówko
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Major
- 2 Department of General Surgery, Jagiellonian University, Collegium Medicum, Krakow, Poland
| | - Kryspin Mitura
- Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, Siedlce, Poland
| | - Piotr Myśliwiec
- 1 Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland
| | - Małgorzata Nowosad
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Aneta Obcowska-Hamerska
- Department of General, Vascular and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Michał Orłowski
- Department of General and Oncological Surgery, Florian Ceynowa Specialist Hospital, Wejherowo, Poland
| | - Monika Proczko-Stepaniak
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Medical University of Gdansk, Gdansk, Poland
| | - Jacek Szeliga
- Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum of the Nicolaus Copernicus University, Torun, Poland
| | - Grzegorz Wallner
- 2 Department and Clinic of General, Gastroenterological and Cancer of the Digestive System Surgery, Medical University of Lublin, Lublin, Poland
| | - Marek Zawadzki
- Department of Oncological Surgery, Provincial Specialist Hospital, Wroclaw, Poland
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Fischer L, Halavach K, Huck B, Kolb G, Huber B, Segendorf C, Fischer E, Feißt M. [The clinical importance of the critical view of safety in laparoscopic cholecystectomy]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:544-549. [PMID: 36867210 PMCID: PMC9983532 DOI: 10.1007/s00104-023-01833-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Injury of the bile duct during cholecystectomy (CHE) is a severe complication. The critical view of safety (CVS) can help to reduce the frequency of this complication during laparoscopic CHE. So far, no scoring of CVS images with a grading system is available. METHOD The CVS images of 534 patients with laparoscopic CHE could be structurally analyzed and assessed with marks from 1 (very good) to 5 (insufficient). The CVS mark was correlated with the perioperative course. Additionally, the perioperative course of patients after laparoscopic CHE with and without a CVS image was investigated. RESULTS In 534 patients 1 or more CVS images could be analyzed. The average CVS mark was 1.9, whereby 280 patients (52.4%) had a 1, 126 patients (23.6%) a 2, 114 (21.3%) a 3 and 14 patients (2.6%) a 4 or 5. Younger patients with elective laparoscopic CHE had CVS images significantly more frequently (p ≤ 0.04). The statistical examination with Pearson's χ2-test and the F‑test (ANOVA) showed a significant correlation between improving CVS marks and reduction of surgery time (p < 0.01) and the hospitalization time (p < 0.01). For senior physicians the quota of CVS images ranged from 71% to 92% and the average marks from 1.5 to 2.2. The marks for the CVS images were significantly better for female than male patients (1.8 vs. 2.1, p < 0.01). DISCUSSION There was a relatively broad distribution of marks for CVS images. Injuries of the bile duct can be avoided with a high degree of certainty with marks 1‑2 for the CVS image. The CVS is not always adequately visualized in laparoscopic CHE.
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Affiliation(s)
- L. Fischer
- Abteilung für Allgemein‑, Viszeral- und Metabolische Chirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532 Baden-Baden, Deutschland
| | - K. Halavach
- Abteilung für Allgemein‑, Viszeral- und Metabolische Chirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532 Baden-Baden, Deutschland
| | - B. Huck
- Abteilung für Allgemein‑, Viszeral- und Metabolische Chirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532 Baden-Baden, Deutschland
| | - G. Kolb
- Abteilung für Allgemein‑, Viszeral- und Metabolische Chirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532 Baden-Baden, Deutschland
| | - B. Huber
- Abteilung für Allgemein‑, Viszeral- und Metabolische Chirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532 Baden-Baden, Deutschland
| | - C. Segendorf
- Abteilung für Allgemein‑, Viszeral- und Metabolische Chirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532 Baden-Baden, Deutschland
| | - E. Fischer
- Abteilung für Allgemein‑, Viszeral- und Metabolische Chirurgie, Klinikum Mittelbaden, Balger-Straße 50, 76532 Baden-Baden, Deutschland
| | - M. Feißt
- Institut für Medizinische Biometrie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 130.3, 69121 Heidelberg, Deutschland
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Symeonidis D, Tepetes K, Tzovaras G, Samara AA, Zacharoulis D. BILE: A Literature Review Based Novel Clinical Classification and Treatment Algorithm of Iatrogenic Bile Duct Injuries. J Clin Med 2023; 12:3786. [PMID: 37297981 PMCID: PMC10253433 DOI: 10.3390/jcm12113786] [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: 03/31/2023] [Revised: 05/18/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSES The management of patients with iatrogenic bile duct injuries (IBDI) is a challenging field, often with dismal medico legal projections. Attempts to classify IBDI have been made repeatedly and the final results were either analytical and extensive but not useful in everyday clinical practice systems, or simple and user friendly but with limited clinical correspondence approaches. The purpose of the present review is to propose a novel, clinical classification system of IBDI by reviewing the relevant literature. METHODS A systematic literature review was conducted by performing bibliographic searches in the available electronic databases, including PubMed, Scopus, and the Cochrane Library. RESULTS Based on the literature results, we propose a five (5) stage (A, B, C, D and E) classification system for IBDI (BILE Classification). Each stage is correlated with the recommended and most appropriate treatment. Although the proposed classification scheme is clinically oriented, the anatomical correspondence of each IBDI stage has been incorporated as well, using the Strasberg classification. CONCLUSIONS BILE classification represents a novel, simple, and dynamic in nature classification system of IBDI. The proposed classification focuses on the clinical consequences of IBDI and provides an action map that can appropriately guide the treatment plan.
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Affiliation(s)
| | | | | | - Athina A. Samara
- Department of Surgery, University Hospital of Larisa, Mezourlo, 41221 Larisa, Greece
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Chen J, Chen Z, Yan X, Liu X, Fang D, Miao X, Tong Z, Wang X, Lu Z, Hou H, Wang C, Geng X, Liu F. Online calculators for predicting the risk of anastomotic stricture after hepaticojejunostomy for bile duct injury after cholecystectomy: a multicenter retrospective study. Int J Surg 2023; 109:1318-1329. [PMID: 37068793 PMCID: PMC10389367 DOI: 10.1097/js9.0000000000000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 04/06/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Anastomotic stricture is a common underlying cause of long-term morbidity after hepaticojejunostomy (HJ) for bile duct injury (BDI) following cholecystectomy. However, there are no methods for predicting stricture risk. This study was aimed at establishing two online calculators for predicting anastomotic stricture occurrence (ASO) and stricture-free survival (SFS) in this patient population. METHODS The clinicopathological characteristics and follow-up information of patients who underwent HJ for BDI after cholecystectomy from a multi-institutional database were reviewed. Univariate and multivariate analyses of the risk factors of ASO and SFS were performed in the training cohort. Two nomogram-based online calculators were developed and validated by internal bootstrapping resamples ( n =1000) and an external cohort. RESULTS Among 220 screened patients, 41 (18.64%) experienced anastomotic strictures after a median follow-up of 110.7 months. Using multivariate analysis, four variables, including previous repair, sepsis, HJ phase, and bile duct fistula, were identified as independent risk factors associated with both ASO and SFS. Two nomogram models and their corresponding online calculators were subsequently developed. In the training cohort, the novel calculators achieved concordance indices ( C -indices) of 0.841 and 0.763 in predicting ASO and SFS, respectively, much higher than those of the above variables. The predictive accuracy of the resulting models was also good in the internal ( C -indices: 0.867 and 0.821) and external ( C -indices: 0.852 and 0.823) validation cohorts. CONCLUSIONS The two easy-to-use online calculators demonstrated optimal predictive performance for identifying patients at high risk for ASO and with dismal SFS. The estimation of individual risks will help guide decision-making and long-term personalized surveillance.
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Affiliation(s)
- Jiangming Chen
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University
| | - Zixiang Chen
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University
| | - Xiyang Yan
- Department of General Surgery, the Second Affiliated Hospital of Anhui Medical University
| | - Xiaoliang Liu
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University
| | - Debao Fang
- Department of General Surgery, the Fourth Affiliated Hospital of Anhui Medical University
| | - Xiang Miao
- Department of General Surgery, Anqing Municipal Hospital of Anhui Medical University
| | - Zhong Tong
- Department of General Surgery, the Third Affiliated Hospital of Anhui Medical University
| | - Xiaoming Wang
- Department of General Surgery, the First Affiliated Hospital of Wannan Medical College
| | - Zheng Lu
- Department of General Surgery, the First Affiliated Hospital of Bengbu Medical College
| | - Hui Hou
- Department of General Surgery, the Second Affiliated Hospital of Anhui Medical University
| | - Cheng Wang
- Department of General Surgery, the First Affiliated Hospital of University of Science and Technology, Hefei, Anhui Province, China
| | - Xiaoping Geng
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University
| | - Fubao Liu
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University
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Ardito F, Lai Q, Savelli A, Grassi S, Panettieri E, Clemente G, Nuzzo G, Oliva A, Giuliante F. Bile duct injury following cholecystectomy: delayed referral to a tertiary care center is strongly associated with malpractice litigation. HPB (Oxford) 2023; 25:374-383. [PMID: 36739266 DOI: 10.1016/j.hpb.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/05/2023] [Accepted: 01/16/2023] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bile duct injury (BDI) following cholecystectomy is associated with malpractice litigation. Aim of this study was to evaluate risk factors for litigation in patients with BDI referred in a tertiary care center. METHODS Patients treated for BDI between 1994 and 2016. Stabilized inverse probability therapy weighting was used and multivariable logistic regression analysis identified risk factors for malpractice litigation. RESULTS Of the 211 treated patients, 98 met the inclusion criteria: early-referral group (<20 days; 51.0%), late-referral (≥20 days; 49.0%). 36 patients (36.7%) initiated malpractice litigation with verdict in favor of plaintiff in 86.7% of cases (median payment = €90 500, up to €600 000). Attempts at surgical and endoscopic repair before referral were significantly higher in late-referral group. Failed postoperative management (delayed referral, attempts at repair before referral) was one of the strongest predictors for litigation. Risk of litigation progressively increased from 23.8%, when referral time was within 19 days, to 54.5% (61-120 days), to 60.0% (121-210 days) and to 65.1% (211-365 days). DISCUSSION Litigation rate after BDI was 37%. Delayed referral to tertiary care center was one of the strongest predictors for litigation. Prompt referral to tertiary experienced centers without any attempt at repair may reduce the risk of litigation.
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Affiliation(s)
- Francesco Ardito
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Quirino Lai
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Italy
| | - Alida Savelli
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simone Grassi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elena Panettieri
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gennaro Clemente
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gennaro Nuzzo
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
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Canakis A, Alseidi AA, Irani SS. A new connection: management of disconnected segments 5 and 6 bile leak via the cystic duct remnant. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:107-109. [PMID: 36935814 PMCID: PMC10020378 DOI: 10.1016/j.vgie.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Video 1Management of disconnected segments 5 and 6 bile leaks.
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Affiliation(s)
- Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Adnan A Alseidi
- Division of Surgical Oncology, University of California, San Francisco, California
| | - Shayan S Irani
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington
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Möller K, Braden B, Culver EL, Jenssen C, Zadeh ES, Alhyari A, Görg C, Ignee A, Hocke M, Dong Y, Sun S, Faiss S, Dietrich CF. Secondary sclerosing cholangitis and IgG4-sclerosing cholangitis - A review of cholangiographic and ultrasound imaging. Endosc Ultrasound 2023; 12:181-199. [PMID: 36588352 PMCID: PMC10237613 DOI: 10.4103/eus-d-22-00208] [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: 11/20/2022] [Accepted: 12/08/2022] [Indexed: 01/01/2023] Open
Abstract
Sclerosing cholangitis (SC) represents a spectrum of chronic progressive cholestatic diseases of the intrahepatic and/or extrahepatic biliary system characterized by patchy inflammation, fibrosis, and stricturing. Primary and secondary SC must be distinguished given the different treatment modalities, risks of malignancy, and progression to portal hypertension, cirrhosis, and hepatic failure. This review focuses on secondary SC and the pathogenic mechanisms, risk factors, clinical presentation, and novel imaging modalities that help to distinguish between these conditions. We explore the detailed use of cholangiography and ultrasound imaging techniques.
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Affiliation(s)
- Kathleen Möller
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | - Emma L. Culver
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland GmbH, Strausberg, Wriezen, Germany
- Brandenburg Institute of Clinical Medicine at Medical University Brandenburg, Neuruppin, Germany
| | - Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Amjad Alhyari
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - André Ignee
- Department of Internal Medicine – Gastroenterology and Rheumatology; Klinikum Wuerzburg Mitte, Wuerzburg, Germany
| | - Michael Hocke
- Medical Department II, Helios Klinikum Meiningen, Meiningen, Germany
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Siyu Sun
- Department of Endoscopy Center, Shengjing Hospital of China Medical University, Liaoning Province, China
| | - Siegbert Faiss
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
| | - Christoph F. Dietrich
- Department of Internal Medicine (DAIM), Hirslanden Private Hospital, Beau Site, Salem und Permanence, Bern, Switzerland
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Burckhardt O, Peisl S, Rouiller B, Colinet E, Egger B. Length of the Remnant Cystic Duct and Bile Duct Stone Recurrence: a Case‒Control Study. J Gastrointest Surg 2023:10.1007/s11605-023-05607-x. [PMID: 36859605 DOI: 10.1007/s11605-023-05607-x] [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: 12/10/2022] [Accepted: 01/21/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Since the introduction of the Critical View of Safety approach in laparoscopic cholecystectomy, exposure of the common bile duct, and common hepatic duct is not recommended, therefore, the length of the cystic duct remnant is no longer controlled. The aim of this case‒control study is to evaluate the relationship between the length of the cystic duct remnant and the risk for bile duct stone recurrence after cholecystectomy. METHODS All MRIs with dedicated sequences of the biliary tract taken between 2010 and 2020 from patients who underwent prior cholecystectomy were reviewed. The length of the cystic duct remnant was measured and compared between the patients with and without bile duct stones using multivariate logistic regression analysis. RESULTS A total of 362 patients were included in this study, 23.5% of whom had bile duct stones on MRI. The cystic duct remnant was significantly longer in the patients with stones than in the control group (median 31 mm versus 18 mm, P < 0.001). In the MRIs performed > 2 years after cholecystectomy, the cystic duct remnant was also significantly longer in the patients with bile duct stones (median 32 mm versus 21 mm, P < 0.001). A cystic duct remnant ≥ 15 mm in length increased the odds of stones (OR = 2.3, P = 0.001). Overall, the odds of bile duct stones increased with an increasing cystic duct remnant length (≥ 45 mm, OR = 5.0, P < 0.001). CONCLUSIONS An excessive cystic duct remnant length increases the odds of recurrent bile duct stones after cholecystectomy.
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Affiliation(s)
- Oliver Burckhardt
- Department of Surgery, HFR Fribourg - Cantonal Hospital, Chemin Des Pensionnats 2-6, 1752, Villars-Sur-Glâne, Switzerland
| | - Sarah Peisl
- Department of Surgery, HFR Fribourg - Cantonal Hospital, Chemin Des Pensionnats 2-6, 1752, Villars-Sur-Glâne, Switzerland
| | | | - Emilie Colinet
- Department of Radiology, HFR Fribourg - Cantonal Hospital, Villars-Sur-Glâne, Switzerland
| | - Bernhard Egger
- Department of Surgery, HFR Fribourg - Cantonal Hospital, Chemin Des Pensionnats 2-6, 1752, Villars-Sur-Glâne, Switzerland. .,University of Fribourg, Av. de l'Europe 20, 1700, Fribourg, Switzerland.
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Manatakis DK, Antonopoulou MI, Tasis N, Agalianos C, Tsouknidas I, Korkolis DP, Dervenis C. Critical View of Safety in Laparoscopic Cholecystectomy: A Systematic Review of Current Evidence and Future Perspectives. World J Surg 2023; 47:640-648. [PMID: 36474120 DOI: 10.1007/s00268-022-06842-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Critical View of Safety (CVS) has been increasingly recognised as the standard method for identification of the cystic structures, to prevent vasculobiliary injuries during laparoscopic cholecystectomy, however, its adoption has been anything but universal. A significant proportion of surgeons has a poor understanding of the three requirements. To bridge this gap between theory and practice, we aimed to summarise the available evidence on CVS, emphasising on current debates and future perspectives. METHOD We systematically reviewed the literature (1995-2021), to identify studies reporting on the CVS. Eligible articles were classified according to methodology and key idea. A quantitative analysis was performed to evaluate effectiveness of the CVS in preventing bile duct injury (BDI). RESULTS 150 relevant articles were identified, focusing on six main points, (1) safety and effectiveness, (2) intraoperative documentation, (3) complementary imaging techniques, (4) bail-out alternatives, (5) adoption among surgeons, and (6) education and training. The quantitative analysis included 11 studies, with 10,938 cases. Overall, the CVS was achieved in 92.5%. Conversion rate was 4.8%. CVS-related BDI was 0.09% (0.05% technical errors and 0.04% misidentification errors). CONCLUSION Routine application of the CVS reduces BDI, but does not eliminate them altogether. Besides operative notes, the CVS should be documented by an imaging modality of sufficient quality. When the CVS cannot be safely established, the threshold for bail-out alternatives or complementary imaging should be low. Adoption by the surgical community worldwide shows great variability and focus should be placed on training through structured educational modules.
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Affiliation(s)
- Dimitrios K Manatakis
- Department of Surgery, Athens Naval and Veterans Hospital, Deinokratous 70, 11521, Athens, Greece. .,Department of Surgical Oncology, St Savvas Cancer Hospital, Athens, Greece.
| | | | - Nikolaos Tasis
- Department of Surgery, Athens Naval and Veterans Hospital, Deinokratous 70, 11521, Athens, Greece
| | - Christos Agalianos
- Department of Surgery, Athens Naval and Veterans Hospital, Deinokratous 70, 11521, Athens, Greece
| | - Ioannis Tsouknidas
- Department of Surgery, Stony Brook University Hospital, Stony Brook, USA
| | | | - Christos Dervenis
- Department of Hepatobiliary and Pancreatic Surgery, Metropolitan Hospital, Piraeus, Greece
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