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Deng SX, Sharma BT, Ebeye T, Samman A, Zulfiqar A, Greene B, Tsang ME, Jayaraman S. Laparoscopic subtotal cholecystectomy for the difficult gallbladder: Evolution of technique at a single teaching hospital. Surgery 2024; 175:955-962. [PMID: 38326217 DOI: 10.1016/j.surg.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND We have developed an algorithmic approach to laparoscopic cholecystectomy, including subtotal cholecystectomy, as a bailout strategy when the Critical View of Safety cannot be safely achieved due to significant inflammation and fibrosis of the hepatocystic triangle. METHODS This is a retrospective cohort study comparing postoperative outcomes in patients with severe cholecystitis who underwent laparoscopic cholecystectomy or laparoscopic subtotal cholecystectomy at St. Joseph's Health Centre from May 2016 to July 2021, as well as against a historical cohort. We further stratified laparoscopic subtotal cholecystectomy cases based on fenestrating or reconstituting subtype. RESULTS The cohort included a total of 105 patients who underwent laparoscopic cholecystectomy and 31 patients who underwent laparoscopic subtotal cholecystectomy. Bile leaks (25.8% vs 1.0%, relative risk 3.5, 95% confidence interval 3.5-208.4) were more common in the laparoscopic subtotal cholecystectomy group. Postoperative endoscopic retrograde cholangiopancreatography (22.6% vs 3.8%, relative risk 5.9, 95% confidence interval 1.9-18.9) and biliary stent insertion (19.4% vs 1.0%, relative risk 20.3, 95% confidence interval 2.5-162.5) were also more common in the laparoscopic subtotal cholecystectomy group. Bile leaks in laparoscopic subtotal cholecystectomy were only documented in the fenestration subtype, most of which were successfully managed with endoscopic retrograde cholangiopancreatography and biliary stenting. Compared to our previous study of laparoscopic cholecystectomy and subtotal cholecystectomy for severe cholecystitis between 2010 and 2016, there has been a decrease in postoperative laparoscopic cholecystectomy complications, subtotal cholecystectomy cases, and no bile duct injuries. CONCLUSION Following our algorithmic approach to safe laparoscopic cholecystectomy has helped to prevent bile duct injury. Laparoscopic cholecystectomy remains the gold standard for the management of severe cholecystitis; however, in extreme cases, laparoscopic subtotal cholecystectomy is a safe bailout strategy with manageable morbidity.
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Affiliation(s)
- Shirley X Deng
- Division of General Surgery, University of Toronto, Toronto, ON Canada
| | - Bree T Sharma
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tega Ebeye
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anas Samman
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Amna Zulfiqar
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Brittany Greene
- Division of General Surgery, University of Toronto, Toronto, ON Canada; HPB Service, St. Joseph's Health Centre, Unity Health, Toronto, ON, Canada
| | - Melanie E Tsang
- Division of General Surgery, University of Toronto, Toronto, ON Canada; HPB Service, St. Joseph's Health Centre, Unity Health, Toronto, ON, Canada
| | - Shiva Jayaraman
- Division of General Surgery, University of Toronto, Toronto, ON Canada; HPB Service, St. Joseph's Health Centre, Unity Health, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, ON, Canada.
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Zhu JH, Zhao SL, Kang Q, Zhu Y, Liu LX, Zou H. Classification of anatomical morphology of cystic duct and its association with gallstone. World J Gastrointest Surg 2024; 16:307-317. [PMID: 38463380 PMCID: PMC10921219 DOI: 10.4240/wjgs.v16.i2.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Gallstones are common lesions that often require surgical intervention. Laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstones. Preoperatively, the anatomical morphology of the cystic duct (CD), needs to be accurately recognized, especially when anatomical variations occur in the CD, which is otherwise prone to bile duct injury. However, at present, there is no optimal classification system for CD morphology applicable in clinical practice, and the relationship between anatomical variations in CDs and gallstones remains to be explored. AIM To create a more comprehensive clinically applicable classification of the morphology of CD and to explore the correlations between anatomic variants of CD and gallstones. METHODS A total of 300 patients were retrospectively enrolled from October 2021 to January 2022. The patients were divided into two groups: The gallstone group and the nongallstone group. Relevant clinical data and anatomical data of the CD based on magnetic resonance cholangiopancreatography (MRCP) were collected and analyzed to propose a morphological classification system of the CD and to explore its relationship with gallstones. Multivariate analysis was performed using logistic regression analyses to identify the independent risk factors using variables that were significant in the univariate analysis. RESULTS Of the 300 patients enrolled in this study, 200 (66.7%) had gallstones. The mean age was 48.10 ± 13.30 years, 142 (47.3%) were male, and 158 (52.7%) were female. A total of 55.7% of the patients had a body mass index (BMI) ≥ 24 kg/m2. Based on the MRCP, the CD anatomical typology is divided into four types: Type I: Linear, type II: n-shaped, type III: S-shaped, and type IV: W-shaped. Univariate analysis revealed differences between the gallstone and nongallstone groups in relation to sex, BMI, cholesterol, triglycerides, morphology of CD, site of CD insertion into the extrahepatic bile duct, length of CD, and angle between the common hepatic duct and CD. According to the multivariate analysis, female, BMI (≥ 24 kg/m2), and CD morphology [n-shaped: Odds ratio (OR) = 10.97, 95% confidence interval (95%CI): 5.22-23.07, P < 0.001; S-shaped: OR = 4.43, 95%CI: 1.64-11.95, P = 0.003; W-shaped: OR = 7.74, 95%CI: 1.88-31.78, P = 0.005] were significantly associated with gallstones. CONCLUSION The present study details the morphological variation in the CD and confirms that CD tortuosity is an independent risk factor for gallstones.
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Affiliation(s)
- Jia-Hai Zhu
- Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
| | - Song-Ling Zhao
- Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
| | - Qiang Kang
- Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
| | - Ya Zhu
- Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
| | - Li-Xin Liu
- Department of Hepatobiliary Pancreatic Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming 650106, Yunnan Province, China
| | - Hao Zou
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming 650106, Yunnan Province, China
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Kivivuori A, Salminen P, Ukkonen M, Ilves I, Vihervaara H, Zalevskaja K, Pajari J, Paajanen H, Rantanen T. Laparoscopic cholecystectomy versus antibiotic therapy for acute cholecystitis in patients over 75 years: Randomized clinical trial and retrospective cohort study. Scand J Surg 2023; 112:219-226. [PMID: 37572012 DOI: 10.1177/14574969231178650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Abstract
BACKGROUND AND OBJECTIVE The prevalence of acute cholecystitis among elderly patients is increasing. The aim of this study was to compare laparoscopic cholecystectomy (LC) to antibiotics in elderly patients with acute cholecystitis. METHODS A randomized multicenter clinical trial including patients over 75 years with acute calculous cholecystitis was conducted in four hospitals in Finland between January 2017 and December 2019. Patients were randomized to undergo LC or antibiotic therapy. Due to patient enrollment challenges, the trial was prematurely terminated in December 2019. To assess all eligible patients, we performed a retrospective cohort study including all patients over 75 years with acute cholecystitis during the study period. The primary outcome was morbidity. Predefined secondary outcomes included mortality, readmission rate, and length of hospital stay. RESULTS Among 42 randomized patients (LC n = 24, antibiotics n = 18, mean age 82 years, 43% women), the complication rate was 17% (n = 4/24) after cholecystectomy and 33% (n = 6/18, 5/6 patients underwent cholecystectomy due to antibiotic treatment failure) after antibiotics (p = 0.209). In the retrospective cohort (n = 630, mean age 83 years, 49% women), 37% (236/630) of the patients were treated with cholecystectomy and 63% (394/630) with antibiotics. Readmissions were less common after surgical treatment compared with antibiotics in both randomized and retrospective cohort patients (8% vs 44%, p < 0.001% and 11 vs 32%, p < 0.001, respectively). There was no 30-day mortality within the randomized trial. In the retrospective patient cohort, overall mortality was 6% (35/630). CONCLUSIONS LC may be superior to antibiotic therapy for acute cholecystitis in the selected group of elderly patients with acute cholecystitis.
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Affiliation(s)
- Antti Kivivuori
- Kuopio University Hospital Puijonlaaksontie 270210 Kuopio Finland
| | - Paulina Salminen
- Turku University Hospital, Turku, Finland
- University of Turku, Turku, Finland
| | | | - Imre Ilves
- Mikkeli Central Hospital, Mikkeli, Finland
| | - Hanna Vihervaara
- Turku University Hospital, Turku, Finland
- University of Turku, Turku, Finland
| | | | | | - Hannu Paajanen
- Mikkeli Central Hospital, Mikkeli, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Tuomo Rantanen
- Kuopio University Hospital, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
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Nawacki Ł, Kozłowska-Geller M, Wawszczak-Kasza M, Klusek J, Znamirowski P, Głuszek S. Iatrogenic Injury of Biliary Tree-Single-Centre Experience. Int J Environ Res Public Health 2022; 20:781. [PMID: 36613104 PMCID: PMC9819931 DOI: 10.3390/ijerph20010781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/18/2022] [Accepted: 12/29/2022] [Indexed: 05/02/2023]
Abstract
Cholecystolithiasis is among the most prevalent gastrointestinal disorders requiring surgical intervention, and iatrogenic damage to the bile tree is a severe complication. We aimed to present the frequency of bile duct injuries and how our facility handles these complications. We retrospectively analyzed bile duct injuries in patients undergoing surgery. We concentrated on factors such as sex, age, indications for surgery, type of surgery, primary procedure, bile tree injury, repair, and timing as well as early and late complications. There were 22 cases of bile duct injury in the studied material, primarily affecting women-15 individuals (68.2%). Eleven cases (45.7%) of acute cholecystitis were the primary reason for surgery, and an injury to the common bile duct that extended up to 2 cm from the common hepatic duct was the most common complication (European Association for Endoscopic Surgery grade 2). Roux-en-Y hepaticojejunostomy was the most common repair procedure in 14 cases (63.6%). Eleven patients (50%) experienced early complications following reconstruction surgery, whereas five patients (22.7%) experienced late complications. An annual mortality rate of 22.7% (five patients) was observed. Iatrogenic bile duct injury is a severe complication of surgical treatment for cholecystolithiasis. Reconstruction procedures are characterized by high complication rates and high mortality.
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Affiliation(s)
- Łukasz Nawacki
- Collegium Medicum, The Jan Kochanowski University in Kielce, 25-369 Kielce, Poland
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Houghton EJ, Rubio JS. Surgical management of the postoperative complications of hepato-pancreato-biliary surgery. Int J Gastrointest Interv 2022. [DOI: 10.18528/ijgii220041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Eduardo Javier Houghton
- Teaching and Research Department, DAICIM Foundation, Buenos Aires, Argentina
- Surgery Division, B. Rivadavia Hospital, Buenos Aires, Argentina
- Department of Surgery, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Juan Santiago Rubio
- Solid Organ Transplant Service, Hospital de Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner, Buenos Aires, Argentina
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Starkov YG, Zamolodchikov RD, Dzhantukhanova SV, Kontorshchikov PK. [Laparoscopic reconstructive Roux-en-Y hepaticojejunostomy]. Khirurgiia (Mosk) 2022:86-90. [PMID: 35477206 DOI: 10.17116/hirurgia202204186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Intraoperative damage to the bile ducts following laparoscopic cholecystectomy is still one of the urgent problems of modern minimally invasive surgery. In some cases, these complications lead to patient disability, deterioration in their quality of life and need for redo surgery including technically difficult procedures. Modern endoscopic technologies are essential in the treatment of postoperative benign strictures of the common bile duct. These approaches can heal some patients after intraoperative bile duct trauma. Nevertheless, endoscopic treatment is ineffective or impossible in some clinical situations. Reconstructive Roux-en-Y hepaticojejunostomy through laparotomy is a preferable procedure in these patients for many years. However, we report successful laparoscopic reconstructive Roux-en-Y hepaticojejunostomy in a patient with postoperative stricture of the common bile duct Halperin type 0.
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Affiliation(s)
- Yu G Starkov
- Vishnevsky National Medical Research Center for Surgery, Moscow, Russia
| | - R D Zamolodchikov
- Vishnevsky National Medical Research Center for Surgery, Moscow, Russia
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Terho P, Sallinen V, Lampela H, Harju J, Koskenvuo L, Mentula P. The critical view of safety and bile duct injuries in laparoscopic cholecystectomy: a photo evaluation study on 1532 patients. HPB (Oxford) 2021; 23:1824-1829. [PMID: 33975802 DOI: 10.1016/j.hpb.2021.04.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LCC) carries a 0.3-1.8% risk of bile duct injury (BDI). This study investigated if intraoperative photo documentation of the critical view of safety (CVS) is related to lower rates of BDIs and postoperative complications in LCC. METHODS Surgeons were instructed to take photos of the view before clipping the cystic duct and artery. Two independent raters scored the photos 0-6 using predefined criteria for CVS. Mean scores of ≥4.5 were satisfactory. RESULTS The study consisted of 1532 patients undergoing LCC between April 2018 and October 2019. CVS was satisfactory in 354 (23.1%), unsatisfactory in 823 (53.7%), and photos were missing in 355 (23.2%) patients. Patients with satisfactory CVS had the lowest BDI rate compared with unsatisfactory CVS or missing photos (0.3% vs. 1.0% vs. 2.3%, p = 0.012). Four major BDIs (Strasberg D-E) occurred, but none in patients with satisfactory CVS. Patients with satisfactory CVS had the lowest postoperative complication rate compared with patients with unsatisfactory CVS or without photos (4.8% vs. 7.9 vs. 9.9%, p = 0.011). Of patients with acute cholecystitis, 15.7% had satisfactory CVS, whereas 26.8% without cholecystitis had satisfactory CVS (p < 0.001). CONCLUSION Intraoperative photo documentation of satisfactory CVS is associated with lower rates of BDIs and complications.
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Affiliation(s)
- Petra Terho
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Finland
| | - Ville Sallinen
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Finland; Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Finland
| | - Hanna Lampela
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Finland
| | - Jukka Harju
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Finland
| | - Laura Koskenvuo
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Finland
| | - Panu Mentula
- Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Finland.
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Borie F, Mathonnet M, Deleuze A, Gravié JF, Gugenheim J. The Cost and the Effectiveness of Cholangiography for the Diagnosis and Treatment of a Bile Duct Injury After Difficult Identification of the Cystic Duct. J Gastrointest Surg 2021; 25:1430-1436. [PMID: 32410182 DOI: 10.1007/s11605-020-04640-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/30/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND This study aims to assess the cost and the effectiveness of intraoperative cholangiography (IOC) for the diagnosis and treatment of a bile duct injury (BDI) after incorrect or difficult identification of the cystic duct (DICD) during a cholecystectomy. METHODS Between 2009 and 2015, 810 surgeons reported 1161 treatment-related adverse events related to the DICD during cholecystectomy in the French REX database; 623 patients (54%) underwent IOC, and 30% (n = 348) of DICD had a BDI. The therapeutic procedures and the treatment costs have been compared between the IOC group (CG) and the group without IOC (WCG). RESULTS The BDI intraoperative diagnosis was significantly higher in the CG: 96% vs. 67% p = 0.001. The number of therapeutic procedure was significantly higher in the WCG OR: 6 (3-10.6). The rate of biliodigestive anastomosis (8.3%) was similar between the both groups. The average cost of cholecystectomy in the at-risk population of DICD was higher in the group that did not undergo IOC (6204 euros vs. 8831 euros). The estimated loss without IOC in the studied population was between 788,170 and 2,039,020 euros. CONCLUSION The IOC was an assurance of quality and cost reduction in the immediate management of the BDI and should be systematic in front of a DICD during a cholecystectomy.
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Affiliation(s)
- Frédéric Borie
- Fédération de chirurgie viscérale et digestive (FCVD), 12, rue BAYARD, 31000, Toulouse, France.
| | - Muriel Mathonnet
- Fédération de chirurgie viscérale et digestive (FCVD), 12, rue BAYARD, 31000, Toulouse, France
| | - Alain Deleuze
- Fédération de chirurgie viscérale et digestive (FCVD), 12, rue BAYARD, 31000, Toulouse, France
| | - Jean-François Gravié
- Fédération de chirurgie viscérale et digestive (FCVD), 12, rue BAYARD, 31000, Toulouse, France
| | - Jean Gugenheim
- Fédération de chirurgie viscérale et digestive (FCVD), 12, rue BAYARD, 31000, Toulouse, France
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Pandit N, Yadav TN, Awale L, Deo KB, Dhakal Y, Adhikary S. Current Scenario of Postcholecystectomy Bile Leak and Bile Duct Injury at a Tertiary Care Referral Centre of Nepal. Minim Invasive Surg 2020; 2020:4382307. [PMID: 32373362 DOI: 10.1155/2020/4382307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/17/2020] [Accepted: 04/04/2020] [Indexed: 11/29/2022] Open
Abstract
Objective With the adoption of safe cholecystectomy principles at an academic institute, the risk of major bile duct injury has decreased. This study aims at evaluating the present status of bile duct injury, compared to the study published in 2013 by index centre. Methods This is a retrospective review of a prospectively maintained database of bile leak and bile duct injury from 2014 to 2019. Patients who completed postcholecystectomy bile leak or bile duct injury treatment and were on regular follow-up were included. Results Eighteen patients (0.78%) among 2,300 consecutive cholecystectomies presented with bile duct injury, including 8 (0.35%) major bile duct injuries and 10 (0.43%) bile leaks compared to major bile duct injury rate of 0.68% (92/11,345 cholecystectomies) between 2001 and 2010. Injuries were classified as Strasberg's type A (52.9%), type D (5.9%), and type E (41.1%). Eight patients (47%) of bile leak were managed conservatively with drains, while two required laparotomy and lavage. The mean time for spontaneous closure of bile leak was 11 days. Intraoperative repair was done in three cases: Roux en Y hepaticojejunostomy in 2 and end-to-end repair over T-tube in 1 for sharp transection of the duct. Delayed repair (Roux-en-Y hepaticojejunostomy) was done in five patients. The median postcholecystectomy hospital stay was 8 days, with no mortality. There was no restricture at a median follow-up of 13 months. Conclusion With the adoption of a safe culture of cholecystectomy, the major bile duct injury rate has decreased currently. Repair of bile duct injury by experienced hepatobiliary surgeon results in excellent outcome.
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Guerra F, Coletta D, Gavioli M, Coco D, Patriti A. Minimally invasive surgery for the management of major bile duct injury due to cholecystectomy. J Hepatobiliary Pancreat Sci 2020; 27:157-163. [PMID: 31945263 DOI: 10.1002/jhbp.710] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/14/2019] [Accepted: 12/19/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Francesco Guerra
- Division of General Surgery Ospedali Riuniti Marche Nord Pesaro Italy
| | - Diego Coletta
- Division of General Surgery Ospedali Riuniti Marche Nord Pesaro Italy
| | - Manuel Gavioli
- Division of General Surgery Ospedali Riuniti Marche Nord Pesaro Italy
| | - Danilo Coco
- Division of General Surgery Ospedali Riuniti Marche Nord Pesaro Italy
| | - Alberto Patriti
- Division of General Surgery Ospedali Riuniti Marche Nord Pesaro Italy
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Zhang Y, Zhao J, Chai S, Zhang Z, Zhang L, Zhang W. Reliable reconstruction of the complex high-location bile duct injury: a novel hepaticojejunostomy. BMC Surg 2019; 19:176. [PMID: 31752907 PMCID: PMC6873689 DOI: 10.1186/s12893-019-0642-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 11/05/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND This study aimed to propose a novel surgical reconstruction technique for complex high-location bile duct injury (CHBDI). METHODS There were eight patients with CHBDI underwent the novel hepaticojejunostomy between Feb 2015 and Feb 2017. Seven patients underwent a primary operation and found CHBDI postoperatively in the inferior hospitals referred to our center. And four of them had received hepaticojejunostomy, but the results were not satisfying. One patient (No.8) with radiographically diagnosed hilar cholangiocarcinoma came to our center for surgical treatment and underwent the novel hepaticojejunostomy technique because CHBDI was found in operation. Perioperative and follow-up data of these patients were retrospectively reviewed. RESULTS The mean age was 47.6 ± 10.7 years, and there was four female. The mean range of time between the injury and the repair operation in our center was 6.3 ± 4.8 months. All repair operations using the novel hepaticojejunostomy technique in our center were successfully performed. No postoperative complications, including biliary fistula, restenosis, peritonitis, and postoperative cholangitis was observed. Besides, no evidence of biliary stenosis or biliary complications happened during the follow-up (median 28 months). CONCLUSIONS The novel hepaticojejunostomy is a reliable and convenient technique for surgical repair of multiple biliary ductal openings like CHBDI.
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Affiliation(s)
| | | | - Songshan Chai
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, Hubei province, China
| | - Zhanguo Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, Hubei province, China
| | - Lei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, Hubei province, China
| | - Wanguang Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, Hubei province, China.
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Garcés-Albir M, Martí-Fernández R, Martínez-Fernández G, Peña-Aldea A, Muñoz Forner E, Sanchiz-Soler V, Dorcaratto D, Gálvez-Castillo C, Martín Arévalo J, Sabater L, Ortega J. The role of endoscopic retrograde cholangiopancreatography in the management of iatrogenic bile duct injury after cholecystectomy. Rev Esp Enferm Dig 2019; 111:690-695. [PMID: 31368333 DOI: 10.17235/reed.2019.6245/2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION iatrogenic bile duct injury (IBDI) is a complication with a high morbidity after cholecystectomy. In recent years, endoscopy has acquired a fundamental role in the management of this pathology. METHODS a retrospective study of IBDI after open cholecystectomy (OC) or laparoscopic cholecystectomy (LC) of patients treated in our center between 1993 and 2017 was performed. Clinical characteristics, type of injury according to the Strasberg-Bismuth classification, diagnosis, repair techniques and follow-up were analyzed. RESULTS 46 patients were studied and IBDI incidence was 0.48%, 0.61% for LC and 0.24% for OC. A diagnosis was made intraoperatively in 12 cases (26%) and by endoscopic retrograde cholangiopancreatography (ERCP) in 10 (21.7%) cases. The most common IBDI patient characteristics were acute cholecystitis (20/46, 43.5%), previous admission due to biliary pathology (16/46, 43.2%) and ERCP prior to cholecystectomy (7/46, 18.9%). The most frequent types of IBDI were D (17/46, 36.9%) and A (15/46, 32.6%). The most commonly used treatment was primary suture (13/46, 28.3%) followed by ERCP (11/46, 23.9%) with sphincterotomy and/or stents. In addition, ERCP was performed during the immediate postoperative period in 6 (13%) patients with a surgical IBDI repair in order to resolve immediate complications. CONCLUSION ERCP is useful in the management of IBDI that is not diagnosed intraoperatively. This procedure facilitates the localization of the injured area of the bile duct, therapeutic maneuvers and successful outcomes in postoperative complications.
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Affiliation(s)
- Marina Garcés-Albir
- Unidad de Cirugía HBP. Servicio de Cirugía General y del Aparato Digestivo. Departamento de Cirugía. Universitat de Valencia. Valencia, España
| | - Rosa Martí-Fernández
- Unidad de Cirugía HBP. Servicio de Cirugía General y del Aparato Digestivo. Departamento de Cirugía. Universitat de Valencia. Valencia, España
| | - Guillermo Martínez-Fernández
- Unidad de Cirugía HBP. Servicio de Cirugía General y del Aparato Digestivo. Departamento de Cirugía. Universitat de Valencia. Valencia, España
| | - Andrés Peña-Aldea
- Unidad de Endoscopia Digestiva. Servicio de Medicina Digestiva. Hospital Clínico Universitario de Valencia. Valencia
| | - Elena Muñoz Forner
- Unidad de Cirugía HBP. Servicio de Cirugía General y del Aparato Digestivo. Departamento de Cirugía. Universitat de Valencia. Valencia, España
| | - Vicente Sanchiz-Soler
- Unidad de Endoscopia Digestiva. Servicio de Medicina Digestiva. Hospital Clínico Universitario de Valencia. Valencia
| | - Dimitri Dorcaratto
- Unidad de Cirugía HBP. Servicio de Cirugía General y del Aparato Digestivo. Departamento de Cirugía. Universitat de Valencia. Valencia, España
| | - Consuelo Gálvez-Castillo
- Unidad de Endoscopia Digestiva. Servicio de Medicina Digestiva. Hospital Clínico Universitario de Valencia. Valencia
| | - José Martín Arévalo
- Unidad de Cirugía HBP. Servicio de Cirugía General y del Aparato Digestivo. Departamento de Cirugía. Universitat de Valencia. Valencia, España
| | - Luis Sabater
- Unidad de Cirugía HBP. Servicio de Cirugía General y del Aparato Digestivo. Departamento de Cirugía. Universitat de Valencia. Valencia, España
| | - Joaquín Ortega
- Unidad de Cirugía HBP. Servicio de Cirugía General y del Aparato Digestivo. Departamento de Cirugía. Universitat de Valencia. Valencia, España
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O'Brien S, Wei D, Bhutiani N, Rao MK, Johnston SS, Patkar A, Vitale GC, Martin RCG 2nd. Adverse outcomes and short-term cost implications of bile duct injury during cholecystectomy. Surg Endosc 2020; 34:628-35. [PMID: 31286250 DOI: 10.1007/s00464-019-06809-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bile duct injury (BDI) is an uncommon but major complication of cholecystectomy that has a poorly defined magnitude of effect on hospital costs. This study sought to calculate the healthcare costs, length of stay, and discharge status associated with bile duct injury in patients undergoing cholecystectomy in the United States. METHODS The Premier Healthcare Database, which comprises hospital-billing records from over 700 hospitals in the United States, was queried for all patients undergoing cholecystectomy between January 2010 and March 2018. BDI was defined by ICD-9-CM and ICD-10-CM codes. Patient demographics, clinical characteristics, and operative information were extracted. Hospital costs, length of stay, and discharge status were compared between BDI and non-BDI patients. Propensity score matching was used to minimize confounding factors. Multivariable regression models were used to estimate the association between BDI and the outcomes variables. RESULTS A total of 1,168,288 cholecystectomies were identified. BDI occurred in 878 patients (0.08%). Laparoscopy was the most common approach (> 95%). The majority of BDI occurred during inpatient admissions (71.0%). BDI patients had higher index admission hospital costs ($18,771 vs. $12,345, p < 0.0001), increased rate of discharge to an institutional post-acute care facility (odds ratio 3.89, 95% CI 2.92-5.19, p < 0.0001), and increased risk of readmission within 30 days after discharge (odds ratio 1.86, 95% CI 1.52-2.28, p < 0.0001), compared to patients without BDI. Among inpatient cholecystectomies, BDI was associated with increased length of stay (8.6 days vs. 4.8 days, p < 0.0001). CONCLUSION BDI is associated with significantly increased hospital costs, length of stay, 30-day readmission, and discharge to an institutional post-acute care facility.
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Fujimoto Y, Ohya Y, Irie T, Kumamoto S, Tuji A, Nakamura S, Shibata H, Kuramoto K, Hayashi H, Araki Y, Iizaka M, Tomiyasu S, Inomata Y. Hypogenesis of right hepatic lobe in a laparoscopic cholecystectomy for acute gallstone cholecystitis: A case report. Intractable Rare Dis Res 2019; 8:146-149. [PMID: 31218167 PMCID: PMC6557236 DOI: 10.5582/irdr.2019.01053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Hypogenesis or agenesis of right hepatic lobe is a rare abnormality and is generally associated with gallbladder and biliary tract abnormalities. Cases of biliary injury following cholecystectomy have been reported in patients with agenesis of right hepatic lobe because the anatomical anomalies complicate the surgical approach. We report a case of laparoscopic cholecystectomy in a patient with hypogenesis of right hepatic lobe. A 92-year-old male patient was admitted to our hospital with fever and right lower abdominal pain with suspected acute appendicitis. Abdominal computed tomography revealed gallstones with acute cholecystitis and hypogenesis of right hepatic lobe. He underwent laparoscopic cholecystectomy with the left semilateral decubitus position. The patient's postoperative course was uneventful. In conclusions, some patients with liver lobe hypoplasia do not present with the typical symptoms of acute cholecystitis due to dislocation of the gallbladder. The left semilateral decubitus position with modified placement of port sites is useful for laparoscopic cholecystectomy in patients with hypogenesis of right hepatic lobe.
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Affiliation(s)
- Yuka Fujimoto
- Department of Surgery, Kumamoto Rosai Hospital, Kumamoto, Japan
| | - Yuki Ohya
- Department of Surgery, Kumamoto Rosai Hospital, Kumamoto, Japan
- Address correspondence to:Dr. Yuki Ohya, Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsusiro, Kumamoto 8668533, Japan. E-mail:
| | - Tomoaki Irie
- Department of Transplantation and Pediatric Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | - Akira Tuji
- Department of Surgery, Kumamoto Rosai Hospital, Kumamoto, Japan
| | | | | | | | | | - Yushi Araki
- Department of Radiology, Kumamoto Rosai Hospital, Kumamoto, Japan
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Abstract
Common bile duct injury is a feared complication of cholecystectomy, with an incidence of 0.1% to 0.6%. A majority of injuries go unnoticed at index operation, and postoperative diagnosis can be difficult. Patient presentation can vary from vague abdominal pain to uncontrolled sepsis and peritonitis. Diagnostic evaluation typically begins with ultrasound or CT scan in the acute setting, and source control is paramount at time of presentation. In a stable patient, hepatobiliary iminodiacetic acid scan can be useful in identifying an ongoing bile leak, which requires intervention. A variety of diagnostic techniques define biliary anatomy. Treatment often requires a multidisciplinary approach.
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Affiliation(s)
- Joshua T Cohen
- Department of Surgery, Rhode Island Hospital, 2 Dudley Street, Suite 370, Providence, RI 02905, USA
| | - Kevin P Charpentier
- Department of Surgery, Rhode Island Hospital, 2 Dudley Street, Suite 370, Providence, RI 02905, USA
| | - Rachel E Beard
- Department of Surgery, Rhode Island Hospital, 2 Dudley Street, Suite 370, Providence, RI 02905, USA.
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16
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Schizas D, Papaconstantinou D, Moris D, Koliakos N, Tsilimigras DI, Bakopoulos A, Karaolanis G, Spartalis E, Dimitroulis D, Felekouras E. Management of Segmental Bile Duct Injuries After Cholecystectomy: a Systematic Review. J Gastrointest Surg 2019; 23:408-416. [PMID: 30402723 DOI: 10.1007/s11605-018-4027-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/22/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Injuries to segmental or aberrant bile ducts are encountered less commonly than their major bile duct counterparts and present a unique diagnostic and therapeutic challenge, since the nature of this injury involves a transected bile duct that loses its communication with the main ductal system. In this systematic review, we aim to pool available data on this particular type of biliary injury in an effort to outline available diagnostic and therapeutic modalities and evaluate their efficacy. MATERIALS AND METHODS An extensive literature search was performed on MEDLINE, Scopus, and Web of Science to identify isolated segmental or aberrant bile duct injuries. RESULTS A total of 21 studies were included in this systematic report. Ten studies reported non-operative management of patients, while 12 reported operative management of included patients. Outcomes of interest were the choice of treatment interventions and their success. Overall, 23 patients were managed non-operatively with a 91% success rate and 30 patients were managed operatively with a 90% success rate. CONCLUSION Non-operative management might be a viable alternative to surgery. Hepatobiliary surgeons should be encouraged to publish their results in treating these rare injuries to further elucidate the role and efficacy of such an approach.
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Affiliation(s)
- Dimitrios Schizas
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Papaconstantinou
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Moris
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Nikolaos Koliakos
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Diamantis I Tsilimigras
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anargyros Bakopoulos
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Karaolanis
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Spartalis
- 2nd Propedeutic Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Dimitroulis
- 2nd Propedeutic Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Felekouras
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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17
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Mutignani M, Forti E, Larghi A, Dokas S, Pugliese F, Cintolo M, Bonato G, Tringali A, Dioscoridi L. Refractory Bergmann type A bile leak: the need to strike a balance. Endosc Int Open 2019; 7:E264-E267. [PMID: 30705960 PMCID: PMC6353644 DOI: 10.1055/a-0732-4899] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/25/2018] [Indexed: 11/06/2022] Open
Abstract
Background and study aims Endoscopic therapy for postoperative Bergmann type A bile leaks is based on biliary sphincterotomy ± stent insertion. However, recurrent or refractory bile leaks can occur. Patients and methods This was retrospective study including all consecutive patients who were referred to our center with a Bergmann type A bile leak refractory to previous conventional endoscopic treatments. Results Seventeen patients with post-cholecystectomy-refractory Bergmann type A bile leak were included. All had received prior endoscopic biliary sphincterotomy with biliary stent or nasobiliary catheter placement and all had a percutaneous or surgical abdominal drainage. Repeat endoscopic retrograde cholangiopancreatography (ERCP) confirmed a Bergmann type A bile leak and in all patients we observed that the abdominal drainage was placed adjacent to the origin of the fistula. Our treatment consisted of pulling the drain away from the fistulous site, with extension of the previous sphincterotomy when needed. The treatment was successful in all cases. Mild complications occurred in three patients. Conclusions Our retrospective study shows that refractory Bergmann type A bile leak may be a consequence of an unfavorable position of the abdominal drainage tube, which can be corrected by pulling the drain away from the origin of the fistula. This establishes a favorable pressure gradient that leads the bile flowing from the bile duct into the duodenum.
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Affiliation(s)
- Massimiliano Mutignani
- Digestive and Operative Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy,Corresponding author Massimiliano Mutignani, MD Digestive and Operative Endoscopy UnitNiguarda-Ca’ Granda HospitalPiazza dell’Ospedale Maggiore 320121, MilanItaly+00390264442471
| | - Edoardo Forti
- Digestive and Operative Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Stefanos Dokas
- Endoscopy Department, St Lukes Private Hospital, Panorama, Thessaloniki, Greece
| | - Francesco Pugliese
- Digestive and Operative Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
| | - Marcello Cintolo
- Digestive and Operative Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
| | - Giulia Bonato
- Digestive and Operative Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
| | - Alberto Tringali
- Digestive and Operative Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
| | - Lorenzo Dioscoridi
- Digestive and Operative Endoscopy Unit, Niguarda-Ca’ Granda Hospital, Milan, Italy
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Abtar HK, Mhana TM, Zbibo R, Mneimneh M, Asmar AE. First case report of bile leak from the duct of Luschka in a patient with mini-gastric bypass: The challenge of management. Ann Med Surg (Lond) 2018; 35:29-32. [PMID: 30263115 PMCID: PMC6156743 DOI: 10.1016/j.amsu.2018.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 09/06/2018] [Accepted: 09/18/2018] [Indexed: 01/24/2023] Open
Abstract
Introduction The incidence of Bile duct injury after laparoscopic cholecystectomy approaches 0.11%–1.4%. Ducts of Luschka are the second most common site of bile leaks. The rarity of these ducts with cases of anatomical alterations in the gastrointestinal tract such as mini-gastric bypass makes the management a challenging option. Presentation of case Hereby we present a unique case of 28 year old female patient with mini-gastric bypass who had done uneventful cholecystectomy. Day 3 postoperatively patient complained of diffuse abdominal pain. Computed tomography showed free fluid in the abdomen. Liver enzymes were normal. Relaparoscopy showed leaking bile duct of Luschka, which was closed by surgical clips and drains left in the spaces. However bile leak continued for 4 weeks then stopped. Patient did well after all. Discussion Endoscopic retrograde cholangiopancreatography with sphincterotomy played a crucial role for diagnosis and treatment of bile leaks with success rate near 94%. However no data were available using this method in a patient with Mini-gastric bypass procedure. Many authors have argued the role of relaparoscopy, but it is still an important way for adequate drainage and control of bile leakage. The only significant factor in determining clinical outcome in cases of non-surgical management is the type of bile duct injury. Conclusion To the best of our knowledge, this is the first case report of bile leak from duct of Luschka after mini-gastric bypass treated successfully with relaparoscopy and drainage. Herein we will discuss all the available options of treatment and the challenge of it. The combination of Duct of Luschka in a patient with mini-gastric bypass is unique in the literature. The challenge of management especially endoscopic one puts a great pressure on both surgeons and gastroenterologists. NO single data available in the literature in doing ERCP by any method in a patient with mini-gastric bypass.
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Affiliation(s)
- Houssam Khodor Abtar
- Makassed General Hospital, Department of Surgery, Beirut, Lebanon
- Corresponding author. Makassed General Hospital, P.O. Box: 11-6301, Riad EI-Solh, 11072210, Beirut, Lebanon.
| | | | - Riad Zbibo
- Makassed General Hospital, Department of Surgery, Beirut, Lebanon
| | | | - Antoine el Asmar
- Sahel General Hospital, Department of Radiology, Beirut, Lebanon
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Lyros O, Rudolph J, Tagkalos E, Scheuermann U, Lang H. Ungewöhnliche Ursache rezidivierender Glutealabszessbildung. Chirurg 2017; 88:884-886. [DOI: 10.1007/s00104-017-0411-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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20
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Abstract
The management of bile duct injury (BDI) remains a considerable challenge in hepatobiliary surgery. BDI is mainly iatrogenic, and mostly occurs in cholecystectomy. Laparoscopic cholecystectomy (LC) has been performed widely, however, the incidence of BDI associated with LC increases 2-3 times compared to that in open cholecystectomy (OC). BDI also occurs in robotic cholecystectomy. In China, the evidence-based Practice Guideline for Diagnosis and Treatment of BDI was published by the Biliary Surgery Group of Surgery Branch of Chinese Medical Association, with the purpose of reducing the incidence of BDI as well as promoting its optimal diagnosis and treatment. Surgery remains the mainstay of treatment for BDI and traumatic bile duct stricture. The definitive repair involves a series of procedures including exposing the proximal and distal bile duct, anastomotic bile duct tissue preparation, minimally invasive tissue anastomoses, and so on. Successful management is a surgical challenge requiring great specialized experience and precise surgical skill. The application of precision biliary surgery is recommended for promoting standardized management of BDI.
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Affiliation(s)
- Xiaobin Feng
- Department of Hepato-Pancreato-Biliary Center, Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Jiahong Dong
- Department of Hepato-Pancreato-Biliary Center, Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
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21
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Suo T, Chen L, Liu H, Ni X, Shen S, Wang Y, Liu H. Management for a complicated biliary stricture after iatrogenic bile duct injury. J Vis Surg 2017; 3:33. [PMID: 29078596 DOI: 10.21037/jovs.2017.03.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/18/2017] [Indexed: 01/11/2023]
Abstract
Bile duct injury (BDI) remains to be a serious complication of biliary surgery. Biliary stricture is likely to occur in cases without proper management of BDI, may be causing such severe complications as repeated strictures, cholangitis or impairment to liver function. Here, we reported a 69-year-old man with a one-more-year history of recurrent cholangitis caused by iatrogenic BDI. The patient underwent a reconstruction of choledochojejunostomy, with liver quadrate lobectomy, and hilar cholangioplasty. The procedure was difficult, but the recovery was smooth. Only through comprehensive pre-operative evaluation and meticulous intraoperative manipulate, the technical challenge of re-operation for complicated biliary stricture after BDI should be easily addressed.
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Affiliation(s)
- Tao Suo
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Ling Chen
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Han Liu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Xiaoling Ni
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Sheng Shen
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Yueqi Wang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200030, China
| | - Houbao Liu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200030, China
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