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1.
F. Panaro A. Glaise M. Miggino H. Bouyabrine JP. Carabalona B. Gallix F. Navarro 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2013,398(1):169-176
Purpose
Bile duct (BD) complications continue to be the “Achilles’ heel” of liver transplantation, and the utilization of bile duct drainage is still on debate. We describe the results of a less invasive rubber trancystic biliary drainage (TBD) compared to a standard silicone T-tube (TT).Methods
The transplanted patients (n?=?248), over a period of 5 years with a TBD (n?=?20), were matched 1:2 with control patients with a TT (n?=?40). Primary end points were the overall incidence of BD complications and graft and patient survival. Secondary end points included the complications after the drainage removal.Results
Although the bile duct leakage rates were not significantly different between both groups, the TT group had a significantly higher rate of overall 1-year BD stenosis (40 versus 10 %) (p?=?0.036). Three-year patient/graft survival rates were 83.2/80.1 and 84.4/84.4 % for the TT and TBD groups, respectively. The postoperative BD complications, after drainage removal (peritonitis and stenosis), were significantly reduced (p?=?0.011) with the use of a TBD.Conclusion
The use of rubber TBD in liver transplant recipients does not increase the number of BD complications compared to the T-tube. Furthermore, less BD anastomotic stenosis and post-removal complications were observed in the TBD group compared to the TT group. 相似文献2.
Yeji Kim Jong Jin Hyun Jae Min Lee Hong Sik Lee Chang Duck Kim 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2014,399(8):1071-1076
Purpose
Anomalous union of the pancreaticobiliary duct (AUPBD) is frequently associated with choledochal cyst and biliary tract cancers. Management of AUPBD with choledochal cyst consists of extrahepatic bile duct excision and cholecystectomy. In cases of AUPBD without choledochal cyst, cholecystectomy alone is usually recommended. This study aimed to evaluate the occurrence of biliary tract cancer in AUPBD patients in order to assess the validity of the currently recommended operative management.Methods
Of a total of 10,255 endoscopic retrograde cholangiopancreatography cases performed at two Korea University hospitals from 2001 to 2010, 55 (0.54 %) cases of AUPBD were identified. Patients with AUPBD were divided according to its subtype (P-C union and C-P union) and the presence of choledochal cyst for analysis. The occurrence of benign and malignant disease was evaluated and compared between the groups.Results
Gallbladder stones were more frequently found in AUPBD patients without choledochal cyst (p?=?0.032). Biliary tract cancer occurred more frequently in P-C union (p?=?0.050), especially the common bile duct cancer (p?=?0.023). When analyzed according to the presence of choledochal cyst, biliary tract cancer occurred more frequently in AUPBD patients without choledochal cyst (p?=?0.005), with bile duct cancer being significantly more common (p?=?0.015). However, there was no difference in the presence of gallbladder cancer between the two groups (p?=?0.318).Conclusions
Since cancers of the biliary tract occur more frequently in the AUPBD group without choledochal cyst, cholecystectomy alone may not be protective of the future occurrence of bile duct cancers, and thus, vigilant surveillance is necessary in this population group. 相似文献3.
V. Verzhbitsky A. R. Zeina R. Depsames B. Ovadia O. Atia Z. Fireman 《Surgical endoscopy》2013,27(12):4620-4624
Background
Patients with choledochocystolithiasis generally undergo endoscopic sphincterotomy (ES) followed by elective cholecystectomy. They can experience the development of recurrent biliary events while waiting for their scheduled surgery.Aim
This study investigated whether stent insertion before cholecystectomy influences the rate of complications.Methods
The study compared retrospective and prospective groups of patients with choledochocystolithiasis who underwent ES with or without prophylactic common bile duct stent insertion before cholecystectomy. The rate of emergency cholecystectomies and biliary complications during the waiting period before the elective procedure was analyzed.Results
For the study, 162 patients with choledochocystolithiasis who underwent endoscopic retrograde cholangiopancreatography (ERCP) with ES were divided to two subgroups. Group A included 52 patients with stent insertion (mean age, 58.3 ± 19.4 years), and group B included 110 patients with no stent insertion (mean age, 61.4 ± 17.7 years) (p = 0.32). Males made up 33.3 % of group A and 53.7 % of group B (p = 0.018). The median time to elective cholecystectomy (open or laparoscopic) was 41.5 days for the patients without bile duct stent insertion before cholecystectomy and 53.5 days for the patients who had the stent insertion before cholecystectomy (p = 0.63). Repeat emergency ERCP due to acute cholangitis was 5.6 % in group A and 1.0 % in group B (p = 0.43). Emergency cholecystectomy rates due to acute cholecystitis after ES were 15.4 % in group A and 14.5 % in group B (p = 1.00). No mortality occurred.Conclusions
According to the study findings, prophylactic stent insertion during ERCP before cholecystectomy has no impact on biliary complications. 相似文献4.
Elizaveta Ragulin-Coyne Elan R. Witkowski Zeling Chau Sing Chau Ng MS Heena P. Santry Mark P. Callery Shimul A. Shah Jennifer F. Tseng 《Journal of gastrointestinal surgery》2013,17(3):434-442
Introduction
Intraoperative cholangiogram (IOC) can define biliary ductal anatomy. Routine IOC has been proposed previously. However, current surgeon IOC utilization practice patterns and outcomes are unclear.Methods
Nationwide Inpatient Sample 2004–2009 was queried for patients with acute biliary disease undergoing cholecystectomy (CCY). Analyses only included surgeons performing ≥10 CCY/year. We dichotomized surgeons into a routine IOC group vs. selective. Outcomes included bile duct injury, complications, mortality, length of stay, and cost.Results
Of the nonweighted patients, 111,815 underwent CCY. A total of 4,740 actual surgeon yearly volumes were examined. On average, each surgeon performed 23.6 CCYs and 7.9 IOCs annually, using IOC in 33 % of cases. The routine IOC group used IOC for 96 % of cases, whereas selective IOC group used IOC ~25 % of the time. Routine IOC surgeons had no difference in mortality (0.4 %) or rate of bile duct injury (0.25 vs. 0.26 %), but higher overall complications (7.3 vs. 6.8 %, p?=?0.04). Patients of routine IOC surgeons received more additional procedures and incurred higher costs.Conclusion
Routine IOC does not decrease the rate of bile duct injury, but is associated with significant added cost. Surgeons’ routine use of IOC is correlated with increased rates of postsurgical procedures, and is associated with increased overall complications. These data suggest routine IOC may not improve outcomes. 相似文献5.
A. Tanemura S. Mizuno A. Hayasaki T. Fujii Y. Iizawa H. Kato Y. Murata N. Kuriyama Y. Azumi M. Kishiwada M. Usui H. Sakurai S. Isaji 《Transplantation proceedings》2018,50(9):2705-2710
Background
Biliary complication is one of the major donor complications during and after hepatectomy in living donor liver transplantation (LDLT). We evaluated risk factors for donor biliary complication in adult-to-adult LDLT.Patients and Methods
From March 2002 to November 2016, 126 consecutive patients who underwent donor hepatectomy in adult-to-adult LDLT were divided into 2 groups according to biliary compilations: nonbiliary complication (non-BC) group (n = 114) and biliary complication (BC) group (n = 12).Results
Among 126 donor hepatectomies, 35 patients (28%) experienced perioperative complications, including 10 (7.9%) with Clavien-Dindo classification grade III. Biliary complications occurred in 12 patients (9.5%): bile leakage in 10 and intraoperative bile duct injury in 2. Additional computed tomography- and/or ultrasound-guided drainage or exchange of original drain was required in 7 patients. In comparison between BC and non-BC groups, future remnant liver volume was significantly higher in the BC group than in the non-BC group (63% vs 40%; P?=?.02). In multivariate analysis, larger future remnant liver volume (P?=?.005) and shorter operating time (P?=?.02) were identified as independent risk factors for biliary complications. We had 2 patients with intraoperative bile duct injury: both were successfully treated by duct-to-duct biliary anastomosis with insertion of biliary stent or T-tube.Conclusion
Large remnant liver volume was a significant risk factor for biliary complications, especially biliary leakage, after donor hepatectomy. For intraoperative bile duct injury, duct-to-duct anastomosis with biliary stent is a feasible method to recover. 相似文献6.
Hiroyuki Isayama Takao Kawabe Yousuke Nakai Yukiko Ito Osamu Togawa Hirofumi Kogure Yoko Yashima Hiroshi Yagioka Saburo Matsubara Takashi Sasaki Naoki Sasahira Kenji Hirano Takeshi Tsujino Minoru Tada Masao Omata 《Surgical endoscopy》2010,24(1):131-137
Background
The covered metallic stent is effective for managing malignant distal biliary obstructions. The most popular covered metallic stent is the covered Wallstent (CWS). This study estimated the efficacy and safety of a new expanded polytetrafluoroethylene (e-PTFE)-covered nitinol metallic stent, the ComVi stent. This covered metallic stent consists of an e-PTFE membrane sandwiched between two uncovered metallic stents with weak axial (straightening) force. Wire is exposed on both the inner and outer surfaces.Methods
Between May 2005 and April 2007, ComVi stents were placed consecutively in 47 patients with unresectable malignant distal biliary obstruction. The cases involved 35 pancreatic cancers, 8 metastatic nodes, 2 gallbladder cancers, and 2 bile duct cancers. The patients were compared with 47 patients who received CWS placement between August 2001 and May 2005 matched for age, sex, and causative disease from 133 cases.Results
No significant differences in stent patency or patient survival were found. Stent occlusion was observed in 13 patients (27.7%) in the ComVi group and 10 patients (21.3%) in the CWS group. The cause of occlusion in both groups was tumor overgrowth (4.25% vs 4.2%), sludge (8.5% vs 6.3%), impaction of food scraps (14.9% vs 2.1%), and bile duct kinking (0% vs 8.4%). Other complications were migration (2.1% vs 17.0%; p = 0.0304) and cholecystitis (2.1% vs 6.3%), and there were significant differences in the incidence of complications except for occlusion (4.2% vs 24.6%; p = 0.0142).Conclusion
The ComVi stent has a patency similar to that of the CWS and a lower incidence of migration. However, early occlusion by food impaction was increased and should be resolved. 相似文献7.
Jumpol Singhirunnusorn Lebeau Roger Xavier Chopin-Laly Vincent Lepilliez Thierry Ponchon Mustapha Adham 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2013,398(2):295-302
Background
In cases with periampullary tumors, the practice of preoperative biliary drainage (PBD) is still debated without clear uniform indications. Our study focused on resectable cases with an obstructive jaundice candidate for curative surgery. Main endpoints were overall complication and mortality rates between patients treated with and without PBD.Methods
From January 2008 to November 2010, 100 consecutive patients with periampullary lesion underwent pancreatectomy. The rates of postoperative complications and mortality were compared between PBD and non-PBD patients.Results
The two groups were well matched for demographics, clinical, and operative characteristics. In patients who completed preoperative PBD protocol, biliary stent was placed systematically in 45 % of these cases without any clear indication. Post-PBD complication delayed surgery in 24 % of cases. Postoperative complications did not differ significantly between the two groups except for a significantly higher positive bile culture in PBD group (p?=?0.001). There were seven cases of hospital mortality, four in PBD and three in non-PBD group. DFS was equal (32 months) in both groups (p?=?0.55), and OS was 43 vs 32 months (p?=?0.45).Conclusion
PBD did not significantly increase the risk of overall postoperative complications, although it was associated to higher rate of biliary infections. PBD was not associated with any advantages in patients with a resectable periampullary lesion by reducing operative morbidity. PBD should be considered in selected patients when surgery has to be delayed. 相似文献8.
L. Sulpice S. Garnier M. Rayar B. Meunier K. Boudjema 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2014,399(5):601-608
Background
Major bile duct injury (MBDI) remains frequent after laparoscopic cholecystectomy (LC) reaching 0.3 to 0.6 % and is associated with a significant mortality rate. The aim of this study was to retrospectively analyze the factors likely to influence the long-term results of surgical repair for MBDI occurring after LC.Methods
Medical records of patients referred to our referral center from January 1992 to January 2010 for management of bile duct injury following LC were retrospectively analyzed, and patients with MBDI were identified. Clinicopathological factors likely to influence long-term results after surgical repair were assessed by univariate and multivariable analysis.Results
During the study period, 38 patients were treated for MBDI. These 38 patients underwent Roux-en-Y hepaticojejunostomy (HJ) or HJ revision in 25 (66 %) and 13 (34 %) cases, respectively. The median follow-up period was 93 (26–204) months. A Clavien-Dindo post-operative morbidity class >3 occurred in 10 (26 %) cases and was independently associated with a surgical repair performed during a sepsis period (OR?=?102.5; IC 95 % [7.12; 11,352], p?<?0.007). Long-term results showed that biliary strictures occurred in 5 (13 %) cases and were associated with sepsis (p?<?0.006), liver cirrhosis (p?<?0.002) and post-operative complications (p?<?0.012). Multivariate analysis revealed that only liver cirrhosis remained predictive of stricture (OR?=?26.4, 95 % CI [2; 1,018], p?<?0.026).Conclusion
When MBDI occurs following LC, HJ seems to be the optimal treatment but should not be performed during a sepsis period. Long-term results are significantly altered by the presence of a biliary cirrhosis at time of repair. 相似文献9.
Rutger M. Schols Nicole D. Bouvy Ronald M. van Dam Ad A. M. Masclee Cornelis H. C. Dejong Laurents P. S. Stassen 《Surgical endoscopy》2013,27(12):4511-4517
Background
Bile duct injury in patients undergoing laparoscopic cholecystectomy is a rare but serious complication. Concomitant vascular injury worsens the outcome of bile duct injury repair. Near-infrared fluorescence imaging using indocyanine green (ICG) is a promising, innovative, and noninvasive method for the intraoperative identification of biliary and vascular anatomy during cholecystectomy. This study assessed the practical application of combined vascular and biliary fluorescence imaging in laparoscopic gallbladder surgery for early biliary tract delineation and arterial anatomy confirmation.Methods
Patients undergoing elective laparoscopic cholecystectomy were enrolled in this prospective, single-institutional study. To delineate the major bile ducts and arteries, a dedicated laparoscope, offering both conventional and fluorescence imaging, was used. ICG (2.5 mg) was administered intravenously immediately after induction of anesthesia and in half of the patients repeated at establishment of critical view of safety for concomitant arterial imaging. During dissection of the base of the gallbladder and the cystic duct, the extrahepatic bile ducts were visualized. Intraoperative recognition of the biliary structures was registered at set time points, as well as visualization of the cystic artery after repeat ICG administration.Results
Thirty patients were included. ICG was visible in the liver and bile ducts within 20 minutes after injection and remained up to approximately 2 h, using the ICG-filter of the laparoscope. In most cases, the common bile duct (83 %) and cystic duct (97 %) could be identified significantly earlier than with conventional camera mode. In 13 of 15 patients (87 %), confirmation of the cystic artery was obtained successfully after repeat ICG injection. No per- or postoperative complications occurred as a consequence of ICG use.Conclusion
Biliary and vascular fluorescence imaging in laparoscopic cholecystectomy is easily applicable in clinical practice, can be helpful for earlier visualization of the biliary tree, and is useful for the confirmation of the arterial anatomy. 相似文献10.
Purpose
We describe a new rat model of biliary atresia, induced by biliary ablation with pure ethanol.Methods
A catheter was inserted and fixed in the common bile duct of male rats. Saline or pure ethanol was injected through the catheter and the animals were monitored for 8 weeks thereafter. We measured total bilirubin (T-Bil), aspartate aminotransferase (AST), alanine transaminase (ALT), and hyaluronic acid (HA) and examined liver biopsy specimens immunohistochemically for α-smooth muscle actin staining (α-SMA) and transforming growth factor-β1 (TGF-β1).Results
The ethanol injection group animals were further divided into a temporary and a persistent liver dysfunction group. In the persistent group, T-Bil, AST, ALT and HA levels were significantly higher after 8 weeks in the persistent group than in the control group and the temporary group. In the ethanol injection group, α-SMA expression was prominent in the surrounding proliferative bile ducts and portal areas. The distribution of TGF-β1 was found prominently in hepatocytes in the center of nodules and in ductular epithelial cells.Conclusions
This study characterizes the effects of ethanol-induced bile duct injury in rats, resulting in sclerosing cholangitis and its secondary effects. We believe that this experimental model will prove useful in the study of biliary atresia. 相似文献11.
Yasuhito Shimizu Taiichi Otani Jun Matsumoto Kijuro Takanishi Tomohito Minami Hiroko Tsunoda Masaru Miyazaki 《Surgery today》2014,44(8):1490-1495
Background/aims
We investigated the association between the magnetic resonance cholangiography (MRC) results and surgical difficulties and bile duct injuries during laparoscopic cholecystectomy (LC).Methods
MRC was performed on 695 consecutive patients before LC. We divided the patients into two groups (visible cystic duct group and “no signal” cystic duct on MRC group) and compared them with regard to the length of the operation, conversion rate to open cholecystectomy (OC) and rate of bile duct injury.Results
The “no signal” cystic duct on MRC group had a longer operation and higher rate of conversion to OC compared with the visible cystic duct group. However, there was no statistically significant difference in the occurrence rate of bile duct injury between the two groups.Conclusions
The “no signal” cystic duct on MRC group was associated with laparoscopic difficulties, but not with an increased rate of biliary injury. When a visible cystic duct is not observed on MRC an early conversion to open surgery may avoid a bile duct injury during LC. 相似文献12.
Yazan S. Khaled Deep J. Malde Ciaran de Souza Amun Kalia Basil J. Ammori 《Surgical endoscopy》2013,27(11):4164-4170
Background
The common bile duct traditionally is managed with T-tube drainage after choledochotomy and removal of common bile duct (CBD) stones, but this approach carries an associated tube-related morbidity rate, including bile leak, of 10.5–20 %. This study examined the safety and effectiveness of laparoscopic CBD exploration (LCBDE) followed by primary duct closure.Methods
This is a retrospective analysis of 120 consecutive patients (81 female) who underwent LCBDE between October 2002 and October 2012. The duct primarily was closed in all patients. The results are given as median (range).Results
Trans-CBD exploration was performed in 120 patients and all cases were successfully completed laparoscopically. The maximum diameter of the CBD was 9.4 (3–30) mm and the number of CBD stones detected was 3 (0–20). The biliary tree was clear at the end of exploration in 116 patients (96.7 %). The operating time was 122 (70–360) min. The mortality rate, morbidity rate, postoperative bile leak rate, rate of retained CBD stones after the primary procedure, and CBD stricture rate at a follow-up of 39.2 (2–82) months were 0, 8.3, 2.5, 3.3, and 0.8 %, respectively. The postoperative hospital stay was 2.1 (1–29) days.Conclusion
Primary duct closure following LCBDE is safe, can be employed routinely as an alternative to T-tube insertion, and has a short hospital stay and low morbidity rate. 相似文献13.
Regimbeau JM Fuks D Bartoli E Fumery M Hanes A Yzet T Delcenserie R 《Surgical endoscopy》2012,26(10):2902-2908
Background
This study aimed to compare the outcomes of endoscopic treatment (ET) and surgical treatment (ST) for common bile duct (CBD) stricture in patients with chronic pancreatitis (CP).Methods
From 2004 to 2009, 39 patients (35 men and 4 women; median age, 52?years; range, 38–66?years) were referred for CBD stricture in CP. Of these 39 patients, 33 (85?%) underwent primary ET, and 6 underwent primary ST. Treatment success was defined in both groups as the absence of signs denoting recurrence, with normal serum bilirubin and alkaline phosphatase levels after permanent stent removal in ET group. The follow-up period was longer than 12?months for all the patients.Results
For the patients treated with ET, the mean number of biliary procedures was 3 (range, 1–10) per patient including extractible metallic stents in 35?% and multiple plastic stents in 65?% of the patients. The mean duration of stent intubation was 11?months. The surgical procedure associated with biliary drainage (4 choledochoduodenostomies, 1 choledochojejunostomy, and 1 biliary decompression within the pancreatic head) was a Frey procedure for five patients and a pancreaticojejunostomy for one patient. The overall morbidity rate was higher in the ST group. The total hospital length of stay was similar in the two groups (16 vs 24?days, respectively; p?=?0.21). In terms of intention to treat, the success rates for ST and ET did not differ significantly (83?% vs 76?%; p?=?0.08). Due to failure, 17 patients required ST after ET. Event-free survival was significantly longer in the ST group (16.9 vs 5.8?months; p?=?0.01). The actuarial success rates were 74?% at 6?months, 74?% at 12?months, and 65?% at 24?months in the ST group and respectively 75?%, 69?%, and 12?% in the ET group (p?=?0.01). After more than three endoscopic procedures, the success rates were 27?% at 6?months and 18?% at 18?months.Conclusion
For bile duct stricture in CP, surgery is associated with better long-term outcomes than endoscopic therapy. After more than three endoscopic procedures, the success rate is low. 相似文献14.
Wu X Yang Y Dong P Gu J Lu J Li M Mu J Wu W Yang J Zhang L Ding Q Liu Y 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2012,397(6):909-916
Purpose
To compare the safety and effectiveness of primary closure with those of T-tube drainage in laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis.Methods
A comprehensive search was performed in the PubMed, EmBase, and Cochrane Library databases. Only randomized controlled trials comparing primary closure with T-tube drainage in LCBDE were considered eligible for this meta-analysis. The analyzed outcome variables included postoperative mortality, overall morbidity, biliary complication rate, biliary leak rate, reoperation, operating time, postoperative hospital stay, time to abdominal drain removal, and retained stone. All calculations and statistical tests were performed using ReviewerManager 5.1.2 software.Results
A total of 295 patients (148 patients with primary closure and 147 patients with T-tube drainage) from three trials were identified and analyzed. No deaths occurred in any of the trials. Primary closure showed significantly better results in terms of morbidity (risk ratio (RR), 0.51; 95% confidence interval (CI), 0.30 to 0.88), biliary complication without a combination of retained stone (RR, 0.44; 95% CI, 0.20 to 0.97), reoperation (RR, 0.16; 95% CI, 0.03 to 0.87), operating time (mean difference (MD), ?20.72; 95% CI, ?29.59 to ?11.85), postoperative hospital stay (MD, ?3.24; 95% CI, ?3.96 to ?2.52), and time to abdominal drainage removal (MD, ?0.45; 95% CI, ?0.86 to ?0.04). Statistically significant differences were not found between the two methods in terms of biliary leak, biliary complication, and retained stones.Conclusion
The current meta-analysis indicates that primary closure of the common bile duct is safer and more effective than T-tube drainage for LCBDE. Therefore, we do not recommend routine performance of T-tube drainage in LCBDE. 相似文献15.
Hirofumi Kogure Hiroyuki Isayama Yousuke Nakai Takeshi Tsujino Yukiko Ito Keisuke Yamamoto Suguru Mizuno Hiroshi Yagioka Kazumichi Kawakubo Takashi Sasaki Kenji Hirano Naoki Sasahira Minoru Tada Masao Omata Kazuhiko Koike 《Surgical endoscopy》2011,25(2):463-467
Background
Whether uni- or bilateral drainage should be performed for malignant hilar biliary obstruction remains a matter of debate. Moreover, endoscopic placement of bilateral metallic stents has been considered difficult and complicated. Although the Y-stent with a central wide-open mesh facilitates bilateral stent placement, it has limitations. This study evaluated the feasibility and efficacy of the Niti-S large cell D-type biliary stent (LCD) with a uniform large cell for both uni- and bilateral drainage of malignant hilar biliary obstruction.Methods
From April 2008 to March 2009, a total of 12 consecutive patients with unresectable malignant hilar biliary obstruction of Bismuth type 2 or greater underwent placement of LCD. Before LCD placement, all the patients underwent endoscopic unilateral biliary drainage using a plastic stent or a nasobiliary drainage tube. If jaundice improved after the procedure, the plastic stent or nasobiliary drainage tube was replaced with the unilateral LCD. If jaundice did not resolve or contralateral cholangitis occurred, bilateral LCD placement was performed.Results
Seven patients had unilateral and five patients had bilateral LCD placement. Technical success was achieved for all 12 patients. An early complication occurred for one patient (8%), and stent occlusion occurred for six patients (50%) because of tumor ingrowth (n?=?4) or sludge (n?=?2). These patients were managed by insertion of plastic stents (n?=?4) or percutaneous transhepatic biliary drainage (n?=?2). The median stent patency period was 202?days.Conclusions
The newly designed endoscopic metallic stent may be feasible and effective for malignant hilar biliary obstruction, and endoscopic reintervention is relatively simple. 相似文献16.
Giuseppe Spinoglio Fabio Priora Paolo Pietro Bianchi Francesco Saverio Lucido Alessio Licciardello Valeria Maglione Federica Grosso Raul Quarati Ferruccio Ravazzoni Luca Matteo Lenti 《Surgical endoscopy》2013,27(6):2156-2162
Background
Bile duct injury is a rare but serious complication of laparoscopic cholecystectomy and the primary cause is misinterpretation of biliary anatomy. This may occur more frequently with a single-incision approach due to difficulties in exposing and visualizing the triangle of Calot. Intraoperative cholangiography was proposed to overcome this problem, but due to multiple issues, it is not used routinely. Indocyanine green (ICG) near-infrared (NIR) fluorescent cholangiography is non invasive and provides real-time biliary images during surgery, which may improve the safety of single-incision cholecystectomy. This study aims to evaluate the efficacy and safety of this technique during single-site robotic cholecystectomy (SSRC).Methods
Patients presenting with symptomatic biliary gallstones without suspicion of common bile duct stones underwent SSRC with ICG-NIR fluorescent cholangiography using the da Vinci Fluorescence Imaging Vision System. During patient preparation, 2.5 mg of ICG was injected intravenously. During surgery, the biliary anatomy was imaged in real time, which guided dissection of Calot’s triangle. Perioperative outcomes included biliary tree visualizations, operative time, conversion and complications rates, and length of hospital stay.Results
There were 45 cases between July 2011 and January 2012. All procedures were completed successfully; there were no conversions and at least one structure was visualized in each patient. The rates of visualization were 93 % for the cystic duct, 88 % for the common hepatic duct, and 91 % for the common bile duct prior to Calot’s dissection; after Calot’s dissection, the rates were 97 % for all three ducts. Mean hospital stay was 1.1 days and there were no bile duct injuries or any other major complications.Conclusion
Real-time high-resolution fluorescent imaging to identify the biliary tree anatomy during SSRC using the da Vinci Fluorescence Imaging Vision System was safe and effective. 相似文献17.
B. Strücker M. Stockmann T. Denecke P. Neuhaus D. Seehofer 《World journal of surgery》2013,37(11):2629-2634
Background
Improved surgical techniques, substantial preoperative diagnostics, and advanced perioperative management permit extensive and complex liver resection. Thus, hepatic malignancies that would have been considered inoperable some years ago may be curatively resected today. Despite all this progress, biliary leakage remains a clinically relevant issue, especially after extended liver resection. Intraoperative decompression of bile ducts by means of distinct biliary drains is controversial. Although drainage is rarely used as a routine procedure, it might be useful in selected patients at high risk for biliary leakage.Methods
We describe surgical management of long-segment exposed or injured bile ducts after extended parenchymal resection with concomitant lymphadenectomy. Because blood supply to the bile duct may be impaired, the risk of biliary necrosis and/or leakage is significant. Internal splinting of the bile duct to ensure optimum decompression plus guidance might be helpful. Thus, in selected cases after trisectionectomy we inserted an external–internal or internal–external drain into long-segment exposed bile ducts. For internal–external drains the tube was diverted via the major duodenal papilla into the duodenum and then transfixed after the duodenojejunal flexure through the jejunal wall by means of a Witzel’s channel.Results
Because the entire bile duct is splinted, this technique is superior to bile duct decompression with a T-tube. This is supported by the course of a patient suffering biliary leakage after extended right-sided hepatectomy for colorectal metastasis. Initially, a T-tube was inserted for decompression, but biliary leakage persisted. After inserting transhepatic external–internal drainage, bile leakage stopped immediately. The patient’s course was then uneventful. Five other patients (mostly with locally advanced hepatocellular or cholangiocellular carcinoma) treated similarly were discharged without complications. Drain removal 6 weeks postoperatively was uncomplicated in five of the 6 patients. In the sixth patient, external–internal drainage was replaced by a Yamakawa-type prosthesis for a biliary stricture. None of the patients suffered severe complications during long-term follow-up.Conclusions
The bile duct drainage technique presented in this study was useful for preventing and treating bile leakage after long-segment exposure of extrahepatic bile ducts during major hepatectomy. Transhepatic or internal–external drains are often used for bilioenteric anastomoses, but similar drainage techniques have not been reported for the native bile duct. T-tubes are generally used in this situation. In particular cases, however, inner splinting of the bile duct and appropriate movement of the bile via a tube can be helpful. 相似文献18.
Shu-Hung Chuang Pai-Hsi Chen Chih-Ming Chang Yung-Fa Tsai Chih-Sheng Lin 《Journal of gastrointestinal surgery》2014,18(4):737-743
Background
Single-incision laparoscopic surgery developed rapidly in recent years. We introduce an innovative technique: single-incision laparoscopic common bile duct exploration (SILCBDE) with conventional instruments. A retrospective comparison between SILCBDE and standard laparoscopic common bile duct exploration (LCBDE) was analyzed.Methods
Thirty-four patients who underwent LCBDE for choledocholithiasis in a period of 17 months were enrolled. Seventeen standard LCBDEs and 17 SILCBDEs were attempted. Simultaneous cholecystectomies were performed.Results
The stone clearance rate was 94.1 % (16 patients) in the standard LCBDE group and 100 % in the SILCBDE group. There was no statistical difference in demographic distribution, clinical presentations, and operative results between the two groups, except the SILCBDE group had a higher rate of acute cholecystitis than the standard LCBDE group (76.5 vs. 35.3 %; p?<?0.05). One procedure (5.9 %) in the SILCBDE group was converted to a four-incision transcystic LCBDE. The complication rate was 11.8 % (two patients) in the standard LCBDE group and 5.9 % (one patient) in the SILCBDE group. The average follow-up period was 4.2 months.Conclusion
SILCBDE is as safe and efficacious as standard LCBDE in experienced hands. Choledochoscope manipulation and bile duct repair are the key skills. Long-term follow-up and further prospective randomized trials are anticipated. 相似文献19.
Kai Zhang Feng Zhan Yun Zhang Chao Jiang Miao Zhang Xiaotian Yu Tieliang Ma Haorong Wu 《The Indian journal of surgery》2016,78(5):364-370
To assess feasibility of primary closure following laparoscopic common bile duct reexploration for the patients who underwent prior biliary operation, we retrospectively studied 50 patients with recurrent or residual common bile duct (CBD) stones who underwent laparoscopic biliary reoperation between June 2008 and June 2013. Endoscopic sphincterotomy (EST) was treated for all these patients and validated failed. They were divided into two groups. Primary closure following laparoscopic common bile duct exploration (LCBDE) was performed in 25 cases (group A); LCBDE plus T-tube drainage was performed in others (group B). The items of operation were compared. The duration of the operation in group A was shorter than that in group B (141?±?85 vs 158?±?71 min, p?<?0.05), as was postoperative hospital stay (16?±?2.3 vs 23?±?2.3 h, p?<?0.05) and the times of postoperative gastrointestinal function recovery (16?±?2.3 vs 23?±?2.3 h, p?<?0.05). Just one duodenum was damaged in group B. Postoperative clinically significant bile leakage occurred in two patients in group A and one case in group B. The median follow-up was 18 months. No postoperative pancreatitis, postoperative bleeding, bile peritonitis after T-tube removal, stricture of bile duct, and death occurred in the two groups. Just two cases in group B were verified residual stones after 1 month. Primary closure following laparoscopic common bile duct reexploration for the patients who underwent prior biliary operation appears to be a minimally invasive, safe, feasible, and effective procedure when done by expert laparoscopic surgeons. 相似文献
20.
Shukun Hong Hongye Wang Shiyong Yang Kunxing Yang 《Journal of gastrointestinal surgery》2013,17(8):1516-1525