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Background & Aim: Roux-en-Y hepaticojejunostomy (RYHJ) is the most common treatment done for benign biliary strictures and as a part of for post CDC excision biliary drainage. In the long term follow up, RYHJ stenosis is a dreaded complication, both for the patients and the attending surgeon, in view of the complexity and difficulty in its management. This is traditionally managedby a combination of medical, radiological and open surgical techniques. There are only a few reports describing the management of strictured biliary anastomosis by a laparoscopic technique. The aim of the present study is to describe our experience of laparoscopic re- establishment of biliary continuity(Re-do hepatico-jejunostomy) Methods: Retrospective analysis of prospectively collected data of RYHJ stenosis post benign biliary stricture (BBS) repair and choledochal cyst (CDC) excision, treated by laparoscopic re-do RYHJ, between January 2018 to December 2018 in the department of GI Surgery, GB Pant Institute & Maulana Azad Medical College. Results: 6 patients underwent laparoscopic Re-do RYHJ during the study period. 4 patients developed RYHJ stenosis post open BBS repair and 2 after open CDC excision. The presenting complaints was repeated episodes of fever with jaundice, refractory to medical management. Three patients also had hepatolithiasis.
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At present, surgical and endoscopic interventions are mainly employed to treat ischemic-type biliary lesion (ITBL). Due to the disadvantages of single therapeutic strategy, high difficulty and expensive medical cost, it is urgent to identify a novel treatment option. Mesenchymal stem cell (MSC) has become potential seed cell for tissue and organ repair in regenerative medicine due to its high self-renewal capability, multi-directional differentiation potential, low immunogenicity and immunoregulatory effects, etc. Recent studies have demonstrated that MSC transplantation into ITBL animal models may not only home to the injured area, but also promote the repair of injured biliary tract tissues through anti-apoptotic and pro-angiogenic effect, which indicates that MSC transplantation is expected to become a new strategy for the treatment of ITBL. In this article, the biological characteristics of MSC, the mechanism and clinical application of MSC transplantation for ITBL were reviewed.
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Objective To investigate the clinical value,safety and efficacy of pancreatic stent in prevention of postoperative acute pancreatitis in patients with benign biliary stricture (BBS) treated by fullcovered self-expanding removable metal stents (FCSERMSs).Methods From Jan 2011 to Dec 2017,92 BBS patients who met the inclusion criteria were admitted and divided into pancreatic stent (PS) group and control group.The acute pancreatitis (AP) and hyperamylase (HP) after FCSERMS implantation and removal was observed.Results 55 cases in PS group and 37 cases in control group underwent successful FCSERMS implantation.The incidences of postoperative elevated amylase and HP had no significant differences between the two groups (23.6％ vs.32.4％,3.6％ vs.10.8％,all P ＞0.05).The incidences of postoperative AP and moderately elevated amylase had significant differences (0 vs.13.5％,20.0％ vs.8.1％,all P ＜ 0.05).The average placement time of FCSERMSs was 7.84 ± 1.22 months.The incidence of elevated amylase,AP,HP and moderately elevated amylase after the FCSERMS and PS removed had no statistical differences (3.6％ vs.14.3％,0vs.2.9％,0 vs.2.9％,3.6％vs.8.6％,all P＞0.05).Conclusion The placement of pancreatic stents in the treatment of BBS with FCSERMS is a simple,safe and effective method for the prevention of post-ERCP pancreatitis.
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Antecedentes: las estenosis benignas de la vía biliar (EBVB) tradicionalmente han sido tratadas con derivaciones biliodigestivas. En la actualidad existe una clara tendencia para resolverlas en forma mínimamente invasiva (endoscópica o percutánea o de ambos modos). Objetivo: describir el manejo y los resultados del tratamiento percutáneo y/o endoscópico de las estenosis biliares benignas. Material y métodos: período del estudio: enero de 2009 a junio de 2015. Etología de las EBVB: 8 lesiones quirúrgicas de la vía biliar (LQVB), 5 trasplantes hepáticos (TH), 5 hidatidosis hepáticas (HH), 2 quistes de colédoco (QC). Se realizaron 4 procedimientos promedio por paciente (r. 1-11). Se colocaron 3 stentis (endoprótesis) promedio por paciente (r. 1-5). Seguimiento promedio: 21 meses con una mediana de 13 meses. Resultados: mortalidad relacionada con los procedimientos: 0%. Morbilidad relacionada con los procedimientos: 35% (bacteriemia, colangitis, hemorragia digestiva, síndrome febril, hemoperitoneo leve, sepsis). Diecinueve pacientes (95%) evolucionaron con control satisfactorio de la estenosis; un paciente (5%) presentó recidiva de la estenosis y debió ser tratado nuevamente. Conclusiones: el tratamiento mininvasivo puede lograr resultados satisfactorios en un alto porcentaje de pacientes con estenosis benignas de la vía biliar.
Background: although benign strictures of the bile duct (BSBD) have traditonally been treated by constructon of a surgical biliodigestive anastomosis at present, there is a clear tendency to resolve them in a minimally invasive way (endoscopic or percutaneous or both). Objective: to describe the management and Results of percutaneous and / or endoscopic treatment of BSBD. Materials and methods: study period: January 2009 to June 2015. Etology of BSBD, 8 surgical injury to the bile duct (BDI), 5 liver transplantis (LT), 5 liver hydatidosis (LH), 2 choledochal cystis (CC). As an average, 4 procedures per patent were done (range, 1-11); and 3 stentis were placed (range, 1-5). Average and median follow up were 21 months, and 13 months, respectively. Results: mortality related to the procedure was 0%. Morbidity was 35% (bacteremia, cholangitis, gas-trointestinal bleeding, febrile syndrome, mild hemoperitoneum, and sepsis). 19 patentis (95%) had satisfactory outicome; one patentis (5%) developed a re-stricture that required a new procedure. Conclusions: mininmally invasive treatment can achieve satisfactory Results in a high percentage of patentis with benign stricture of the bile duct.
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Objective To study the long-term results of using an autologous vascularized pedicled flap of gastric tissues in the repair of traumatic bile duct strictures.Methods From 2002 to 2016,38 patients with traumatic bile duct strictures underwent repair using an autologous vascularized pedicled flap of stomach tissues.The postoperative morbidity,mortality,long-term clinical results,liver function and the rate of biliary stricture recurrence were studied.Results The overall complication rate was 18.4％ (7/38).A delay in healing of the incision wound occurred in 4 patients,biliary fistula in 2,and ascites in 1.Two patients died of malignant tumor.The median follow-up was 92 (61 ～ 107) months and the follow-up rate was 100％.Excellent results were obtained in 97.2％ (35/36) of patients.Abnormal liver function was detected in 1 patient which improved with treatment using choleretic drugs.The remaining 35 patients had normal liver functions with absence of abdominal pain.Conclusions To repair traumatic bile duct strictures using an autologous vascularized pedicled flap of stomach tissues was safe and reliable,and good long-term outcomes are available.
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The endoscopic insertion of the self-expandable metal stent (SEMS) in benign biliary stricture has become an alternative to surgery. Fracture or migration of SEMS can occur rarely as complications. We report a case of fracture of SEMS during endoscopic retrieval in patients with chronic pancreatitis. In this case, broken stent was successfully removed with endoscopic ballooning of bile duct and with a snare device.
Subject(s)
Humans , Bile Ducts , Constriction, Pathologic , Pancreatitis, Chronic , SNARE Proteins , StentsABSTRACT
Benign biliary stricture is a challenging problem in hepatobiliary surgery. Benign biliary stricture is associated with major portal vein variation, which is not be found in literatures. A male patient with benign biliary stricture was admitted to the Chinese PLA General Hospital in March, 2010.The stricture was located in the hilar confluence with intrahepatic biliary dilation and hepatolithiasis. The result of computed tomography showed that the hilar biliary confluence was compressed by the left portal vein and right anterior portal vein. The patient was cured after receiving gallbladder interposition, choledocholithotomy and T tube drainage. We suggested that the benign hilar biliary stricture due to portal vein variation may be named as biliary nut-craker syndrome.
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Biliary papillomatosis is a rare disease with a high risk of recurrence and malignant transformation. Therapeutic options include partial hepatectomy, Whipple's procedure and liver transplantation. If there is no surgical option left due to several reasons, local palliative procedures such as biliary stenting and drainage for the treatment of cholestasis are considered, but tumor growth cannot be influenced. Photodynamic therapy might be a new additional, palliative option for patients with biliary papillomatosis who are not eligible for surgery. Benign biliary stricture is a rare complication of photodynamic therapy. We report here a case of a 63-year-old male who developed benign biliary stricture after photodynamic therapy using the photosensitizer photofrin.
Subject(s)
Humans , Male , Middle Aged , Cholestasis , Constriction, Pathologic , Dihematoporphyrin Ether , Drainage , Hepatectomy , Liver Transplantation , Papilloma , Photochemotherapy , Rare Diseases , Recurrence , StentsABSTRACT
Benign biliary strictures constitute about 25% of all biliary strictures. Benign biliary strictures are a heterogenous group of lesions with variousvariable pathogenesis. The majority of benign biliary strictures occur as a result of bile duct injury during surgery or as a consequence of bile duct repair after accidental injury, performing , choledochotomy, or performing duct-to-duct anastomosis after liver transplantation. However, bile duct strictures are also typical of other diseases, such as chronic pancreatitis, primary sclerosing cholangitis, and other uncommon cholangiopathies. The aim of treatment is to relieve the symptoms of biliary obstruction or cholangitis, and to prevent of secondary biliary cirrhosis. The Management of benign biliary stricture remains a challenge for both the surgeons and the therapeutic endoscopists. Surgery is, though traditionally considered as the mainstay of treatment, but this is associated with significant morbidity and variousvariable long-term outcomes. Endoscopic management, i.e., stricture dilatation and stent placement, is more appealing because it is less invasive, better tolerated, and it may be safer than operative management in selected patients. Recently, benign biliary strictures are now being increasing treated with endoscopic techniques. The Outcome of endoscopic management depends on both the etiology and location of the stricture. The benign nature of the stricture should be first confirmed in order to ensure appropriate therapy. The Current data suggest that the long-term results with using multiple plastic stent are superior to those with using a single plastic stent. Removable covered metal stents are also a good alternative. The role of bio-absorbable self-expanding stents for treating benign biliay strictures needs to be evaluated further.
Subject(s)
Humans , Bile Ducts , Cholangitis , Cholangitis, Sclerosing , Constriction, Pathologic , Dietary Sucrose , Dilatation , Liver Cirrhosis, Biliary , Liver Transplantation , Pancreatitis, Chronic , Plastics , StentsABSTRACT
BACKGROUND/AIMS: The problem with endoscopic management for benign biliary stricture is the occurrence of restenosis after removal of biliary stents. However the factors that influence the rate of restenosis have not yet been identified. The aim of this study was to identify the factors that affect patency of the bile duct after removal of an endoscopic stent for management of benign biliary stricture. METHODS: The medical records and potential factors that influence biliary restenosis were analyzed in 19 patients with benign biliary stricture. RESULTS: At the time of stent removal, successful stricture resolution was noted in 13 out of 19 patients. Among these 13 patients, good biliary patency, without restenosis, was observed in 10 patients during a mean follow-up of 24 months. The time interval, from biliary surgery to stricture, tended to be shorter in the group with good results compared to the group with poor results (6.2+/-3.3 months vs. 80.2+/-139.3 months respectively: p=0.07). Other factors did not affect the rate of restenosis after removal of the stent. CONCLUSIONS: The time interval, from biliary surgery to stricture, tends to influence restenosis after endoscopic management for benign biliary stricture.
Subject(s)
Humans , Bile Ducts , Constriction, Pathologic , Follow-Up Studies , Medical Records , StentsABSTRACT
BACKGROUND/AIMS: There are some cases difficult to discriminate between benign biliary stricture and malignant one even through intraoperative findings and frozen biopsy. We reviewed our experiences of cancer-mimic benign biliary stricture to find whether there are any clinicopathological characteristics helpful for differentiation. PATIENTS AND METHODS: From 1991 to 1998, we have had 9 patients with cancer-mimic benign biliary stricture without definite causes such as stones, operation and etc. Their clinicopathological findings were reviewed. RESULTS: Only 5 patients had jaundice. Serum tumor markers were normal in all patients. Cholangiographic findings of 6 cases were compatible with bile duct cancer presenting long segment stricture and abrupt cut-off of bile duct. Six patients had CT findings compatible to cancer such as enhanced mass, thickened bile duct wall, or enlarged lymph node. Stricture site was hilar duct in 5 cases(2 cases : Bismuth type II ; 1 case : IIIa ; 2 cases : IV) and intrahepatic bile duct in 4 cases. Laparotomy was performed in 8 cases(4 cases : resection of strictured bile duct ; 2 cases : left lobectomy ; 1 case : right lobectomy ; 1 case : left lateral segmentectomy). In one case, choledochoscopic biopsy and balloon dilatation were performed. According to the operative findings, 2 cases underwent radical cancer operations. Pathological findings were chronic inflammatory cholangitis which have inflammatory cell infiltration in mucosal and submucosal layer, submucosal fibrosis, hypertrophy and stenosis of bile duct wall, which could be observed also in the secondary stricture caused by stone or infection. CONCLUSION: Primary benign biliary stricture should be included in the differential diagnosis for bile duct obstruction. Tumor marker and choledochoscopy as well as radiologic study might be helpful to differentiate it from the malignant stricture. Some of these cases might be categorized into rare type of primary sclerosing cholangitis.