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Benign gallbladder diseases are common in general surgery practice, and laparoscopic cholecystectomy (LC) has become the standard treatment for these conditions. With the widespread adoption of LC and the improved understanding of gallbladder disease, it is necessary to re-evaluate the diagnosis and treatment of benign gallbladder disease. Based on the latest expert consensus on the diagnosis and treatment of benign gallbladder disease, this review aims to provide an overview of the diagnostic and treatment strategies for benign gallbladder diseases. Specifically, it focuses on enhancing our understanding of the role of benign gallbladder diseases in the development of gallbladder cancer, the impact of congenital biliary anomalies on the diagnostic and treatment processes of benign gallbladder diseases, and the significance of the preoperative examinations.
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Objective To investigate the type,clinical and imaging features of iatrogenic bile duct injury and the efficacy and safety of endoscopic and interventional radiology therapy.Methods A total of 48 patients with iatrogenic bile duct injury who have undergone endoscopic and/or interventional therapy from January 1st 2013 to June 30th 2016 were enrolled.Patients' general information,causes of injury,clinical manifestations,treatment methods,efficacy and complications were retrospectively analyzed.Results The causes of iatrogenic bile duct injury were cholecystectomy(45.8％,22/48),liver transplantation (35.4％,17/48),transjugular intrahepatic portosystemic shunt (8.3％,4/48),Roux-en-Y anastomosis (6.3％,3/48) and endoscopic retrograde cholangiopancreatography (4.2％,2/48).The most common type of iatrogenic bile duct injury was stenosis of intra/extra bile ducts (66.7％,32/48).Other types included biliary fistula(18.8％,9/48),hemobilia (10.4％,5/48) and stenosis of anastomotic stoma (4.2％,2/48).The most common clinical manifestations were jaundice (37.5％,18/48) and abdominal pain (29.2％,14/48).Other clinical manifestations were fever (14.6％,7/48),hematemesis or melena (8.3％,4/48) and abnormal drainage fluid (8.3％,4/48).Diagnosis was confirmed by angiography,cholangiography or endoscopy.The overall effective rate of minimally invasive therapy was 91.7％ (44/48) and the most common complications were fever (16.7％,8/48) and pancreatitis (10.4％,5/48).Other complications were hemobilia (2.1％,1/48),cardia dilaceration (2.1％,1/48) and biliary fistula caused by catheter shedding(2.1％,1/48).Conclusion Iatrogenic bile duct injury could occur after upper abdominal surgeries,endoscopic or interventional procedures.Early diagnosis and treatment with endoscopic or vascular interventional methods can achieve satisfying efficacy and safety.
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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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ObjectiveTo review the management and prevention of stenosis after hepaticojejunostomy. MethodsWe retrospectively analyzed 133 patients who developed stenosis after hepaticojejunostomy carried out for iatrogenic bile duct injuries. ResultThrough our active reoperative protocol, we were able to achieve satisfactory results in 131 patients, although the results were still unsatisfactory in 2 patients. ConclusionsStenosis after hepaticojejunostomy is a severe complication which should actively be prevented. Once it happens, doctors should apply active, appropriate and effective measures to correct the stenosis.
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ObjectiveTo investigate the influence of timing of definitive operation on prognosis of patients with iatrogenic bile duct injury (IBDI). MethodsThe clinical data of 38 patients with IBDI were retrospectively analyzed. Of the 38 patients, the injury happened in 7 patients in our hospital while 31 patients were transferred in from other hospitals. We analyzed the previous operative records, the clinical manifestations of the patients, the radiological images and our operative findings in the definitive operations. According to the timing of the definitive operation, the patients were divided into the intraoperative repair group (n=26), the early repair group (n=15) and the delayed repair group (n=17). ResultsPatients in the intraoperative repair group had the best short-and long-term results, the shortest length of hospital stay and the lowest total cost. The early repair group, though having worse Results than the intraoperative repair group was still better than the delayed repair group. However, early detection of injuries and the ability to carry out timely corrective procedures depended on the availability of surgical expertise in the hospital. ConclusionsThe timing of definitive operation to provide corrective surgery to IBDI was a vitally important factor which affected prognosis.It is best to repair the injury within the same operation. The repair should be carried out by a doctor with ample experience in bile duct surgery.
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Objective To discuss the curative effect of Choledo-choledochostomy by observing different means of biliary duct reconstruction in the iatrogenic bile duct damage and the liver trans-plant. Method The clinical data of 19 patients who were found to have iatrogenic bile duct injury dur-ing operation and immediately repaired and 66 patients receiving liver transplantation in our hospital in the past 10 years were retrospectively analyzed. Meanwhile, the means for bile duct reconstruction were discussed. Results The rate of curative effect of the Choledo-choledochostomy was 86.6% for iatrogenie bile duct injury. However, whether to leave the T-tube or not was not a determinant factor for the procedure in liver transplantation (P>0. 05). Conclusion Choledo-choledochostomy has good curative effect for iatrogenic bile duct injury and liver transplantation. During the operation, the bile duct may not be excessively freed to guarantee blood supply in at the anastomosis site to further en-hance the curative effect.
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Objective:To explore the early diagnosis and treatment of iatrogenic bile duct injury.Methods:The clinical data of 16 patients with iatrogenic bile duct injury from July 1997 to September 2009 were analyzed retrospectively.The clinical types of the bile duct injuries:BismuthⅠ(5 cases),BismuthⅡ(9 cases),Bismuth Ⅲ(0 case),Bismuth Ⅳ(2 cases),BismuthⅤ(0 case).The treatment of the bile duct injuries:Roux-enY biliary-enteric anastomosis with stent tube drainage(6 cases),bile duct suture without T tube drainage(2 cases),bile duct suture with T tube drainage(3 cases),bile duct repair utilizing umbilical vein with T tube drainage(1 case),bile duct repair utilizing cystic duct with T tube drainage(2 cases),single drainage of abdominal cavity(2 cases).Results:All patients had been followed up for 3 months to 12 years.11(68.8%,11/16)cases obtained better effect,while the other 5(31.2%,5/16)cases received second operation because of unsatisfactory effect.Conclusion:Early diagnosis and correct treatment of iatrogenic bile duct injury are necessary for better effect.Otherwise,the effect will be unsatisfactory.Both bile duct suture or repair with T tube drainage and Roux-en Y biliary-enteric anastomosis with stent tube drainage are better treatment in the early stage of iatrogenic bile duct injury.