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OBJECTIVE: To investigate the clinical value of pancreaticogastrostomy(PG) in the treatment ofpancreatojejunostomy stricture(PJS) after pancreaticoduodenectomy(PD).METHODS: The clinical data of 3 patients withPJS who failed the endoscopic treatment underwent PG followed by resection of pancreatojejunostomy(PJ) from May2010 to December 2017 in Department of General Surgery,Xinhua Hospital,Shanghai Jiaotong University School ofMedicine were analyzed retrospectively. After the pancreatointestinal anastomosis was explored and resected, thedigestive tract of the remnant pancreas was reconstructed by using the single-layer bundle pancreaticogastric mucosaanastomosis. The intraoperative and postoperative conditions were observed.RESULTS: The median time of presentationwas 72,37 and 21 months. Three cases of operation were completed successfully. The operation time was 137, 210, 120 min,and blood loss was 210, 350, 180 m L. No pancreatic fistula,surgical bleeding and other serve complicationoccurred postoperatively. All the 3 patients experienced resolution of symptoms without recurrent acute pancreatitis afterPG during the follow-up of 23, 58 and 15 months.CONCLUSION: PG especially duct-to-mucosa PG followed byresection of PJ could be used in the PJS patients who failed the endoscopic treatment.
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Introduction: Without the knowledge of the normal pattern of the duct system and its variations, a radiologistcan’t interpret an Endoscopic Retrograde Cholangiopancreatography (ERCP) picture. So it becomes important tostudy the anatomy of pancreatic ducts, their relation to each other, to common bile duct and to duodenum in theavailable human cadavers. The present paper is about the study of distance between minor and major duodenalpapilla from pylorus which was carried out on 96 cadaveric specimens of human duodeno-pancreas. To visualiseand to see distance between minor and major duodenal papillae is necessary for the endoscopist who aims toperform the dilation, stenting, or papillotomy of the minor papilla.Materials and Methods: The study was conducted in 96 (64 male and 32 female) cadavers. Major and minorduodenal papillae were visualized through eosin dye installation in both common bile duct and the accessorypancreatic duct. The measurement of distance between the duodenal papillae and to pylorus was done in cm.Results: In the present work, the mean ± SD of the Distance between pylorus to MAP is 8.05 ± 1.71 cm, pylorus toMIP is 6.19 ± 1.49 cm, the major to minor duodenal papilla was on an average 2.02 ± 0.40 cm, these distanceswere more in males as compared to females. But the size of Orifice of MAP in specimens is 7.25 ± 1.25 mm morein females as compared to males.Conclusion: The length of the duct shows sexual dimorphism; the length being more in males than females.
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The accessory pancreatic duct is the smaller and less constant pancreatic duct in comparison with the mainpancreatic duct. We investigated the patency of the accessory pancreatic duct and its role in pancreaticpathophysiology. The present study was carried out in the department of Anatomy and forensic medicine, ACSRGovt. medical college, Nellore, Andhra Pradesh, India and in the department of Anatomy, RIMS, Ongole, AndhraPradesh, India. With 96 human cadavers (64 males and 32 females) with 30 to 80 years age group have beenstudied after obtained of ethical committee permission. The dissection method was followed to obtain specimenof pancreas along with C-loop of duodenum, papillae were identified ad dye was injected into APD to see itspatency at MIP. 93.75% specimens present MIP. The prevalence of patency of APD at MIP in population understudy was 38.89%; this is more in males was 43.33%, when compared to the females was 30% but this differencewas not significant statistically. It observed that out of 35 patent APD cases, 33 cases had inter papillarydistance either 2cm or more than 2cm. I t indicates 94.29% of patent APD cases had inter-papillary distancee”2cm. So there is strong relationship between APD patency and inter papillary distance in population understudy. The means inter-papillary distance in patent APD cases was 2.29 ± 0.2cm and non-patent APD cases was1.85 ± 0.25 cm. This difference was statistically significant.
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Objective?To evaluate the application of guidewire-assisted biopsy and balloon dilatation cytology smear through ERCP in diagnosis of patients with hilar cholangiocarcinoma.?Methods?During the ERCP procedure, 52 patients with hilar cholangiocarcinoma were treated with balloon dilatation, and cytology smear from the surface of the balloon. At the same time, biopsy forceps assisted by guidewire inserted into the bile duct to biopsy the lesion and obtain specimens.?Results?Success rate of obtaining histopathological through ERCP guidewire assisted biopsy in biliary bile duct was 100.0%, 31 cases were histological diagnosed by forceps biopsy in 52 cases, positive diagnosis rate was 59.6%; The patient with balloon dilatation in 52 cases give cytology smears obtained diagnosis in 22 cases, the positive rate was 42.3%; cytology smear combined with biopsy, a total of 34 cases were diagnosed, the positive rate was 65.4%. There was no serious complications occurred.?Conclusion?Biopsy assisted by guidewire through ERCP is a safe, simple, easy technique and an effective means of obtaining pathological, meanwhile, the cytology smear after balloon dilatation can be used as a supplement to biopsy, and provides an effective means in pathological diagnosis of hilar cholangiocarcinoma.
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Objective To evaluate the curative value of the tauroursodeoxycholic acid (TUDCA) and Danning table (DN) in the prevention of bile duct stones recurrence after ERCP. Methods 210 patients with Choledocholithiasisby ERCP were randomly divided into 3 groups. The patients in the control group were not given any medicine. The patients in the TUDCA group took TUDCA every night. The patients in the DN group took Danning tablets of three times a day. The course of medication and followed up for the patients was 24 months after the operation. All the patients would be examined regularly by Biliary color doppler ultrasound and MRCP. The recurrence rates of Choledocholithiasis, cholesterol saturation index and serum lipid were recorded and compared statistically between the three groups. Results In total, 190 patients completed the treatment and follow-up according to the experimental design. The recurrence rates of the control, TUDCA and DN group were 17.46%(11/63), 6.34% (4/63) and 10.94% (7/64). The recurrence rates in the TUDCA and DN group were significantly lower than those the control group (P < 0.05).The recurrence rate in the TUDCA group was significantly lower than that in the DN group; On the tenth days after the operation, the CSI in the TUDCA were significantly lower than those the control group and the DN group (P < 0.05). There was no statistically significant difference between the DN group and the control group (P > 0.05); To the patients without recurrence, the level of TC, LDL in the TUDCA group were significantly lower than those the control group and and the DN group (P < 0.05). The level of HDL in the TUDCA group were significantly higher than those the control group and and the DN group (P < 0.05). There was no statistically significant difference on the level of HDL between the DN groupand the control group (P > 0.05). Conclusion The application of TUDCA and DN for patients with Choledocholithiasis after ERCP can effectively reduce the recurrence rates, the curative effect of TUDCA more than DN.
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Objective To compare the clinical curative effect of endoscopic retrograde cholangio-pancreatography (ERCP) and percutaneous transhepatic cholangial drainage (PTCD) in treatment of malignant obstructive jaundice. Methods Clinical data of 97 patients with malignant obstructive jaundice were collected and analyzed retrospectively, includs 54 patients in ERCP group and 43 patients in PTCD group. The clinical curative effect, postoperative complications, comfort score and hospitalization time and costs were compared between the two groups. Results The symptoms improved compared with preoperative. The total remission rate of jaundice in ERCP group and PTCD group was 77.78％ vs 79.07％, and the remission rate of high obstructive jaundice was 55.00％, vs 89.29％, and the remission rate of low obstruction jaundice was 91.18％, vs 60.00％.There was significant difference between the two groups (P < 0.05); The incidence of postoperative complications in ERCP group and PTCD group was 37.04％ vs 16.28％. There was significant difference between the two groups (P < 0.05); The comfort scale of ERCP group and PTCD group was (15.13 ± 3.89) points vs (16.60 ± 3.15) points. There was significant difference between the two groups (P < 0.05); The hospitalization time of ERCP group and PTCD group were (8.74 ± 4.94) days vs (11.12 ± 4.82) days, and the hospitalization costs were (22.70 ± 6.30) thousand yuan vs (21.90 ± 3.40) thousand yuan. Conclusion Satisfactory clinical curative effect for patients with malignant obstructive jaundice can be derived from both ERCP and PTCD. The treatment of ERCP has more advantages than PTCD in patients with low obstruction, while PTCD is better than ERCP in patients with high obstruction. But ERCP group is better than PTCD in comfort score and shorter in hospitalization time. There is no obvious difference on hospitalization costs.
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Objective To investigate the anesthetic effect and adverse events on different doses of oxyco-done combined with propofol target controlled infusion(TCI)in patients with choledocholithiasis undergoing endo-scopic retrograde cholangio pancreatography(ERCP)with endoscopic sphincterotomy(EST).Methods One hun-dred and twenty patients with choledocholithiasis underwent ERCP with EST in Department of Gastroenterology, Fuzhou General Hospital,from January,2016 to March,2017 were enrolled in this study.Patients were randomly divided into 4 groups(n=30 in each group)including the sufentanil control group(Group A),low dose of oxyco-done group(Group B),moderate dose of oxycodone group(Group C),and high dose of oxycodone group(Group D).Patients in Group A received 0.10 μg/kg intravenous sufentanil,and patients in Group B,C,and D received 0.08 mg/kg,0.10 mg/kg,and 0.12 mg/kg intravenous oxycodone,respectively,at 5 min before induction of gener-al anesthesia followed by propofol TCI. Effect of compartment concentration(Ce)of propofol,mean arterial pres-sure(MAP),and heart rate(HR)at the given time point when patients transferring to operation room(T0),after induction(T1),endoscope through throat(T2),and endoscope through major duodenal papilla(T3)were record-ed.The accumulative dose of propofol,duration of operation,and recovery time were also recorded.Intraoperative sever hypotension,bradycardia,respiratory depression,coughing and moving,and postoperative nausea and vom-iting were recorded. Results Propofol Ce at T1~T3as well as MAP and HR at T2and T3in Group B were signifi-cantly higher than those in Group A,C,and D,respectively(P < 0.05). The accumulative dose of propofol in Group B was more than that in Group A and C,while the accumulative dose of propofol in Group D was less than that in Group A,B,and C,respectively(P<0.01).Recovery time in Group D was longer than that in Group A, B,and C,respectively(P<0.05).Similar incidences of intraoperative sever hypotension,bradycardia,respiratory depression,coughing and moving,and postoperative nausea and vomiting were also observed. Conclusions 0.10 mg/kg intravenous oxycodone at 5 min before induction of general anesthesia combined with propofol TCI presents a favorable anesthetic effect in patients with choledocholithiasis undergoing ERCP with EST without a prolonged recovery time and the increased incidence of adverse events.
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Objective To evaluate the safety of anesthesia endoscopic retrograde cholangio pancreatography (ERCP) under general anesthesia.Methods From January 1st,2008 to June 30th,2016,patients underwent ERCP under general anesthesia were enrolled as anesthesia group and from January 1st,2005 to December 31st,2007,patients accepted ERCP without anesthesia were enrolled as control group.Chi-square test was performed to analyze disease composition,conditions during operation,success rate of operation and complications in these two groups.Results A total of 14 724 patients with ERCP under general anesthesia and 2 102 patients received ERCP without anesthesia were enrolled.In 14 724 patients with ERCP under general anesthesia,1 799 cases had malignant biliary and pancreatic diseases and 12 925 cases with biliary and pancreatic diseases.During the operation,transient hypoxemia occurred in 441 cases (3.00％) and relieved by increasing oxygen flow,lower anesthetic dose or lifting lower jaw.The success rate of ERCP in the anesthesia group (98.41 ％,14 490/14 724) was higher than that in the control group (97.34％,2 046/2 102),and the difference was statistically significant (x2 =11.500,P=0.001).The incidence rate of post-ERCP pancreatitis in the anesthesia group was 2.35％ (346/14 724),which was lower than that in the control group (3.85％,81/2 102),and the difference was statistically significant (x2 =16.813,P＜0.01).Conclusion ERCP under general anesthesia is safe,which could increase the success rate of operation and reduce the incidence rate of post-ERCP pancreatitis.
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Objective To study the combined used of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic surgery in the treatment of Mirizzi syndrome and in the prevention of bile duct injury in minimally invasive surgery.Methods A retrospective analysis was conducted on patients who suffered from Mirizzi syndrome treated with ERCP and laparoscopic surgery from March 2011 to February 2016 at the Center Hospital of Xianyang City,Southern Medical University.Results Of 1762 patients who underwent ERCP,56 patients were diagnosed to suffer from Mirizzi syndrome (3.2％).Thirty-six patients with type Ⅰ disease successfully completed LC.The adjacent tissues were used to repair the defects in the first stage for type Ⅱ disease in 12 patients and for type Ⅲ disease in 4 patients.T tube was not used.The bile was drained with a ENBD drainage tube.After LC,a bile duct to jejunum Roux-en-Y anastomosis was carried out for the type Ⅱ disease in 2 patients and for the type Ⅲ disease in 2 patients.There was no perioperative death for the whole group of patients.Two patients developed symptoms of cholangitis,and the disease was stable after non-operative treatment.For the other patients,follow-up for more than 2 years showed good results.Conclusions ERCP was useful in the diagnosis of Mirizzi syndrome and in the Csendes typing before operation.ENBD could be used as a guide to find the hepatic duct,thus avoiding bile duct injury during laparoscopic surgery and for the placement of T tube drainage.ERCP combined with laparoscopic surgery in the treatment of Mirizzi syndrome was safe and effective.It is an operation which has the advantage of minimal trauma,less pain and rapid recovery.
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Objective To study the combined used of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic surgery in the treatment of Mirizzi syndrome and in the prevention of bile duct injury in minimally invasive surgery.Methods A retrospective analysis was conducted on patients who suffered from Mirizzi syndrome treated with ERCP and laparoscopic surgery from March 2011 to February 2016 at the Center Hospital of Xianyang City,Southern Medical University.Results Of 1762 patients who underwent ERCP,56 patients were diagnosed to suffer from Mirizzi syndrome (3.2％).Thirty-six patients with type Ⅰ disease successfully completed LC.The adjacent tissues were used to repair the defects in the first stage for type Ⅱ disease in 12 patients and for type Ⅲ disease in 4 patients.T tube was not used.The bile was drained with a ENBD drainage tube.After LC,a bile duct to jejunum Roux-en-Y anastomosis was carried out for the type Ⅱ disease in 2 patients and for the type Ⅲ disease in 2 patients.There was no perioperative death for the whole group of patients.Two patients developed symptoms of cholangitis,and the disease was stable after non-operative treatment.For the other patients,follow-up for more than 2 years showed good results.Conclusions ERCP was useful in the diagnosis of Mirizzi syndrome and in the Csendes typing before operation.ENBD could be used as a guide to find the hepatic duct,thus avoiding bile duct injury during laparoscopic surgery and for the placement of T tube drainage.ERCP combined with laparoscopic surgery in the treatment of Mirizzi syndrome was safe and effective.It is an operation which has the advantage of minimal trauma,less pain and rapid recovery.
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Objective To determine the independent risk factors for postoperative nausea and vomiting (PONV) after endoscopic retrograde cholangio-pancreatography (ERCP) under total intravenous anesthesia.Methods Ninety patients,47 males and 43 females,aged 18 years old or more,falling into ASA physical status Ⅰ-Ⅲ,undergoing ERCP under total intravenous anesthesia from July 18,2016 to August 31,2016 in Ruijin Hospital were included in our study.General information and intraoperative situation of patients were collected.The incidence of PONV within 24 h was recorded.A multivariate Logistic regression model was performed to analyze the independent risk factors of PONV after ERCP under total intravenous anesthesia.Results In total,90 patients were included in this study,with 33 patients (36.7%) suffering PONV.Logistic analyses showed that female (OR=3.73,95%CI 1.36-10.27),history of PONV/motion sickness(OR=4.39,95%CI 1.40-13.76),and serum-amylase greater than 3 times the normal value (OR=5.22,95%CI 1.30-20.95) were the independent risk factors for PONV after ERCP under total intravenous anesthesia.Conclusion Female,history of PONV/motion sickness,and serum-amylase greater than 3 times the normal value were the independent risk factors for PONV after ERCP under total intravenous anesthesia.
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BACKGROUND/AIMS: Options for the endoscopic management of symptomatic pancreatic fluid collections (PFCs) include transmural drainage (TM) alone, transpapillary drainage (TP) alone, or a combination of both drainage method (CD). There have been conflicting reports about the best method. This study performed a meta-analysis to determine whether CD presents an added clinical benefit over TM. METHODS: The included studies compared TM with CD and reported clinical success for both methods. A random-effects model was used to determine the pooled odds ratios (ORs) and the 95% confidence intervals (CIs) for the following outcomes: technical success, clinical success, complications, and recurrence. RESULTS: Nine studies involving a combined total of 604 drainage procedures—373 TMs (62%) and 231 CDs (38%)—were included. CD showed no additional benefit over TM in terms of technical success (OR, 1.12; 95% CI, 0.37–3.37; p=0.85), clinical success (OR, 1.11; 95% CI, 0.65–1.89; p=0.70), recurrence (OR, 1.49; 95% CI, 0.53–4.21; p=0.45), or complications (OR, 1.15; 95% CI, 0.61–2.18; p=0.67). CONCLUSIONS: Pancreatic duct (PD) stenting provides no additional clinical benefit for the TM of PFCs (particularly pseudocysts). Patients undergoing the TM of symptomatic pseudocysts may not require endoscopic retrograde pancreatography (ERP).
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Humans , Drainage , Endoscopy , Methods , Odds Ratio , Pancreatic Ducts , Pancreatic Pseudocyst , Recurrence , StentsABSTRACT
Acalculus eosinophilic cholecystitis is a variant of chronic cholecystitis which is an inflammation of gall bladder. Here we presents a case of female child of 10 years age with features of abdominal pain for 6 months which after investigations found to be of an eosinophilic cholecystitis cuased by Ascaris lumricoides- a rare entity.
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Objective To investigate the causes, diagnosis and surgical treatment of ERCP related duodenal per﹣foration. Methods Clinical data of 6 cases of surgical treatment of ERCP related duodenal perforation were retro﹣spective analyzed. All the 6 perforation patients underwent emergency surgical procedure, including 3 cases trans﹣fered from other hospital after duodenal perforation. 4 cases with a history of abdominal surgery. Preoperative con﹣firmed bravery manager stone 4 cases, 1 case of obstructive jaundice after gallbladder surgery, bile duct expansion in 1 case. Results Perforation causes include duodenum mirror improper operation related in 2 cases, duodenal papilla sphincterotomy related 3 cases (1 case of pre-dissection operation with needle knife), small endoscopic sphincteroto﹣my combined with endoscopic papillary balloon dilation lead to perforation in 1 case.4 cases of intraoperative found right kidney week pneumatosis, 2 cases of postoperative CT found after peritoneal pneumatosis, effusion. All patients with surgery including common bile duct exploration, T tube drainage, duodenal perforation repair, jejunum colostomy, among them 2 cases at the same time line of gastrointestinal anastomosis. 5 cases recovered, 1 case died. Conclusions Inappropriate duodenal papilla sphincter incision indications and Many previous abdominal surgery have higher perforated ration;Found in time, reasonable treatment is the most important;For serious typeⅠand typeⅡperforation, active surgical treatment in time, can effectively reduce serious consequences caused by the ERCP related perforation.
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Objective To evaluate the clinical effect of ultrasound-guided percutaneous transhepatic cholangial drainage (PTCD) combined with endoscopic retrograde cholangio-pancreatography (ERCP) in treating malignant obstructive jaundice, and to discuss its technical points. Methods A total of ten cases with malignant biliary obstruction were enrolled in this study. After the failure of ERCP treatment, the patients had to be treated with ultrasound-guided PTCD immediately. The guide-wire was inserted into the duodenum through intrahepatic bile duct and common bile duct to connect with ERCP, which was followed by the biliary stent implantation or the removal of physical factors causing obstruction. The clinical results were analyzed. Results Technical success was obtained in all 10 cases. In the patients who underwent a successful guide-wire docking with ERCP the postoperative serum bilirubin was significantly decreased. The main complications were fever, elevation of amylase and transient bloody bile. Conclusion With the help of docking technique the combination use of ultrasound-guided PTCD and ERCP is a new tentative treatment for malignant obstructive jaundice after the failure of initial ERCP treatment. This technique carries promising value in clinical practice as it can significantly increase the success rate of ERCP.
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Objective To observe the clinical effects of external application of Chinese medicine ion introduction through acupiont in the prevention and treatment of hyperamylasemia and pancreatitis following endoscopic retrograde cholangio pancreatography (ERCP). Methods Three hundred subjects were divided into treatment group and control group randomly, and treated with routine therapy after surgery, moreover, treatment group was treated with external application of Chinese medicine ion introduction through acupiont. The incidence of hyperamylasemia and pancreatitis, the time of serum amylase returned to normal in patients with hyperamylasemia and pancreatitis was observed, and the abdominal pain after ERCP was scored. Results Excluding 17 cases according to the exclusion criteria, the treatment group included 142 cases and the control group included 141 cases. The hyperamylasemia and pancreatitis happened less frequently in the treatment group than in control group, but there was no significant difference (P>0.05). The time of serum amylase returned to normal in patients with pancreatitis was (4.25±0.95)d in treatment group and (5.28±1.11)d in control group, with no significant difference (P>0.05). The time of serum amylase returned to normal in patients with hyperamylasemia was (2.88 ± 0.78)d in treatment group and (3.81±1.62)d in control group, showed a significant difference (P<0.05). The score of abdominal pain was 0.95±1.04 in treatment group and 1.21±1.12 in control group, showed a significant difference (P<0.05). Conclusion External application of Chinese medicine ion introduction through acupoint can promote the recovery of the patients postoperative ERCP combined with hyperamylasemia or pancreatitis, and can better alleviate abdominal pain.
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Objective: The present paper is about the study of distance between minor and major duodenal papillae which was carried out on 30 cadaveric specimens of human duodeno-pancreas. With introduction of ERCP, the pattern of pancreatic ductal system visualization has attained popularity. Without the knowledge of the normal pattern of the duct system and its variations, a radiologist can’t interpret an Endoscopic Retrograde Cholangio-Pancreatography (ERCP) picture. So it becomes important to study the anatomy of pancreatic ducts, their relation to each other, to common bile duct and to duodenum in the available human cadavers. To visualise and to see distance between minor and major duodenal papillae is necessary for the endoscopist who aims to perform the dilation, stenting, or papillotomy of the minor papilla. ERCP is proved to be “first line” therapeutic tool in the management of surgical, medical and pathological disorders involving the biliary tree and pancreatic duct. Methods: The study was conducted in thirty (20 male and 10 female) cadavers. Major and minor duodenal papillae were visualized through eosin dye installation in both common bile duct and the accessory pancreatic duct. The measurement of distance between the duodenal papillae was done in cm. Results: In the present work, the distance measured between the major and minor duodenal papilla was on an average 1.93+0.61 cm. in females and in males it was 2.05+0.31 cm. Conclusion: The length of the duct shows sexual dimorphism; the length being more in males than females.
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Aim Large pancreatic ductal calculi and pain are a feature of chronic calcific pancreatitis (CCP) in the tropics. This large single center study evaluates the role of extracorporeal shock wave lithotripsy (ESWL) in fragmentation of large pancreatic stones and relief of pain in patients with CCP. Methods Patients with CCP presenting with pain and large pancreatic duct (PD) calculi (>5 mm diameter) not amenable to extraction at routine endoscopic retrograde cholangio pancreatography (ERCP) were taken up for ESWL using a 3rd generation lithotripter. Stones in the head and body of pancreas were targeted at ESWL; 5,000 shocks were given per session. The calculi were fragmented to <3 mm size and then cleared by endotherapy. Pancreatic duct stents were deployed when indicated. A total of 1,006 patients underwent ESWL. Complete clearance was achieved in 762 (76%), partial clearance in 173 (17%) and unsuccessful in the rest. More than 962 (90%) of patients needed less than three sessions of ESWL. At 6 months, 711 (84%) of 846 patients who returned for follow up had significant relief of pain with a decrease in analgesic use. Complications were mild and minimal. Conclusion ESWL is an effective and safe modality for fragmentation of large PD calculi in patients with CCP.
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Background: Magnetic resonance pancreatography (MRCP) is a safe noninvasive imaging technique that has proven to be accurate in the diagnosis of biliary tract diseases. Objective: To evaluate the role of MRCP in diagnosis of the anatomic variants of the biliary tree. Subjects and method: A retrospective study (from Augusts 2003 to April 2006, at Gia Dinh People Hospital) was conducted in 147 MRCP. All of anatomic variants of the biliary tract were classified. Results: MRCP had the sensitivity of 85.1%, the specificity of 92.1%, and the accuracy of 89.2%. Anatomic variants of the biliary tract included: type I (65%), type II (33.6%), type III (0%), type IV (1.4%). The anatomic variants of extrahepatic biliary tract that had high risk of damaged bile duct during laparoscopic cholecystectomy such as ectopic of right posterior hepatic duct (18.2%) and abnormal of junction of cystic duct and hepatic commune bile duct (2.9 - 44.6%). Conclusions: In this study, MRCP showed the modality of choices in the evaluation of hepatobiliary diseases and the anatomic variants of the biliary tree. MRCP helped the surgeons to avoid the injury of bile ducts during the operations.
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Biliary Tract/metabolism , PathologyABSTRACT
PURPOSE: This study was designed to delineate the anatomical details of the pancreatic head for a ventral or dorsal segmental pancreatic resection along the embryological fusion plane, and to determine the feasibility of both procedures. METHODS: The resected pancreaticoduodenectomy specimens were analyzed (n=8), with the pancreatic and distal common bile ducts visualized by pancreatography (n=8). Immunohistochemical staining, with pancreatic polypeptide (PP), was performed in serially sliced specimens (n=3). The immunohistochemical and H&E staining were performed to evaluate the composition of the anatomical structures of the two differentially stained pancreas. RESULTS: What was presumed to be the embryological fusion plane was discovered between two differentially stained segments. This started just above the anterior inferior pancreaticoduodenal artery, directed to the posterior superior part of the pancreatic head and ended at the anterior surface of the distal common bile duct. The duct of Wirsung and the distal common bile duct were included in the posterior segment of the pancreas (ventral pancreas). There were two types of pancreatic duct arrangement, with the differences between the two types being; (1) the distance between the fusion point of the ventral and dorsal pancreatic ducts and the papilla of Vater, and (2) the stream of the Santorini duct. The branches of the pancreatic ducts were scattered over the entire pancreatic head region in multiple-directions. CONCLUSION: The fusion plane of the ventral and dorsal pancreas seems to initiate just above the anterior inferior pancreaticoduodenal artery, in a posterior-superior direction along the anterior surface of the distal common bile duct. A ventral pancreatectomy seems an impractical procedure with regard to the postoperative morbidity and operative difficulty, while a dorsal pancreatectomy seems to be more practical and feasible in its clinical aspects.