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Liver transplantation has become an effective treatment for end-stage liver diseases. With rapid development of surgical techniques, donor selection, organ preservation and transportation, immunosuppressants and perioperative management, the overall incidence of complications after liver transplantation has been significantly decreased, whereas the incidence of biliary complications remains relatively high. At present, biliary complications after liver transplantation are still an important cause of graft failure. Nevertheless, the pathogenesis, diagnosis and treatment of biliary complications remain controversial, which are also research hotspots in the field of organ transplantation in recent years. In this article, new breakthrough and research progress upon biliary complications after orthotopic liver transplantation in adults were reviewed, aiming to provide theoretical basis for resolving biliary complications-related clinical issues.
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Objective To investigate the risk factors for bile leakage after hepatectomy without biliary reconstruction. Methods CNKI, Wanfang Data, VIP, PubMed, Embase, Web of Science, and The Cochrane Library were searched for English and Chinese study reports on the risk factors for bile leakage after hepatectomy without biliary reconstruction published up to April 2021. The method of Cochrane systematic review was used for literature screening and data extraction, and Newcastle-Ottawa Scale was used for quality assessment. RevMan 5.4 software was used to perform a meta-analysis of the extracted data. Results A total of 16 articles (13 in English and 3 in Chinese) were included in this study, with a total of 16036 cases. The meta-analysis showed that sex (odds ratio [ OR ]=1.27, 95% CI : 1.09-1.48, P =0.003), diabetes ( OR =1.23, 95% CI : 1.07-1.41, P =0.003), past history of liver surgery ( OR =2.50, 95% CI : 1.74-3.59, P < 0.001), anatomic hepatectomy ( OR =1.58, 95% CI : 1.09-2.30, P =0.02), segment I hepatectomy ( OR =2.56, 95% CI : 1.50-4.40, P < 0.001), central hepatectomy (S4, S5, S8) ( OR =3.51, 95% CI : 2.80-4.40, P < 0.001), left third hepatectomy ( OR =3.53, 95% CI : 2.32-5.36, P < 0.001), and intraoperative blood transfusion ( OR =2.64, 95% CI : 1.93-3.60, P < 0.001) were the risk factors for bile leakage after hepatectomy. Liver cirrhosis, preoperative liver function grade, preoperative chemotherapy, and left/right hemihepatectomy were not the risk factors for bile leakage. Conclusion There are complex influencing factors for bile leakage after hepatectomy, and in addition to the patient's own factors such as sex, diabetes, and past history of liver surgery, intraoperative factors, such as surgical procedures, extent of hepatectomy, and intraoperative blood transfusion, are also risk factors for bile leakage after hepatectomy. The surgeon should conduct adequate preoperative assessment and perform careful operation during surgery to reduce the incidence rate of postoperative bile leakage.
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Objective:To evaluate clinical characteristics and treatment of postoperative anastomotic stricture in pediatric congenital biliary dilatation patients.Methods:The clinical data of 24 children with postoperative anastomotic stricture from Apr 2012 to Oct 2019 in Beijing Children's Hospital was retrospectively analyzed.Results:There were 6 males and 18 females. Patients were divided into bile- leak group (BL, n=6) and non bile-leak group (NBL, n=18) based on whether there was anastomotic leakage after primary surgery. The main symptoms in BL group was persistent obstructive jaundice, and recurrent cholangitis in NBL group. Postoperative symptoms were first shown in an average of 7.0 months in BL group, compared to 59.0 months in NBL group, P<0.05. In BL group, 4 underwent redoing hepaticojejunostomy, 2 underwent anastomosis plasty. In NBL group, 3 underwent redoing hepaticojejunostomy, 15 did anastomosis plasty with multiple biliary stones found necessitating extraction. After reoperation, one patient had bile leakage, 2 patients had recurrent cholangitis within one-month, 21 patients had uneventful recovery. Five were found to have biliary stones in long-term follow-up. Conclusions:Biliary-enteric anastomotic leakage can cause stricture in postoperative patients of congenital biliary dilatation ,reoperation is necessary in symptomatic patients.
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Objective:To evaluate the clinical application efficacy of four-stitch cholangiojejunostomy.Methods:Of 38 patients who received four-needle biliary and enterointestinal anastomosis in the Department of Hepatobiliary Surgery, Yuebei People's Hospital Affiliated to Shantou University Medical College from November 2016 to April 2020 were included, and the diseases, surgical methods and postoperative complications of four-needle biliary and enterointestinal anastomosis were analyzed.Results:There were 26 males and 12 females with an average of 57.3(44-77) years. Among 38 patients, there were 12 hilar cholangiocarcinoma patients, 10 pancreatic head cancer, 9 duodenal papillary cancer, 4 intrahepatic and extrahepatic bile duct stones, 1 pancreatic cystic adenoma, 1 gastric cancer invading pancreatic head and 1 gallbladder carcinoma. The procedure included pancreatoduodenectomy in 20, radical resection of hilar cholangiocarcinoma in 12, hepatectomy with biliary-enteric anastomosis in 4, radical resection of gastric cancer combined with pancreaticoduodenectomy in 1, radical resection of gallbladder carcinoma in 1. One, two and three ductal openings were anastomosed in 27, 7 and 4 patients, respectively. 10 patients have bile duct diameter <6 mm. Postoperative anastomotic leakage occurred in 1, and all patients were received followed-up visit for 2 months to 4 years without anastomotic stenosis.Conclusion:Four-stitch cholangiojejunostomy is simple, safe, effective, and convenient for small biliary ductal surgeries.
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Objective To analyze the clinical characteristics, pathogenic causes and therapeutic experience of right diaphragmatic hernia after pediatric living donor liver transplantation. Methods Clinical data of 3 recipients with right diaphragmatic hernia after pediatric living donor liver transplantation were retrospectively analyzed. The clinical characteristics, diagnosis and treatment process and therapeutic experience were analyzed and summarized. Results The primary diseases of 3 children with diaphragmatic hernia after living donor liver transplantation were biliary atresia. The diaphragmatic hernia occurred at 4-6 months after liver transplantation. The contents of diaphragmatic hernia included the intraperitoneal and interperitoneal tissues and organs. Diaphragmatic defects were all located in the posterior medial area of the right diaphragm. The primary stage intermittently suturing repair was performed during intraoperative period. No diaphragmatic hernia recurred during long-term follow-up. Conclusions The clinical manifestations of right diaphragmatic hernia after pediatric living donor liver transplantation are diverse. The risk factors include malnutrition, low body weight, surgical trauma, chemical erosion caused by bile leakage, focal infection and pleural-peritoneal pressure gradient, etc. Surgical intervention is the preferred treatment strategy for diaphragmatic hernia after liver transplantation.
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Objective@#To study hemihepatectomy combined with a circular-stretching suturing technique in bile duct anastomosis in treatment of high level bile duct injuries (BDI).@*Methods@#From January 2000 to January 2018, eleven patients with high level BDI caused by laparoscopic cholecystectomy (LC) were treated in Mianyang Central Hospital with hemihepatectomy combined with a circular-stretching suturing technique in the bile duct anastomosis. The hilar confluence was involved in all these patients. A total of six patients had combined right hepatic artery injury with 1 having associated right portal vein injury. A total of five patients had developed right liver atrophy. The median time interval from LC to hepatectomy was 17.0(2.0~61.0) months. The number of previously attempted biliary repairs was 1~4 times (median 2 times). The bile duct anastomosis was performed by the circular-stretching suturing technique.@*Results@#There was no perioperative death. One patient underwent left hemihepatectomy and 10 patients right hemihepatectomy. Roux-en-Y hepaticojejunostomy was carried out in 9 patients, and bile duct end-to-end anastomosis in 2 patients. The operation time was (245.9±87.4) min, intraoperative blood loss (655.7±413.6) ml, and the median postoperative hospital stay 12.0(7.0~29.0) days. Five patients developed complications. The median follow-up was 47.0(15.0~89.0) months. One patient developed anastomotic stenosis and 1 patient had cholangitis. The remaining 9 patients were well.@*Conclusion@#After adequate preoperative preparation, patients who were treated with hemihepatectomy combined with the circular-stretching suturing technique for bile duct anastomosis to treat high level BDI achieved good results.
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Objective@#To summarized the experience in laparoscopic duodenum-preserving pancreatic head resection (LDPPHR).@*Methods@#The clinical data of four patients who underwent LDPPHR from February 2017 to June 2018 in Hunan Provincial People’s Hospital were retrospectively analyzed. The Clinical characteristics, operation time, intraoperative blood loss, biliary fistula rate, pancreatic fistula rate and follow-up data were analyzed.@*Results@#The four patients included one patient with a solid pseudopapillary tumor and three patients with a serous cystadenoma. Two patients underwent duodenum-preserving total pancreatic head resection, and two patients underwent duodenum-preserving subtotal pancreatic head resection. The operation time of the four patients was (525.8±121.8) minutes, and the blood loss (250.0±191.5) ml. Biliary duct drainage was carried out in 2 patients: one patient developed biochemical bile leakage, while another had no postoperative complication. The two patients without biliary drainage developed grade B pancreatic leakage, delayed bile leakage, abdominal bleeding and infection. All the three patients who developed postoperative complications were treated conservatively and they recovered well.@*Conclusions@#LDPPHR was designed to better preserve the integrity and function of digestive tract. However, the perioperative complications were high. This operation should only be carried out in large pancreatic centers. Routine biliary drainage is recommended to surgeons with little experience in this operation.
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Objective To summarized the experience in laparoscopic duodenum-preserving pancreatic head resection ( LDPPHR ) . Methods The clinical data of four patients who underwent LDPPHR from February 2017 to June 2018 in Hunan Provincial People' s Hospital were retrospectively analyzed. The Clinical characteristics, operation time, intraoperative blood loss, biliary fistula rate, pancreatic fistula rate and follow-up data were analyzed. Results The four patients included one patient with a solid pseudopapillary tumor and three patients with a serous cystadenoma. Two patients underwent duodenum-preserving total pancreatic head resection, and two patients underwent duodenum-preserving subtotal pancreatic head resection. The operation time of the four patients was (525. 8 ± 121. 8) minutes, and the blood loss (250. 0 ± 191. 5) ml. Biliary duct drainage was carried out in 2 patients: one patient developed biochemical bile leakage, while another had no postoperative complication. The two patients without biliary drainage developed grade B pancreatic leakage, delayed bile leakage, abdominal bleeding and infection. All the three patients who developed postoperative complications were treated conservatively and they recovered well. Conclusions LDPPHR was designed to better preserve the integrity and function of digestive tract. However, the perioperative complications were high. This operation should only be carried out in large pancreatic centers. Routine biliary drainage is recommended to surgeons with little experience in this operation.
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Objective To study hemihepatectomy combined with a circular-stretching suturing technique in bile duct anastomosis in treatment of high level bile duct injuries (BDI).Methods From January 2000 to January 2018,eleven patients with high level BDI caused by laparoscopic cholecystectomy (LC) were treated in Mianyang Central Hospital with hemihepatectomy combined with a circular-stretching suturing technique in the bile duct anastomosis.The hilar confluence was involved in all these patients.A total of six patients had combined right hepatic artery injury with 1 having associated right portal vein injury.A total of five patients had developed right liver atrophy.The median time interval from LC to hepatectomy was 17.0 (2.0 ～ 61.0) months.The number of previously attempted biliary repairs was 1 ～ 4 times (median 2 times).The bile duct anastomosis was performed by the circular-stretching suturing technique.Results There was no perioperative death.One patient underwent left hemihepatectomy and 10 patients right hemihepatectomy.Roux-en-Y hepaticojejunostomy was carried out in 9 patients,and bile duct end-to-end anastomosis in 2 patients.The operation time was (245.9 ± 87.4) min,intraoperative blood loss (655.7 ±413.6) ml,and the median postoperative hospital stay 12.0(7.0 ～29.0) days.Five patients developed complications.The median follow-up was 47.0(15.0 ～ 89.0) months.One patient developed anastomotic stenosis and 1 patient had cholangitis.The remaining 9 patients were well.Conclusion After adequate preoperative preparation,patients who were treated with hemihepatectomy combined with the circularstretching suturing technique for bile duct anastomosis to treat high level BDI achieved good results.
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OBJECTIVE: To investigate the curative effect of choledchojejunostomy combined with T-tube drainage on patients with hepatolithiasis.METHODS: The clinical data of 95 patients with hepatolithiasis electivly undergoing choledchojejunostomy from January 2014 to July 2018 in the First Affiliated Hospital,Anhui Medical University were retrospectively analyzed.According to the operation methods,the patients were divided into two groups:choledchojejunostomy group and choledchojejunostomy group with T-tube drainage group.The short-term and longterm clinical efficacy of T tube external drainage were analyzed.RESULTS: Among 95 cases of hepatolithiasis,71 cases were treated with choledchojejunostomy and 24 cases were treated with choledchojejunostomy combined with T tube drainage.There was no significant difference in incision infection,hemorrhage and hepatic insufficiency between the two groups(P>0.05).The incidence of bile leakage in the choledchojejunostomy group was significantly higher than that in the choledchojejunostomy with T tube drainage group(P0.05).CONCLUSION: Choledochojejunostomy plus T-tube drainage can effectively reduce the incidence of bile leakage in patients with hepatolithiasis who can not remove all the stones during operation,and improve the stone clearance rate.
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OBJECTIVE: To explore therapeutic strategies of type Ⅲa hepatolithiasis. METHODS: The clinical data of 86 patients with type Ⅲ a hepatolithiasis admitted from July 2014 to December 2017 in Department of Hepatobiliary Surgery, the First Affiliated Hospital of Guangxi University of Chinese Medicine were retrospectively analyzed. Patients without liver resection were included. Variables including residual stones,times of choledochoscopy performing,stone clearance rate and recurrence rate were observed. RESULTS: There was a total of 23 patients with biliary strictures and 2 cases of bile leakage after operation,83 patients(96.5%) residual stones after Initial treatment. About six weeks after surgery,the choledochoscopy was performed via T tube sinus or subcutaneous blind loop. The median lithotomy times was 3. There were 4 cases of residual small stones,and stone clearance rate was 95.4%. Median follow-up time was 24 months. 6 patients(7.0%) had recurrent intrahepatic bile duct stones,and the proficiency was 93.0%(80/86). 6 patients(7.0%) had sporadic cholangitis. CONCLUSION: It is safe and feasible to correct the stricture and remove the stones through the combination of biliary surgery and choledochoscope for type Ⅲa hepatolithiasis. The short-term outcomes are satisfactory.
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Objective To investigate the clinical value of methylene blue test detecting intraoperative surgical wounds in prevention of the bile leakage after excision of internal capsule combined with external capsular subtotal resection of hepatic cystic echinococcosis.Methods The retrospective cohort study was conducted.The clinical data of 128 patients who underwent excision of internal capsule combined with external capsular subtotal resection of hepatic cystic echinococcosis in the Xilin Gol League Hospital of Inner Mongolia Autonomous Region between December 2008 and June 2016 were collected.Sixty-eight patients in the later stage (between May 2011 and June 2016) whose surgical wounds were detected using methylene blue test for preventing postoperative bile leakage were allocated into the study group,and 68 in the early stage (between December 2008 and April 2011)whose surgical wounds were not detected using methylene blue test were allocated into the control group.After cholecystectomy,catheters of patients in the study group were inserted into common bile duct for blocking the distal common bile duct via stump of cystic duct,and mehylene blue dilutions were injected into common bile duct via catheters,observing and judging whether or not there were blue dyes of residual cavity and bile leakage.Patients in the control group used dry gauze to wipe residual external capsular wall,and judging whether or not there was bile leakage.Observation indicators:(1) surgical and postoperative recovery situations;(2) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative patients'survival and recurrence of hepatic cystic echinococcosis up to June 2017.Measurement data with normal distribution were represented as-x±s.The comparisons between groups were evaluated with the t test,and the count data were analyzed using the chi-square test.Results (1) Surgical and postoperative recovery situations:all patients between groups underwent successful surgery,without perioperative death.Dominant and recessive bile leakages were detected in 30,34 patients in the study group and 15,10 patients in the control group,respectively.Operation time,volume of intraoperative blood loss,time of postoperative gastrointestinal function recovery,time of postoperative drainage-tube removal,cases with postoperative bile leakage and duration of postoperative hospital stay were respectively (191±37)minutes,(156±20) mL,(2.8±1.5) days,(6.4±2.5) days,8,(10.3±2.5)days in the study group and (137±22) minutes,(115±11)mL,(2.2±1.2)days,(9.5±3.9)days,22,(13.5±3.8)days in the control group,with statistically significant differences between groups (t =9.944,14.540,2.477,-5.415,x2 =11.015,t =-5.689,P＜0.05).Number of patients with postoperative incision liquefaction and infection,residual cavity abscess and jaundice were respectively 5,2,0,0 in the study group and 6,3,1,1 in the control group,with no statistically significant difference between groups (x2 =0.284,0.360,1.142,1.142,P＞0.05).Patients with postoperative bile leakage received sufficient drainage,patients with postoperative incision liquefaction and infection received drainage and changing dressing,patients with residual cavity abscess received tube placement by reoperation and sufficient drainage and patients with jaundice received liver-and cholagogic-protective treatments.All the patients with complications were improved.(2) Follow-up:120 of 128 patients were followed up for 6-36 months,including 66 in the study gorup and 54 in the control group,with a median time of 24 months.During the follow-up,all patients were survived;3 patients had recurrence of hepatic cystic echinococcosis,including 2 undergoing reoperation and 1 undergoing albendazole treatment.Conclusion Methylene blue test detecting intraoperative surgical wounds has better clinical value in prevention of the bile leakage after excision of internal capsule combined with external capsular subtotal resection of hepatic cystic echinococcosis.
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Objective To explore the risk factors of bile leakage in patients with laparoscopic common bile duct exploration and primary suture for the purpose of providing clues for reducing occurrence of bile leakage.Methods The clinic data of 193 choledocholithiasis patients with laparoscopic common bile duct exploration and primary suture from October 2012 to March 2017 were retrospective analysed.All patients were divided into bile leakage group (23 patients) and non-bile leakage group (170 patients).Risk factors influencing the incidence of bile leakage were determined by analyzing 21 relevant factors with one-way analysis of variance and Logistic multivariate regression analysis.Count data and ordinal data was expressed as frequency or a percentage.Chi-square test was used to compare with groups of count data,rank-sum test was for comparison between groups of ordinal data,and Logistic regression was for multivariate analysis.Results Among all the patients,the incidence of bile leakage was 11.92％ (23/193).The results of univariate analysis revealed that cholangitis,jaundice,bile characteristics,muddy stone,number of stones,incarcerated stone,open and close peristalsis of duodenal papilla were correlated with bile leakage (x2/Z =2.537,2.122,81.834,50.709,13.242,26.958,90.207,P ＜0.05).The result of multivariate analysis revealed that bile characteristics,muddy stone,incarcerated stone,open and close peristalsis of duodenal papilla was correlated with bile leakage (Wals =14.002,8.899,6.577,5.582,P ＜0.05).Conclusion Bile characteristics,muddy stone,incarcerated stone,open and close peristalsis of duodenal papilla were main risk factors of bile leakage in patients with laparoscopic common bile duct exploration and primary suture.
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BACKGROUND/AIMS: Despite improvements in surgical techniques and postoperative patient care, bile leakage can occur after hepatobiliary surgery and may lead to serious complications. The aim of this retrospective study was to evaluate the efficacy of endoscopic treatment of bile leakage after hepatobiliary surgery. METHODS: The medical records of 20 patients who underwent endoscopic retrograde cholangiopancreatography because of bile leakage after hepatobiliary surgery from August 2009 to September 2014 were reviewed retrospectively. Endoscopic treatment included insertion of an endoscopic retrograde biliary drainage stent after endoscopic sphincterotomy. RESULTS: Most cases of bile leakage presented as percutaneous bile drainage through a Jackson-Pratt bag (75%), followed by abdominal pain (20%). The sites of bile leaks were the cystic duct stump in 10 patients, intrahepatic ducts in five, liver beds in three, common hepatic duct in one, and common bile duct in one. Of the three cases of bile leakage combined with bile duct stricture, one patient had severe bile duct obstruction, and the others had mild strictures. Five cases of bile leakage also exhibited common bile duct stones. Concerning endoscopic modalities, endoscopic therapy for bile leakage was successful in 19 patients (95%). One patient experienced endoscopic failure because of an operation-induced bile duct deformity. One patient developed guidewire-induced microperforation during cannulation, which recovered with conservative treatment. One patient developed recurrent bile leakage, which required additional biliary stenting with sphincterotomy. CONCLUSIONS: The endoscopic approach should be considered a first-line modality for the diagnosis and treatment of bile leakage after hepatobiliary surgery.
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Humans , Abdominal Pain , Bile Ducts , Bile , Catheterization , Cholangiopancreatography, Endoscopic Retrograde , Cholestasis , Common Bile Duct , Congenital Abnormalities , Constriction, Pathologic , Cystic Duct , Diagnosis , Drainage , Hepatic Duct, Common , Liver , Medical Records , Patient Care , Retrospective Studies , Sphincterotomy, Endoscopic , StentsABSTRACT
Objective To investigate bile leakage prevention in laparoscopic common bile duct (CBD) choledochoscopic exploration through micro-incision approach at the cystic duct-CBD junction.Methods From August 2007 to February 2015,a total of 147 cases undergoing laparoscopic CBD choledochoscopic exploration through micro-incision approach at the cystic duct-CBD junction were included in this study.From August 2007 to November 2012,57 patients were treated with laparoseopic CBD exploration (control group).From November 2012 to February 2015,90 patients were with optimized suture method of CBD (study group).The outcomes of patients in two groups were compared,including procedure time (PT),postoperative hospitalization time (PHT),and postoperative complications.Results In control group,the bile leakage rate was 5.3％,compared to 1.1％ in study group.There were significant differences in postoperative hospitalization time(t =1.98,P =0.0007) and hile leakage rate (x2 =139.5,P =0.04)between the two groups.Conclusions The prophylaxis measurements during operation are important to prevent bile leakage in laparoscopic CBD choledochoscopic exploration through micro-incision approach,including strict indications for micro-incision operation,proper expertise for laparoscopic cholecystectomy and laparoscopic suturing,choledochoscopic exploration,and suturing the whole layer of CBD wall,and carefully checking the suturing spot in case of bile leakage.T-tube placement is recommended while bile leakage is suspected.
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Objective To summarize the experience in diagnosis and treatment of donor bile leakage after living donor liver transplantation. Methods Clinical data of 95 donors underwent living donor liver transplantation were retrospectively analyzed.Postoperative complications of bile leakage were observed,and clinical performance,treatment methods and therapeutic effects were analyzed. Results Bile leakage occurred in 9 donors of 95 donors with liver transplantation,and the incidence was 9%.The location of donor liver was left lateral lobe in 9 cases with bile leakage,all of which were delayed bile leakage of liver section.The clinical performance showed no typical bile peritonitis with increased serum bilirubin.All patients were cured after treatment of percutaneous puncture drainage or drainage tube retention,and there were no cases underwent second operation and death cases. Conclusions Changes in donor liver function and hepatic artery hemodynamics shall be monitored after living donor liver transplantation,and the donors with bile leakage shall be treated actively and will achieve favorable prognosis.
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Objective To explore the reasons and preventive measures for the postoperative complications of hilar cholangiocarcinoma.Methods The clinical features,diagnosis,surgical therapy,postoperative complications and follow-up result were retrospectively analyzed on 89 cases of hilar cholangiocarcinoma admitted into our hospital from January 2008 to September 2014.Surgical approach:47 cases of radical resection including hepatoduodenal ligament skeletonized resection in 18 cases; concurrent partial hepatectomy in 29 cases,palliative resection in 17 cases,biliary tract drainage in 25 cases.There were 6 cases receiving partial portal vein resection and reconstruction.Results Among 89 patients there were 93 postoperative complications.Biliary complications developed in 22 cases (24.7％,22/89) including bile leakage in 13 cases (14.6％),biliary tract infection in 7 cases,anastomotic stricture in 2 cases.Wound infection in 19 cases,lung infection in 4 cases,ascites in 31 cases,pleural effusion in 10 cases,liver abscess in 1 case,intraabdominal bleeding in 2 cases,postoperative gastrointestinal bleeding,intestinal fistula,liver failure and multiple organ failure (MODS) developed in one each cases.One case died of MODS with the mortality of 1.1％.Conclusions Postoperative complications were common in hilar cholangiocarcinoma combined liver resection and/or vascular resection and reconstruction.Bile leakage is the most frequently seen necessitating long term proper drainage.
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Objeetive To analyze the causes and to explore prevention and management of bile leakage after laparoscopic common bile duct exploration with choledochoscopy followed by primary suturing of choledochal incision.Methods The clinical data of 52 patients with bile leakage after laparoscopic common bile duct exploration choledochoscopy and primary suturing of choledochal incision carried out for choledocholithiasis between June 2011 to June 2013 were retrospectively studied.Results All the 52 patients successfully underwent the laparoscopic surgery and left hospital.The operation time was (101 ± 26) minutes (range 55～ 145 minutes).The intraoperative blood loss was (36±28) ml (range 10～ 100 ml).All the patients were ambulatory after the first postoperative day.The recovery time of postoperative gastrointestinal function was (49.8 ± 12.5) hours (range 37 ～ 74 h).The total hospitalization time was (10.8 ± 2.5) days (range 7 ～ 15 days).The average hospitalization days after surgery was (5.7 ± 1.7) days.The average hospitalization cost was (24 827 ± 3 776) yuan.There were two patients who developed intraoperative bile leakage which was treated with further suturing.Five patients developed postoperative bile leakage and they were cured after unobstructed drainage for 5 days through conservative treatment.After a follow-up of 1 ～ 2years,there was no recurrent lithiasis.The stone clearance rate was 100％.There was no bile duct stricture or other complications.Conclusion In expert hands and with proper selection of patients,laparoscopic common bile duct exploration,choledochoscopy and primary suturing of choledochal incision were safe,effective and feasible for choledocholithiasis.
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BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) can be an effective treatment for bile leakage after liver transplantation. We evaluated the efficacy of endoscopic treatment in liver transplantation in patients who developed bile leaks. METHODS: Forty-two patients who developed bile leaks after liver transplantation were included in the study. If a bile leak was observed on ERCP, a sphincterotomy was performed, and a nasobiliary catheter was then inserted. If a bile leak was accompanied by a bile duct stricture, either the stricture was dilated with balloons, followed by nasobiliary catheter insertion across the bile duct stricture, or endoscopic retrograde biliary drainage was performed. RESULTS: In the bile leakage alone group (22 patients), endoscopic treatment was technically successful in 19 (86.4%) and clinically successful in 17 (77.3%) cases. Among the 20 patients with bile leaks with bile duct strictures, endoscopic treatment was technically successful in 13 (65.0%) and clinically successful in 10 (50.0%) cases. Among the 42 patients who underwent ERCP, technical success was achieved in 32 (76.2%) cases and clinical success was achieved in 27 (64.3%) cases. CONCLUSIONS: ERCP is an effective and safe therapeutic modality for bile leaks after liver transplantation. ERCP should be considered as an initial therapeutic modality in post-liver transplantation patients.
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Adult , Female , Humans , Male , Middle Aged , Young Adult , Anastomotic Leak/etiology , Bile , Biliary Tract Diseases/etiology , Cholangiopancreatography, Endoscopic Retrograde/methods , Constriction, Pathologic/therapy , Drainage , Liver Transplantation , Stents , Treatment OutcomeABSTRACT
BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) can be an effective treatment for bile leakage after liver transplantation. We evaluated the efficacy of endoscopic treatment in liver transplantation in patients who developed bile leaks. METHODS: Forty-two patients who developed bile leaks after liver transplantation were included in the study. If a bile leak was observed on ERCP, a sphincterotomy was performed, and a nasobiliary catheter was then inserted. If a bile leak was accompanied by a bile duct stricture, either the stricture was dilated with balloons, followed by nasobiliary catheter insertion across the bile duct stricture, or endoscopic retrograde biliary drainage was performed. RESULTS: In the bile leakage alone group (22 patients), endoscopic treatment was technically successful in 19 (86.4%) and clinically successful in 17 (77.3%) cases. Among the 20 patients with bile leaks with bile duct strictures, endoscopic treatment was technically successful in 13 (65.0%) and clinically successful in 10 (50.0%) cases. Among the 42 patients who underwent ERCP, technical success was achieved in 32 (76.2%) cases and clinical success was achieved in 27 (64.3%) cases. CONCLUSIONS: ERCP is an effective and safe therapeutic modality for bile leaks after liver transplantation. ERCP should be considered as an initial therapeutic modality in post-liver transplantation patients.