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Objective:To investigate the "V" -shaped anatomical approach in the prevention of bile duct injury during laparoscopic complex cholecystectomy and its clinical application value.Methods:The patients with complex gallbladder from June 2020 to June 2021 in the First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology were selected as the research objects, and they were randomly divided into observation group and control group, with 60 cases in each group. All patients underwent laparoscopic cholecystectomy. The observation group underwent laparoscopic cholecystectomy through the triangle "V" shape of the gallbladder, and the control group did not use the "V" shape anatomy. The operation status, complications and postoperative recovery of the two groups of patients were compared.The measurement data of normal distribution were expressed by ( Mean± SD), and t test was used for comparison between groups, and chi-square test was used for comparison between groups of count data. Results:The conversion rate to laparotomy, intraoperative bleeding and operation time of observation group were 3.33%, (97.31±13.27) mL, (65.27±13.82) min, which were significantly lower than those in the control group[8.33%, (111.27±25.18) mL, (81.35±12.12) min], the differences between the two groups were statistically significant( P<0.05). The incidence of biliary injury, total incidence of complications of the observation group were 0, 8.33%, which were significantly lower than those in the control group(6.67%, 28.33%), the differences between the two groups were statistically significant( P<0.05). The postoperative exhaust time, drainage tube retention time, hospitalization cost and hospitalization time of the observation group were (9.89±3.58) h, (32.58±5.17) h, (3 142.92±137.93) yuan, (4.73±1.42) d, and significantly lower than those in the control group [(11.65±2.45) h, (46.18±6.49) h, (3 424.29±156.34) yuan, (5.38±1.25) d], the differences between the two groups were statistically significant ( P<0.05). Conclusions:For laparoscopic complex cholecystectomy, the use of the triangular "V" -shaped gallbladder anatomical approach is more conducive to the operation, can reduce the patient's operation time and intraoperative blood loss, reduce the rate of intraoperative conversion to laparotomy, and reduce biliary tract injury and bile leakage. Such as the incidence of complications, prompting patients to recover as soon as possible, it is worthy of clinical application and promotion.
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In order to facilitate the treatment strategies for biliary tract injury, hilar cholangiocarcinoma, bile duct tumor thrombus, cholangiocellular carcinoma and bile duct cystic dilatation, many classifications have been made, even more than 10 types for one disease. Each type is represented by numbers or English alphabet, which are not only confusing but also difficult to remember. The Academician Mengchao Wu divided the liver into five sections and four segments base on its anatomy, this classification is very direct and visual, thus had been using till now. In order to overcome those complicated problems, it is considered to develop a new classification based on actual anatomic location similar to that for liver cancer, which is easy to remember and to directly determine the treatment strategy. All kinds of classifications have their own characteristics and advantages and disadvantages. This practical classifications avoid the complexity and may be useful for clinicians.
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Introducción: en ocasiones es necesario culminar una colecistectomía laparoscópica por la vía convencional, esta estrategia se conoce como conversión. Objetivo: determinar y cuantificar la influencia de diferentes factores que condicionan la conversión durante la colecistectomía laparoscópica. Método: durante 2000 a 2010, se realizó una investigación transversal en una población de 22 pacientes tratados con colecistectomía en los que fue necesario convertir la intervención vía laparoscópica en cirugía abierta. Se determinó y cuantificó la influencia de diferentes variables en la conversión; basados en la estimación del Odds Ratio (OR), se obtuvo estimaciones puntuales y por intervalo de confianza (del 95 %) del OR. Resultados: en las intervenciones urgentes se produjeron cinco conversiones para el 6,02 %, este porcentaje fue inferior en las electivas (0,42 %); el valor general para toda la población estudiada fue de 0,53 %. La lesión de la vía biliar principal con ocho casos, al igual que la colecistitis aguda fueron las principales causas de conversión. Los pacientes convertidos por cirujanos con menos de 200 intervenciones fueron 9 (1,8 %). De los pacientes intervenidos por cirujanos con más de 200 intervenciones se convirtieron 13 (1,6 %). Conclusiones: el índice de conversiones presentó un descenso considerable con el transcurso de los años. Las condiciones locales desfavorables incrementaron el riesgo de conversiones. La experiencia del cirujano en más de 200 intervenciones redujo considerablemente las posibilidades de conversión, así como, el índice de lesiones sobre la vía biliar principal.
Introduction: sometimes it is necessary to complete a laparoscopic cholecystectomy by the conventional way, this approach is known as conversion. Objective: to identify and quantify the influence of different factors affecting the conversion during laparoscopic cholecystectomy. Methods: a cross-sectional study was carried out during 2000-2010 in a population of 22 patients that underwent cholecystectomy in which the intervention was necessary to modify to open surgery. The influence of different variables in the conversion was determined and quantified; based on the estimated odds ratio (OR) point estimations and confidence intervals (95%) of the OR were obtained. Results: five conversions were done in the urgent interventions (6.02 %), this percentage is lower in elective ones (0.42 %), the overall value for the whole study population was 0.53 %. Injuries of the main biliary tract in eight cases as well as acute cholecystitis were the main causes of conversion. There were nine patients (1.8 %) that underwent conversions with less than 200 interventions. Patients converted by surgeons with less than 200 interventions were 9. Of the patients operated on with more than 200 interventions 13 (1.6 %) of then underwent conversion. Conclusions: conversion rate showed a significant decrease over the years, unfavorable local conditions increased the risk of conversions. The surgeon's experience in over 200 interventions significantly reduced the conversion possibilities as well as the rates of lesions.
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Objective To study the feasibility and morphological characteristics of wide caliber of local biliary tract constructed by increasing pressure of local bile duct in a short period of time.Methods Twelve mongrel dogs were randomized into 2 groups.In group A,only inlaid bile duct dilator(IBDD)was placed for biliary drainage in common bile duct.In group B,IBDD was placed in tommort bile duct for biliary drainage and dilated it through affusing 0.1 ml,0.1 5 ml,0.2 ml and 0.25 ml water on postoperative day 1,8,15 and 22,respectively.The expandable ballbladders were kept on being dilated with increasing pressure for a month.Total bilirubin(TB),alanine aminotransferase (ALT),aspartate aminotransferase;aspartate transaminase(AST)of serum,bile duct diameter (BDD),histologic changes of biliary duct wall and hepatic tissue,and postoperative biliary tract contrast were determined before and after operation in both groups.Results There was no significant difference in TB,ALT,AST and histologic changes of hepatic tissue in bilary predilation and postdilation of each group and between group A and group B.There was great difference in BDD in bilary predilation and postdilation of each group and between group A and group B.In group B,the biliary wall was thickened and the lumina of bile duct widened,favorable tenacity of broaden biliary tract was shown.The specific staining of the broadened biliary wall showed that collagen and elastic fibers compacted fine and close and there was no breakage.Conclusion Dilated local bile duct constructed by increasing internal pressure of local bile duct has thick wall,wide caliber and its collagen and elastic fibers compact fine and close.This provides condition to supply early-stage cholangio-jejunostomotic reconstruction of bile duct iniury and create wide stoma for cholangio-jejunostomy in dogs.
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Antecedentes: La lesión transoperatoria de la vía biliar durante la colecistectomía abierta y laparoscópica es un evento catastrófico que se asocia con morbilidad y mortalidad significativas. El objetivo fue documentar si el tamaño de la incisión en colecistectomía abierta está asociado a lesiones más complejas de la vía biliar. Métodos: Estudio de cohorte prospectivo de marzo de 2006 a febrero de 2007. Se incluyeron 66 pacientes con lesiones de la vía biliar posterior a colecistectomía abierta. Se analizó el tamaño de la incisión. Resultados: Se incluyeron 66 pacientes, 70% del sexo femenino, con un promedio de edad de 44 años. El 70% fue tratado por colecistitis aguda. La mayoría tuvo sobrepeso o sufría diferentes grados de obesidad. En 76% de los casos, la lesión no fue advertida durante el procedimiento quirúrgico primario. Todos los pacientes con lesión de vía biliar grave (Strasberg E-3 y E-4) tuvieron incisiones menores a 10 cm de longitud. El tamaño de la incisión se asoció con lesiones inadvertidas (p=0.000), así como con el grado de lesión (p=0.000). No pudo demostrarse asociación estadísticamente significativa entre lesiones de la vía biliar y colecistectomía electiva o urgente, e incisión quirúrgica media o subcostal para la colecistectomía. Conclusiones: Nuestros hallazgos sugieren que el acceso quirúrgico menor durante la colecistectomía abierta puede ser un factor de riesgo, ya que incisiones pequeñas se asociaron con lesiones de la vía biliar más graves e imposibilidad para reconocer este daño durante el procedimiento. Sugerimos cumplir estrictamente los principios quirúrgicos de una adecuada exposición durante la colecistectomía abierta como medida para prevenir lesiones de la vía biliar.
BACKGROUND: Transoperative biliary tract injury during open or laparoscopic cholecystectomy is a catastrophic event associated with significant morbidity and mortality. Our objective was to determine if wound size during open cholecystectomy is associated with more complex biliary tract injuries. METHODS: Prospective cohort study performed between March 2006 and February 2007. Sixty-six patients with biliary tract injuries after open cholecystectomy were included. Wound size was analyzed. RESULTS: Sixty six patients were included, 70% were female with a median age of 44. Seventy four percent were treated for acute cholecystitis. Most participants were overweight or had various degrees of obesity. Biliary tract injuries were not recognized during the primary surgical procedure in 76% of cases. All patients with severe biliary tract injuries (Strasberg E-3 and E-4) had a wound size less than 10 cm in length. Wound size was associated with unrecognized injuries (p=0.000), as well as with injury severity (p=0.000). We were notable to demonstrate a statistically significant association between biliary tract injuries and elective or emergency surgical procedures and midline or subcostal surgical incision for cholecystectomy. CONCLUSIONS: Our findings suggest that minor surgical access during open cholecystectomy may constitute a risk factor since smaller incisions were associated with more severe biliary tract injuries and an inability to observe this damage during the surgical procedure. We suggest to adhere strictly to the guidelines of an adequate surgical exposure during open cholecystectomy to prevent biliary tract injuries.
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Humans , Male , Female , Adult , Cholecystectomy , Intraoperative Complications , Biliary Tract/injuries , Biliary Tract/pathology , Cholecystectomy/methods , Iatrogenic Disease , Injury Severity Score , Prospective StudiesABSTRACT
Objective To explore the diagnosis and treatment of anatomic variation of the extrahepatic biliary tree in laparoscopic cholecystectomy(LC).Methods From October 1999 to January 2008,totally 1216 cases of LC were performed in our hospital,anatomic variation of the extrahepatic biliary tree was found in 15(1.2%) of them.Among the 15 patients,3 had wide and short cystic duct with the opening at the junction of the right and left hepatic ducts;1 patient showed dislocation of a relatively thin choledoch owing to calculus incarceration;1 case was found having a cystic duct parallel to the common hepatic duct with a low-level opening;1 patient had twisted cystic duct at the right side of the common bile duct with an opening at the right hepatic duct;2 patients were suffered from massive adhesion in the cystic ampulla that covering the common bile and common hepatic ducts;3 cases showed aberrant bile ducts lying on the gallbladder bed;3 patients were found having the right posterior hepatic duct opened to the common hepatic duct;1 case was diagnosed with Mirizzi syndrome,in whom the anatomical structure was unclear.For all of the patients,the abnormal structures were separated carefully,ligated with sutures or titanium clips if necessary.Results LC was completed in 13 of the 15 cases,the other 2 patients were converted to open surgery because of the injury to the right hepatic duct or Mirizzi syndrome.None of the series had intra-abdominal bleeding or infection,bowel injury,or death.The patients were followed up for 3 months to 4 years(over 1 year in 11 cases).None of them developed biliary stenosis or residual calculus.Conclusion Identification of the Calot triangle is crucial to prevent surgical injuries to the extrahepatic biliary tree.
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Objective To explore the prevention and management of biliary tract injury during laparoscopic cholecystectomy(LC) in patients with acute cholecystitis.Methods Between October 1999 and October 2008,368 patients with acute cholecystitis received LC in our hospital,7 of them developed biliary tract injury during the operation,and therefore underwent the biliary repair or Roux-en-Y anastomosis between the common bile duct and jejunum as well as T-tube drainage.Results Among these 7 cases,5 cases was converted to open abdominal operation during the procedure of LC,of which 2 cases(1 with total bile duct transection and 1 with electric burn of bile duct) showed stenosis of the bile duct in 12 and 3 months respectively after the T tube was removed,and then was cured by a second Roux-en-Y anastomosis.Two of the 7 patients received biliary repair because of electric burn;cholangiography showed no stenosis after 3-month T-tube drainage.In one patient who had severe injury to the common bile duct,Roux-en-Y anastomosis was performed,and then the patient was discharged from the hospital in 2 weeks with the T tube;one month later,re-examination by cholangiography showed that the case was cured.In the 7 patients,jaundice was observed in 2 cases in 3 to 5 days after the surgery;ERCP showed biliary stenosis in one of them,and complete biliary atresia in another.Subsequent abdominal exploration on the two cases revealed complete common bile duct occlusion in one and partially occluded common hepatic duct in the other.Roux-en-Y anastomosis between the bile duct and jejunum combined with T-tube drainage was therefore made on the patients.The 7 cases were followed up for 0.5 to 6 years,during the period,none of them showed biliary stenosis,residual stones or other complications.No patient died during the follow-up.Conclusion Biliary tract injury during LC in patients with acute cholecystitis can be avoided as long as we choose the right time for LC as well as for conversion to an open surgery.