Clinical characteristics, treatments, and outcomes of dificult biliary stones in a reference hospital in Colombia

The local experience and the success rate of different available treatments for dificult biliary stones in Colombia are poorly described. We made an observational study reporting patients treated for dificult biliary stones, at Hospital Universitario San Ignacio in Bogotá, Colombia between January 2015, and November 2021. Clinical characteristics, endoscopic retrograde cholangiopancreatography (ERCP) findings, and outcomes are presented. Additionally, the success rates of Endoscopic Sphincterotomy Plus Large Balloon Dilation (ESLBD), Mechanical Lithotripsy (ML), temporary stenting (TS), cholangioscopy-guided laser lithotripsy (CGLL), and surgery are described. A total of 146 patients were included (median age 69 years, IQR 58.5-78.5, 33.8% men). The median stone diameter was 15 mm (IQR 10 - 18 mm). One stone was presented in 39.9%, two stones in 18.2%, and ≥3 stones in the remaining stone. A 67.6% disproportion rate was observed between the stone and distal common bile duct. Successful stone extraction was achieved in 56.2% in the first procedure, 22.6% in the second, 17.1% in the third, 3.4% in the fourth, and 0.7% in the fifth procedures. The successful extraction rates were 56.8% for ESLBD, 75% for ML, 23.4% for TS, 57.7% for CGLL, and 100% for surgery. Endoscopic management of dificult stones is usually successful, although it usually requires 2 or more ERCPs procedures. The surgical requirements were low. ESLBD is an effective technique unlike TS. Few patients required advanced techniques such as ML or CGLL. Endoscopic procedures are associated with a low rate of complications.

La tasa de éxito de diferentes tratamientos de Cálculo Biliar Difícil (CBD) en Colombia no está descrita. Hemos realizado un estudio descriptivo observacional sobre el tratamiento de CBD en el Hospital Universitario San Ignacio en Bogotá, Colombia entre enero 2015 y noviembre 2021. Se presentan las características clínicas, hallazgos en la Colangiopancreatografía Retrógrada Endoscópica (CPRE) y desenlaces asociados. Adicionalmente, se describe la tasa de éxito de los pacientes tratados mediante esfinterotomía asociada a dilatación endoscópica con balón grande (EDEBG), litotripsia mecánica (LM), stent temporal (ST), litotripsia con láser guiada por colangioscopia (LLGC) y cirugía. 146 pacientes fueron incluidos (Mediana de edad 69 años, RIC 58,6-78,5). 33,8% eran hombres. La mediana del tamaño del CBD fue de 15 mm (RIC 10-18 mm). 39,9% tenían un solo cálculo, 18,2% tenían 2 y el resto ≥3 cálculos. 67,6% tenían desproporción entre el cálculo y el colédoco distal. La extracción exitosa se logró en 56,2% en el primer procedimiento, 22,6% en el segundo, 17,1% en el tercero, 3,4% en el cuarto y 0,7% en el quinto procedimiento. La tasa de extracción exitosa fue de 56,8% con EDEBG, 75% con LM, 23,4% con ST, 57,7% con LLGC y 100% con cirugía. El manejo endoscópico del CBD es usualmente exitoso. Sin embargo, requiere usualmente ≥2 CPRE. El tratamiento quirúrgico no es común. EDEBG es una técnica efectiva a diferencia del ST. Pocos pacientes requirieron técnicas avanzadas como LM o LLGC. Los métodos endoscópicos presentan una baja tasa de complicaciones.

Comparative evaluation of three laparoscopic cholecystectomy techniques in rabbit's model

Purpose: The aim of this randomized study was to compare the complications and perioperative outcome of three different techniques of laparoscopic cholecystectomy (LC). Changes in the liver function test after LC techniques were investigated. Also, we compared the degree of postoperative adhesions and histopathological changes of the liver bed. Methods: Thirty rabbits were divided into three groups: group A) Fundus-first technique by Hook dissecting instrument and Roeder Slipknot applied for cystic duct (CD) ligation; group B) conventional technique by Maryland dissecting forceps and electrothermal bipolar vessel sealing (EBVS) for CD seal; group C) conventional technique by EBVS for gallbladder (GB) dissection and CD seal. Results: Group A presented a longer GB dissection time than groups B and C. GB perforation and bleeding from tissues adjacent to GB were similar among tested groups. Gamma-glutamyl transferase and alkaline phosphatase levels increased (p ≤ 0.05) on day 3 postoperatively in group A. By the 15th postoperative day, the enzymes returned to the preoperative values. Transient elevation of hepatic transaminases occurred after LC in all groups. Group A had a higher adherence score than groups B and C and was associated with the least predictable technique. Conclusions: LC can be performed using different techniques, although the use of EBVS is highly recommended.

Research progress and prospect of surgical treatment of intrahepatic cholangiocarcinoma in the era of liver transplantation / 国际外科学杂志

The incidence of intrahepatic cholangiocarcinoma has been increasing worldwide in recent years. Hepatectomy is the first choice for surgical treatment of intrahepatic cholangiocarcinoma. However, due to high tumor invasion, early lymph node metastasis and other factors, only less than 30% of cases are resectable, and the overall prognosis of patients is very poor. Theoretically, liver transplantation can not only remove the tumor, but also replace the damaged liver. Therefore, many scholars have proposed liver transplantation for the treatment of intrahepatic cholangiocarcinoma in order to obtain better results. Intrahepatic cholangiocarcinoma was once listed as a contraindication of liver transplantation due to limited cases, tumor recurrence, and shortage of donors. However, with the optimization of recipient screening criteria and the development of neoadjuvant therapy, part of patients can also benefit from it, making liver transplantation a potential therapeutic strategy. Based on the literature review and the author′s experience, this article introduced the current situation of surgical treatment of intrahepatic cholangiocarcinoma, the comparison between hepatectomy and liver transplantation, the latest progress of liver transplantation treatment and the future challenges and solutions.

Acute hemorrhagic cholecystitis with gallbladder rupture and massive intra-abdominal hemorrhage

Acute hemorrhagic cholecystitis is a rare, life-threatening condition that can be further complicated by perforation of the gallbladder. We describe a patient with clinical and radiologic findings of acute cholecystitis with a gallbladder rupture and massive intra-abdominal bleeding. Our patient is a 67-year-old male who presented with an ischemic stroke and was treated with early tissue plasminogen activator. His hospital course was complicated by a fall requiring posterior spinal fusion surgery. He recovered well, but several days later developed subxiphoid and right upper quadrant pain and an episode of hemobilia and melena. A computed tomography scan revealed an inflamed, distended gallbladder with indistinct margins and a large hematoma in the gallbladder fossa extending to the right paracolic gutter. The patient also developed hemodynamic instability concerning for hemorrhagic shock. He underwent an emergent laparoscopic converted to open subtotal fenestrating cholecystectomy with abdominal washout for management of his acute hemorrhagic cholecystitis with massive intra-abdominal hemorrhage. Prompt recognition of this lethal condition in high-risk patients is crucial for optimizing patient care.

Tratamiento endoscópico de la fuga biliar postcolecistectomía. Presentación de dos casos / Endoscopic treatment of bile leak after post-cholecystectomy. Presentation of two cases

RESUMEN Las lesiones o fugas biliares que ocurren luego de una colecistectomía abierta o laparoscópica, son poco frecuentes, con una incidencia de 0,1-1 %. La presentación clínica de la fuga biliar postoperatoria se caracteriza por dolor en el cuadrante superior derecho, náuseas, vómitos, anorexia y fiebre. Se presentan dos pacientes, de 53 y 58 años de edad, respectivamente, que después de haber sido intervenidos quirúrgicamente, tuvieron manifestaciones clínicas e imagenológicas de fuga biliar. Ambos fueron tratados mediante colangiopancreatografía retrógrada endoscópica con esfinterotomía biliar y colocación de prótesis. La evolución fue satisfactoria. El objetivo del trabajo es exponer el resultado del tratamiento endoscópico en la fuga biliar postcolecistectomía.

ABSTRACT Biliary lesions or leaks that occur after an open or laparoscopic cholecystectomy are rare, with an incidence of 0.1-1%. The clinical presentation of postoperative bile leak is characterized by pain in the upper right quadrant, nausea, vomiting, anorexia and fever. Two patients, 54 and 58 years of age, respectively are presented. After having undergone surgery, they had clinical and imaging manifestations of biliary leakage. Both were treated by endoscopic retrograde cholangiopancreatography with biliary sphincterotomy and prosthesis placement. The evolution was satisfactory. The objective of the work is to expose the result of endoscopic treatment in the biliary leak post- cholecystectomy.

Risk of bleeding complications in percutaneous biliary drainage: the paradox of the normal hemostasis / Risco de complicações de sangramento na drenagem biliar percutânea: o paradoxo da hemostase normal

ABSTRACT Background: Percutaneous biliary drainage is a safe procedure. The risk of bleeding complications is acceptable. Frequently, patients with biliary obstructions usually have coagulation disorders thus increasing risk of bleeding. For this reason, patients should always fit the parameters of hemostasis. Aim: To determine whether the percentage of bleeding complications in percutaneous biliary drainage is greater in adults with corrected hemostasis prior to the procedure regarding those who did not require any. Methods : Prospective, observational, transversal, comparative by independent samples (unpaired comparison). Eighty-two patients with percutaneous biliary drainage were included. The average age was 64±16 years (20-92) being 38 male and 44 female. Patients who presented altered hemostasis were corrected and the presence of bleeding complications was evaluated with laboratory and ultrasound. Results: Of 82 patients, 23 needed correction of hemostasis. The approaches performed were: 41 right, 30 left and 11 bilateral. The amount of punctures on average was 3±2. There were 13 (15.8%) bleeding complications, 12 (20%) in uncorrected and only one (4.34%) in the corrected group with no statistical difference. There were no differences in side, number of punctures and type of drainage, but number of passes and the size of drainage on the right side were different. There was no related mortality. Conclusion: Bleeding complications in patients requiring hemostasis correction for a percutaneous biliary drainage was not greater than in those who did not require any.

RESUMO Racional: A drenagem biliar percutânea é procedimento seguro. O risco de complicações hemorrágicas é aceitável. Frequentemente, os pacientes com obstruções biliares apresentam distúrbios de coagulação, aumentando o risco de sangramento. Por esse motivo, eles devem sempre ser adequados aos parâmetros da hemostasia. Objetivo: Determinar se a porcentagem de complicações hemorrágicas na drenagem biliar percutânea é maior em adultos com hemostasia corrigida antes do procedimento em relação àqueles que necessitaram nenhuma. Métodos: Estudo prospectivo, observacional, transversal, comparativo por amostras independentes (comparação não pareada). Oitenta e dois pacientes foram submetidos à drenagem biliar percutânea. A idade média foi de 64±16 anos (20-92), 38 eram homens e 44 mulheres. Os pacientes que apresentaram hemostasia alterada foram corrigidos, e a presença de complicações hemorrágicas foi avaliada com exames laboratoriais e ultrassonográficos. Resultados: Dos 82 pacientes, 23 necessitaram de correção da hemostasia. O acesso à direita foi em 41 casos, 30 à esquerda e 11 bilaterais. A quantidade de punções em média foi de 3±2. Houve 13 (15,8%) complicações hemorrágicas, 12 (20%) no grupo não corrigido e apenas uma (4,34%) no corrigido sem diferença estatística. Não houve diferenças no lado, no número de perfurações e no tipo de drenagem, mas o número de passagens e o tamanho da drenagem no lado direito foram diferentes. Não houve mortalidade. Conclusão: As complicações hemorrágicas em pacientes que necessitam de correção da hemostasia antes da drenagem biliar percutânea não são maiores do que naqueles que não a requerem.

A consensus statement on the standardized application of antibacterial agents in biliary tract surgery (2019) / 中华外科杂志

The standardized application of antibacterial agents in the treatment of biliary tract diseases is of great significance.On the basis of international and domestic guidelines and consensuses, combining with the actual situation of Chinese biliary tract infection, Study Group of biliary Tract Surgery in Chinese Society of Surgery of Chinese Medical Association and Enhanced Recovery After Surgery Committee of Chinese Research Hospital Association and Editorial Board of Chinese Journal of Surgery organized experts to make recommendations which adopted a problem-oriented approach on the severity grade of biliary tract infection, the protocol of specimen examination, the use of antibiotics, the indication of drug withdrawal, the agents application strategy of drug-resistant bacteria infection and special situation to guide surgeons getting the accurate judgement of the severity of biliary tract infection and the formulation of standard protocols for the use of antibacterial agents on the premise of following the bacteriological and drug resistance monitoring information.

Three-dimensional visual assessment and VR study of hilar cholangiocarcinoma with portal vein as the axis / 中华肝胆外科杂志

Objective To explore the application value of three-dimensional visual (3DV) assessment and virtual reality (VR) study of type Ⅲ and Ⅳ hilar cholangiocarcinoma with portal vein as the axis.Methods The CT image data of 10 patients who were diagnosed as Bismuth type Ⅲ and Ⅳ hilar cholangiocarcinoma by B-ultrasound and CT in Zhujiang Hospital,Southern Medical University were imported into 3D visualization system (3DVS) for 3D image reconstruction,and the portal vein was used as the axis for 3DV analysis and evaluation.The 3D data were then imported into the VR development engine to perform VR research,so as to help the operation planning.Both of the image data were taken into the operation room for intraoperative navigation.Results 10 patients completed 3D visualization reconstruction and VR model transformation.According to the 3D visualization of hepatic hilar hepatocarcinoma,there were 1 case of type Ⅱ,2 cases of type Ⅲa,5 cases of type Ⅲb,1 case of type Ⅳa and 1 case of type Ⅳb.The portal vein was classified according to Cheng type:6 cases of type Ⅰ,3 cases of type Ⅱ,and 1 case of type Ⅲ.The hepatic artery was classified according to Michels type:5 cases of type Ⅰ,1 case of type Ⅱ,3 cases of type Ⅲ,and 1 case of type Ⅸ.The 3DV assessment and VR study were almost consistent with the intraoperative findings.No liver failure or death occurred during the perioperative period.Conclusion The 3DV assessment and VR study with the portal vein as the axis have potential application for the surgical treatment of type Ⅲ and Ⅳ hilar cholangiocarcinoma.

Percutaneous transhepatic one-step biliary fistulation for patients with hepatolithiasis and hepatobiliary surgery history / 中华肝胆外科杂志

Objective To observe the clinical effect of percutaneous transhepatic one-step biliary fistulation (PTOBF) and percutaneous transhepatic cholangioscopy (PTCS) in the treatment of hepatolithiasis with hepatobiliary surgery history,and to explore the clinical application value of PTOBF.Methods This is retrospective analysis of 68 patients with hepatolithiasis who were admitted to hepatobiliary surgery in the First Affiliated Hospital of Guangzhou Medical University from November 2009 to October 2017.Among these cases,35 patients in the observation group (group PTOBF) were treated with PTOBF,and 33 patients in the control group (group PTCS) received PTCS treatment.The final clearance rate,the postoperative complications rate,the hospitalization time,the operation times within the course of treatment,the recurrence rate and the residual stenosis rate of the two groups were compared.Results Compared with group PTCS,the clearance rate was significantly higher in group PTOBF(82.9％ vs 54.6％,P＜0.05),while the postoperative complications rate between the two groups are similar (14.3 ％ vs 30.3 ％,P＞ 0.05);Besides,the hospitalization time(12.3±5.3 d vs 17.4±7.0 d,P＜0.05),the operation times within the course of treatment (2.2±1.3 vs 2.8±1.0,P＜0.05) and the recurrence rate(17.4％ vs 39.4％,P＜0.05) of group PTOBF were obviously lower.Conclusions PTOBF is a safe and feasible treatment for hepatolithiasis with hepatobiliary surgery history.Compared with PTCS,it has the advantages of short hospitalization time,fewer operations and better recovery.

Comparison of the effect of double-mirror combined with gallbladder removal and laparoscopic cholecystectomy for gallbladder stones / 中国基层医药

Objective To compare the effect of double-mirror combined with gallbladder removal and laparoscopic cholecystectomy for gallstones.Methods From January 2016 to December 2017,120 patients with gallstones in the Department of Hepatobiliary Surgery of Dongyang People's Hospital were enrolled.The patients were divided into laparoscopic group (n =60) and double-mirror group (n =60) according to the random number table method.Laparoscopic cholecystectomy was performed in the laparoscopic group,and double-mirror (laparoscopic and choledochoscopy) combined with gallstone removal was performed in the double-mirror group.The surgical results of the two procedures were analyzed.Surgical index,postoperative recovery status,postoperative complications and recurrence rate of one year after surgery were observed.Results The success rate of surgery in both two groups was 100.0％.The operation time of the double-mirror group [(48.2 ± 5.3) min] was significantly longer than that of the laparoscopic group [(41.2 ± 5.8) min] (t =6.901,P ＜ 0.001).The first exhaust time [(14.3 ± 2.5) h],the first time of getting out of bed [(21.1 ±3.7)h],and the recovery time of diet [(2.8 ±0.6)d] in the double-mirror group were significantly shorter than those in the laparoscopic group [(19.2 ± 3.8) h,(25.1 ± 4.8) h,(3.5 ± 0.7) d](t =8.344,5.112,5.881,all P ＜ 0.001).There were no statistically significant differences in the amount of bleeding and postoperative hospital stay between the two groups (all P ＞ 0.05).The total incidence rate of postoperative complications in the double-mirror group was 3.3％,which was significantly lower than 15.0％ in the laparoscopic group (x2 =4.904,P =0.027).In the double-mirror group,the recurrence rate of calculi was 1.7％ in 1 year after surgery,which in the laparoscopic group was 0,there was no statistically significant difference between the two groups (x2 =1.008,P =0.315).Conclusion Double-mirror combined with gallbladder stone removal and laparoscopic cholecystectomy can achieve good stone removal effect,the short-term efficacy is similar to long-term efficacy,laparoscopic cholecystectomy has shorter operation time.Double-mirror combined with gallstone removal has advantages in postoperative recovery and lower complications.

A consensus statement on the standardized application of antibacterial agents in biliary tract surgery (2019) / 中华外科杂志

The standardized application of antibacterial agents in the treatment of biliary tract diseases is of great significance.On the basis of international and domestic guidelines and consensuses, combining with the actual situation of Chinese biliary tract infection, Study Group of biliary Tract Surgery in Chinese Society of Surgery of Chinese Medical Association and Enhanced Recovery After Surgery Committee of Chinese Research Hospital Association and Editorial Board of Chinese Journal of Surgery organized experts to make recommendations which adopted a problem-oriented approach on the severity grade of biliary tract infection, the protocol of specimen examination, the use of antibiotics, the indication of drug withdrawal, the agents application strategy of drug-resistant bacteria infection and special situation to guide surgeons getting the accurate judgement of the severity of biliary tract infection and the formulation of standard protocols for the use of antibacterial agents on the premise of following the bacteriological and drug resistance monitoring information.

Comparison of the effect of double-mirror combined with gallbladder removal and laparoscopic cholecystectomy for gallbladder stones / 中国基层医药

Objective@#To compare the effect of double-mirror combined with gallbladder removal and laparoscopic cholecystectomy for gallstones.@*Methods@#From January 2016 to December 2017, 120 patients with gallstones in the Department of Hepatobiliary Surgery of Dongyang People's Hospital were enrolled.The patients were divided into laparoscopic group (n=60) and double-mirror group (n=60) according to the random number table method.Laparoscopic cholecystectomy was performed in the laparoscopic group, and double-mirror (laparoscopic and choledochoscopy) combined with gallstone removal was performed in the double-mirror group.The surgical results of the two procedures were analyzed.Surgical index, postoperative recovery status, postoperative complications and recurrence rate of one year after surgery were observed.@*Results@#The success rate of surgery in both two groups was 100.0%.The operation time of the double-mirror group [(48.2±5.3)min] was significantly longer than that of the laparoscopic group [(41.2±5.8)min](t=6.901, P<0.001). The first exhaust time [(14.3±2.5)h], the first time of getting out of bed [(21.1±3.7)h], and the recovery time of diet [(2.8±0.6)d] in the double-mirror group were significantly shorter than those in the laparoscopic group [(19.2±3.8)h, (25.1±4.8)h, (3.5±0.7)d] (t=8.344, 5.112, 5.881, all P<0.001). There were no statistically significant differences in the amount of bleeding and postoperative hospital stay between the two groups (all P>0.05). The total incidence rate of postoperative complications in the double-mirror group was 3.3%, which was significantly lower than 15.0% in the laparoscopic group (χ2=4.904, P=0.027). In the double-mirror group, the recurrence rate of calculi was 1.7% in 1 year after surgery, which in the laparoscopic group was 0, there was no statistically significant difference between the two groups (χ2=1.008, P=0.315).@*Conclusion@#Double-mirror combined with gallbladder stone removal and laparoscopic cholecystectomy can achieve good stone removal effect, the short-term efficacy is similar to long-term efficacy, laparoscopic cholecystectomy has shorter operation time.Double-mirror combined with gallstone removal has advantages in postoperative recovery and lower complications.

Development of bile duct cancer as a long-term complication of biliary-enteric anastomosis for benign diseases: a report of five patients / 中华肝胆外科杂志

Objective To study the association, clinical presentation, and diagnosis and treatment of bile duct cancer as a late complication of biliary-enteric anastomoses for benign diseases. Methods A retrospective study was carried out on 5 patients and the medical literature was reviewed. Results They were 3 males and 2 females. The average age was ( 66. 0 ± 0. 7 ) years. The average time period was ( 14. 0 ± 6. 1 ) years after biliary-enteric anastomosis. The clinical presentations included right upper quadrant pain, fever, chills and jaundice. CA19-9, CT and MRI were valuable in diagnosis. There were two patients with distal and three patients with perihilar cholangiocarcinomas (type IIIa, n=2, and type IV, n=1). Local resection with lymphadenectomy was carried out in one patient. Another patient underwent pancreaticoduodenectomy. The remaining three patients only underwent percutaneous transhepatic cholangial drainage ( PTCD). The 2 patients who underwent surgery died of progressive tumor disease at 8 and 13 months postoperatively. The other three patients who underwent palliative biliary drainage died within 6 months of PTCD. There was no significant difference between the two types of treatment ( P ＞0. 05). Conclusions Chronic cholangitis caused by reflux and bacterial infection was properly a predisposing factor leading to late development of bile duct cancer after biliary-enteric anastomosis for benign diseases. Patients treated with biliary-enteric anastomosis should be closely monitored for late development of cholangiocarcinoma. Some procedures such as choledochoduodenostomy and jejunum interposition choledochoduodenostomy should be abandoned because of their poor outcomes and severe complications. Proper indications of biliary-enteric anastomosis should strictly be followed and the Oddi's sphincter should be protected if possible to prevent late development of bile duct cancer.

The application of laparoscopic ultrasound in biliary surgery / 中华肝胆外科杂志

Laparoscopic ultrasound (LUS) has the advantage of high resolution,multi-angle exploration,and is widely used in minimally invasive surgery of biliary tract.LUS has a series of auxiliary function in difficult laparoscopic cholecystectomy (LC),common bile duct exploration,surgery of intrahepatic biliary calculi,and intraoperative staging of pancreato-biliary tumor.This paper summarizes the application of LUS in laparoscopic biliary surgeries and the related technical essentials.

Detalles técnicos de la doble anastomosis hepático-yeyuno en Y de Roux, con base en la descripción de un caso / Technical details of double Roux-en-Y hepaticojejunostomy based on a clinical case description

La anastomosis hepático-yeyuno en Y de Roux se considera la técnica de elección para tratar lesiones quirúrgicas de la vía biliar, como su sección o resección. La pérdida de confluencia de los conductos hepáticos principales derecho e izquierdo es uno de los factores que incrementan la complejidad técnica durante el procedimiento y, en algunos de estos pacientes, se requiere una doble anastomosis hepático-yeyuno para garantizar resultados satisfactorios a largo plazo. Se describen los aspectos técnicos y los resultados posoperatorios del tratamiento quirúrgico empleado, con base en la intervención de una paciente con una lesión quirúrgica de la vía biliar y pérdida de la confluencia de los conductos hepáticos. La evolución de la paciente fue satisfactoria y se mantiene asintomática después de 12 meses de seguimiento. A pesar de ser una técnica compleja, la doble anastomosis hepático-yeyuno en Y de Roux resultó una opción segura de tratamiento en esta paciente

Roux-en-Y hepato-jejunostomy (RYHJ) is the technique of choice for the surgical treatment of bile duct injuries (BDI), such as section or resection. The loss of the hepatic confluence (LHC) increases the technical difficulties during the procedure and, in some of these patients, a doble-RYHJ is required to achieve a long term successful result. We report the technical aspects of the surgical technique as well as the results, based on the case of a young female patient with BDI and LHC. The patient shows a satisfactory evolution and remains asymptomatic during the 12 months of follow up. Double RYHJ, although technically demanding, resulted a safe option for treating this patient

Expert consensus on standardized processes of ambulatory biliary surgery (2018 edition) / 中华外科杂志

The definition of ambulatory surgery is that the patient is admitted, operated and discharged within a day (24 hours) , but does not include outpatient surgery. It can shorten the average hospital stay, reduce medical expenses, accelerate the recovery of patients, and has been approved to have great social and economic benefits.The main contents of this consensus include: (1)the establishment of ambulatory biliary surgery system, which involves the facilities building, team building, the construction of management systems, operation management, operation state analysis and benefit evaluation; (2)Patient selection criteria, pre-hospital assessment, surgical scheduling, preoperative education, anesthesia and management of adverse reactions after anesthesia, intraoperative application of general surgical principles and postoperative emergency plans, perioperative nursing; (3)Discharge criteria and pre-discharge assessment, post-discharge follow-up and rehabilitation guidance; (4) quality and safety control index system of ambulatory biliary surgery.The publication of this consensus is conducive to the establishment of ambulatory biliary surgery system, the evaluation of effectiveness and quality control, and the promotion of ambulatory biliary surgery.

Progress in the study of preoperative evaluation and surgical treatment of hilar cholangiocarcinoma / 国际肿瘤学杂志

Hilar cholangiocarcinoma (HCCA) is a malignant tumor from the biliary epithelium.Its incidence is concealed,the anatomical structure is relatively complex,and the prognosis is poor.Surgical treatment is the only way to get a cure.At present,there are still many controversies in the preoperative evaluation and surgical treatment of HCCA at home and abroad.Further research on preoperative imaging diagnosis of HCCA,preoperative biliary drainage,portal vein embolization,scope of surgical resection,vascular resection and reconstruction,and orthotopic liver transplantation may provide a new reference for clinical treatment of HCCA.

Expert consensus on standardized processes of ambulatory biliary surgery (2018 edition) / 中华外科杂志

The definition of ambulatory surgery is that the patient is admitted, operated and discharged within a day (24 hours) , but does not include outpatient surgery. It can shorten the average hospital stay, reduce medical expenses, accelerate the recovery of patients, and has been approved to have great social and economic benefits.The main contents of this consensus include: (1)the establishment of ambulatory biliary surgery system, which involves the facilities building, team building, the construction of management systems, operation management, operation state analysis and benefit evaluation; (2)Patient selection criteria, pre-hospital assessment, surgical scheduling, preoperative education, anesthesia and management of adverse reactions after anesthesia, intraoperative application of general surgical principles and postoperative emergency plans, perioperative nursing; (3)Discharge criteria and pre-discharge assessment, post-discharge follow-up and rehabilitation guidance; (4) quality and safety control index system of ambulatory biliary surgery.The publication of this consensus is conducive to the establishment of ambulatory biliary surgery system, the evaluation of effectiveness and quality control, and the promotion of ambulatory biliary surgery.

Drenaje biliar transparietohepático: experiencia en el Hospital Universitario y Centro Médico de Caracas / Transhepatic Biliary Drainage: University Hospital and Medical Center of Caracas experience

Introducción: El drenaje biliar transparietohepático (DTPH) es un procedimiento terapéutico, temporal o definitivo, mediante el cual se cateteriza la vía biliar para descomprimirla. Indicaciones: Imposibilidad de resolver la patología biliar por otros métodos (CPRE), tratar la vía biliar en anastomosis bilioentéricas (estenosis), localización y tratamiento de fístulas biliares o patología maligna. Objetivos: Evaluar la experiencia de la Unidad de Radiología Intervencionista del Hospital Universitario de Caracas (HUC) y Centro Medico de Caracas (CMC) en el manejo de DTPH. Método: Estudio retrospectivo, analítico, de corte transversal, con muestreo no probabilístico e intencional. Se procesó estadísticamente la casuística obtenida de la combinación de pacientes atendidos en el CMC entre 2002 y 2017, y en el HUC entre 2010 y 2017, en una población de 528 pacientes, de los cuales 174 fueron reintervenidos, para un total de 702 casos de ambas instituciones. Se utilizó el equipo de arco en "C" fluoroscopia. Se procesaron datos en IBM SPSS 22.0. Resultados: 702 casos, promedio de edad 54±2. El 58,7 %, mujeres (n = 310). Principal incidencia de etiología de patología maligna n = 329 pacientes (62,3 %), seguido por patología benigna encabezada por estenosis posquirúrgica biliodigestiva en n = 191 pacientes (36,1 %). La patología maligna en mayor porcentaje la constituye el ADC de páncreas con n = 156 (29,5 %). En los procedimientos realizados se obtuvo un mayor porcentaje de drenaje interno-externo 48 % (n = 254).Conclusiones: El DTPH constituye una técnica efectiva con poco índice de complicaciones para tratamiento de ictericia obstructiva. La experiencia evaluada ha resultado estadísticamente óptima con buenos resultados.

Introduction: Biliary transparietohepatic drainage (BTHD) is a therapeutic element, temporary or definitive, through which the biliary path is accessed, being able toleave a catheter to decompress it. Indications: Impossibility of resolving biliary pathology by other methods (ERCP), treating the biliary tract in biliary-enteric anastomosis (stenosis), location and treatment of biliary fistulas or malignant pathology. Objectives: evaluate the experience of the interventional radiology unit of the University Hospital of Caracas (UHC) and Medical Center of Caracas (MCC) in the management of BTHD. Method: Retrospective, descriptive, cross-sectional study, with non-probabilistic and intentional sampling. The casuistry from the combination of patients in MCC period 2002 to 2017, and UHC from 2010 to 2017 was statistically processed. 528 patients were obtained, of which 174 were operated on, making 702 cases performed in both institutions. Arc equipment fluoroscopy was used. Data was processed in IBM SPSS 22.0. Results: 702 cases, average age 54 ± 2. 58.7% of female patients n = 310. Main incidence of malignant pathological etiology n = 329 patients (62.3%), followed by benign pathology headed by postsurgical stenosis of biliodigestive in n = 191 patients (36.1%). The malignant pathology with highest percentage is pancreatic ADC with n = 156 (29.5%). Procedures performed obtained a greater percentage of internal external drainage 48% n = 254. Conclusions: BTHD is an effective technique with a low rate of complications for the treatment of obstructive jaundice. Our experience has been statistically optimal with good results.