Caracterización clínica-epidemiológica de quiste de colédoco en la población infantil atendida en el Hospital Materno Infantil

Objetivo: Realizar caracterización clínica-epidemiológica de quiste de colédoco en la población infantil atendida en el Hospital Materno Infantil. Material y Método: Estudio transversal, retrospectivo, descriptivo. La población del estudio consistió en los expedientes con diagnóstico de quiste de colédoco (QC) en el servicio de cirugía pediátrica. Criterios de inclusión: desde el nacimiento hasta los 18 años, operados en este hospital, diagnóstico clínico e imagenológico. Análisis estadístico: base de datos Epi Info.12.0, usando medidas de frecuencia, como la media y varianza. Resultados: Un total de 12 pacientes, la relación entre mujer hombre fue de 3:1, con predominio en mujeres. El grupo etario con mayor frecuencia fue el preescolar con 41,7%. El síntoma más frecuente fue el dolor abdominal con 83,3%; el tipo de QC más frecuente fue el tipo I con 75%, todos fueron resecados y la reconstitución de tránsito más utilizada fue la hepaticoyeyuno anastomosis en Y de Roux (HYYR) con 83,3%. Discusión: El grupo etario, el sexo y el tipo de QC en este estudio, coincide con la literatura citada. El ultrasonido puede ser suficiente para el diagnóstico de QC, la colangiopancreatografia por resonancia magnética permite identificar el subtipo de quiste y planificar la intervención quirúrgica. Conclusión: en nuestro hospital hay poca experiencia en la realización de hepaticoduodeno anastomosis (HD) y ninguna experiencia en la realización de HD y HYYR laparoscópicas, por lo cual, se plantea la necesidad de mejorar las opciones terapéuticas según estándares internaciones. Además, tomando este estudio como base, se deben realizar investigaciones posteriores con mayor complejidad metodológica.

Objective: To perform a clinical-epidemiological characterization of choledochal cyst in the pediatric population attended at the Hospital Materno Infantil. Material and Methods: Cross-sectional, retrospective, descriptive study. The study population consisted of records with a diagnosis of choledochal cyst (CC) in the pediatric surgery service. Inclusion criteria: from birth to 18 years of age, operated in this hospital, clinical and imaging diagnosis. Statistical analysis: Epi Info.12.0 database, using frequency measures, such as mean and variance. Results: A total of 12 patients, female to male ratio was 3:1, with female predominance. The age group with the highest frequency was preschool with 41.7%. The most frequent symptom was abdominal pain with 83.3%, the most frequent type of CC was type I with 75%, all of them were resected and the most frequent reconstruction was Roux-en-Y hepaticojejunostomy (HJ) with 83.3%. Discussion: The age group, sex and type of CC in this study coincides with the literature cited. Ultrasound may be sufficient for the diagnosis of CC, magnetic resonance cholangiopancreatography allows identification of the subtype of cyst and planning of surgical intervention. Conclusion: In our hospital there is little experience in performing hepaticoduodenostomy (HD) and no experience in performing laparoscopic HD and HJ, therefore, there is a need to improve the therapeutic options according to international standards. Furthermore, taking this study as a basis, further research with greater methodological complexity should be carried out.

Tratamiento quirúrgico inmediato en niños con perforación espontánea de la vía biliar. Experiencias de 16 años

Introducción: La perforación espontánea de los conductos biliares es una rara enfermedad caracterizada por una disrupción no traumática de la vía biliar en pacientes aparentemente sanos. Se trata de una grave situación potencialmente letal, pero diagnosticada y tratada correctamente tiene un pronóstico excelente. Objetivo: Caracterizar los principales elementos clínico-quirúrgicos expresados en una serie de 5 pacientes operados en un servicio de referencia nacional. Presentación de casos: Se presenta la experiencia con una serie de casos en 16 años en una sola institución. La afección se observó en niñas recién nacidas y lactantes con una edad media de 4 meses, y se presentó desde la clínica como una colestasis acompañada de distensión abdominal, ascitis biliar, acolia, y signos de irritación peritoneal. El 80 % de los casos se intervinieron en el hospital "William Soler", y en un caso se ejecutó el procedimiento después de una laparotomía por una posible apendicitis aguda, en otro hospital. El diagnóstico se basó en el cuadro clínico descrito, la ecografía abdominal, la paracentesis con medición del índice bilirrubina líquido ascítico/bilirrubina sérica, y la colangiografía intraoperatoria. La cirugía definitiva se realizó inmediatamente, y consistió en: lavado peritoneal, colangiografía diagnóstica, reparación hepaticoyeyunostomía en Y de Roux y colocación de drenaje. Conclusiones: El tratamiento realizado resulta eficaz y seguro en todos los casos, con una excelente evolución, sin complicaciones importantes y con una total supervivencia posoperatoria. La colangiografía intraoperatoria permitió identificar el sitio de la perforación y diagnosticar malformaciones asociadas como dilataciones biliares congénitas y anomalías de la unión bilio-pancreática.

Introduction: Spontaneous bile duct perforation is a rare condition characterized by non-traumatic disruption of the bile duct in apparently healthy patients. It is a serious potentially lethal situation, but correctly diagnosed and treated its prognosis is excellent. Objetive: To characterize the main clinical-surgical elements expressed in a series of 5 patients operated in a national referral service. Case presentation: The experience with a series of cases during a period of 16 years in a single institution is presented. The condition was observed mainly in newborn girls and infants with an average age of 4 months, and presented clinically as cholestasis accompanied by abdominal distension, biliary ascites, acholia, and signs of peritoneal irritation. 80% of the cases were operated primarily in the "William Soler" hospital, and in one case the procedure was performed after a laparotomy for a possible acute appendicitis, in another hospital. The diagnosis was based on the clinical picture described, abdominal ultrasound, paracentesis with measurement of the ascitic liquid bilirubin/serum bilirubin index, and intraoperative cholangiography. Definitive surgery was performed immediately and consisted of: peritoneal lavage, diagnostic cholangiography, Roux-en-Y liver and jejunostomy repair and drainage placement. Conclusions: The treatment performed was effective and safe in all cases, with an excellent evolution, no major complications and total postoperative survival. Intraoperative cholangiography made it possible to identify the site of perforation and to diagnose associated malformations such as congenital biliary dilatations and anomalies of the biliary-pancreatic junction.

Hepaticoyeyunostomía asistida por Robot vs la técnica abierta en un Hospital de tercer nivel / Robotic-Assisted vs open technique Hepaticojejunostomy in a third level Hospital

Resumen A pesar de la evidencia científica de la seguridad, la eficacia de la cirugía robótica, existen pocas publicaciones en la reparación de la vía biliar. El principal objetivo de este estudio fue evaluar los resultados de la hepaticoyeyunostomía en Y de Roux asistida por robot (HYR) y la hepaticoyeyunostomía en Y de Roux abierta (HYA) en el HCM en el periodo de enero de 2012 a enero de 2019. Este es un estudio retrospectivo se recolectaron los datos sociodemográficos, las principales comorbilidades y se determinó la principal indicación quirúrgica de la hepaticoyeyunostomía; se agruparon según la indicación quirúrgica para comparar el sangrado transoperatorio, tiempo quirúrgico, los días de estancia hospitalaria y morbilidad entre la HYR vs HYA. Se registraron 78 hepaticoyeyunostomías (31 fueron HYR y 47 HYA), la edad promedio fue 55.2 ± 17.7 años predominio del género femenino, la principal comorbilidad fue la hipertensión arterial. La principal indicación quirúrgica de hepaticoyeyunostomía fue la disrupción de vía la biliar, en estos pacientes se encontró menor tiempo quirúrgico, días de hospitalización, y morbilidad en los pacientes sometidos a HYR que los pacientes tratados mediante HYA.

Abstract Despite the scientific evidence of safety, the efficacy of robotic surgery, there are few publications on bile duct repair. The main objective of this study was to evaluate the results of Robotic-assisted Hepaticojejunostomy (RHJ) versus open Hepaticoyejunostomy (OHJ) in the HCM during the period from January 2012 to January 2019. This is a retrospective study, database of patients was collected: sociodemographic data, the main comorbidities, and the main surgical indication of hepaticojejunostomy were determined. They were grouped according to the surgical indication to compare: transoperative bleeding, surgical time, hospital length of stay and morbidity RHJ vs. OHJ. Seventy-eight hepaticojejunostomies were registered (31 RHJ and 47 OHJ), the average age was 55.2 ± 17.7 years, predominantly female, the main comorbidity was arterial hypertension. The main surgical indication of hepaticoyeynostomy was bile duct disruption. Shorter surgical time, days of hospitalization, and morbidity were found in patients undergoing RHJ than patients treated with OHJ.

Experience in using needle-grasper assisted single-port laparoscopic hepaticojejunostomy to treat choledochal cysts in children / 中华肝胆外科杂志

Objective:To study the treatment efficacy and safety in using needle-grasper assisted single-port laparoscopic hepaticojejunostomy to treat choledochal cysts in children.Methods:The data of 41 patients with choledochal cysts treated at the Department of Pediatric Surgery, the First Affiliated Hospital of Xiamen University and the Second Hospital of Hebei Medical University from January 2018 to December 2021 were reviewed. There were 8 males and 33 females, aged (2.5±1.9) years. These patients were divided into the needle-grasper assisted single-port laparoscopic hepaticojejunostomy group (needle-grasper group, n=21) and the single-port laparoscopic hepaticojejunostomy group (control group, n=20). Operation time, intestinal function recovery time, gastric tube retention time, abdominal drain indwelling time, postoperative hospital stay, and perioperative complications were compared between the two groups. Results:All 21 children in the needle-grasper group underwent successful surgery without any need to convert to conventional laparoscopic or open surgery. The operation time (156.4±21.2) min was significantly shorter than the control group (218.3±28.6) min ( t=2.95, P=0.017). There were no significant differences in intestinal function recovery time, gastric tube retention time, abdominal drain indwelling time, postoperative hospital stay and perioperative complications between the two groups (all P>0.05). Parents were very satisfied with the cosmetic effect of the invisible scar after surgery. Conclusion:Needle-grasper assisted single-port laparoscopic hepaticojejunostomy was safe, reliable and the operation time was shorter than using a single-port to achieve minimally invasive and scarless surgery.

Laparoscopic surgery for treatment of hepaticojejunostomy strictures after cholangiectasis surgery in children / 中华肝胆外科杂志

Objective:To study the safety and feasibility of laparoscopic surgery for treatment of hepaticojejunostomy strictures after cholangiectasis surgery in children.Methods:The clinical data of 12 children was retrospectively analysed. There were 5 males and 7 females, aged 4 (range 0.45 to 9.00) years old, who developed hepaticojejunostomy strictures after cholangiectasis surgery and underwent reoperative treatment at Anhui Provincial Children's Hospital from January 2013 to January 2021. These patients were divided into the laparoscopic surgery group ( n=5) and the open surgery group ( n=7) based on the mode of reoperation. The children were followed-up by outpatient review and the relevant clinical data of the children in the 2 groups was analyzed. Results:The reoperations were completed successfully in the 2 groups. The maximum preoperative dilated common hepatic duct diameter was significantly larger in the laparoscopic group (1.26±0.23) cm than the open group (0.64±0.19) cm ( P<0.05). The alkaline phosphatase and glutamyltransferase levels in the laparoscopic surgery group were significantly lower before the operation (all P<0.05), and the total bilirubin, direct bilirubin, alkaline phosphatase, and glutamyltransferase levels were significantly lower in the laparotomy group than before the operations (all P<0.05). In the laparoscopic group, the time of the reoperations, postoperative hospital stay, and blood loss were 268(117, 340) min, (9.0±2.9) d and (14.0±5.5) ml, respectively, while those in the open group were 180(150, 205) min, (9.7±3.4) d and (13.3±2.6) ml, respectively. There were no significant differences between the two groups (all P>0.05). On follow-up, all children were well except for one child who showed mild elevation levels of alanine aminotransferase and aspartate aminotransferase. Conclusion:Laparoscopic surgery for hepaticojejunostomy strictures after cholangiectasis surgery in children was safe and feasible. Its curative effect was no less than that of open surgery.

Re-do Laparoscopic Hepaticojejunostomy: Technique and Outcomes

Background & Aim: Roux-en-Y hepaticojejunostomy (RYHJ) is the most common treatment done for benign biliary strictures and as a part of for post CDC excision biliary drainage. In the long term follow up, RYHJ stenosis is a dreaded complication, both for the patients and the attending surgeon, in view of the complexity and difficulty in its management. This is traditionally managedby a combination of medical, radiological and open surgical techniques. There are only a few reports describing the management of strictured biliary anastomosis by a laparoscopic technique. The aim of the present study is to describe our experience of laparoscopic re- establishment of biliary continuity(Re-do hepatico-jejunostomy) Methods: Retrospective analysis of prospectively collected data of RYHJ stenosis post benign biliary stricture (BBS) repair and choledochal cyst (CDC) excision, treated by laparoscopic re-do RYHJ, between January 2018 to December 2018 in the department of GI Surgery, GB Pant Institute & Maulana Azad Medical College. Results: 6 patients underwent laparoscopic Re-do RYHJ during the study period. 4 patients developed RYHJ stenosis post open BBS repair and 2 after open CDC excision. The presenting complaints was repeated episodes of fever with jaundice, refractory to medical management. Three patients also had hepatolithiasis.

Laparoscopic Choledochal Cyst Excision with Hepaticoduo-denostomy: An Experience

Background: Standard treatment for choledochal cyst (CDC) is excision of cyst with biloenteric reconstruction. Most common methods of reconstruction following CDC excision are Roux en y hepaticojejunostomy (RYHJ) and Hepaticoduodenostomy (HD). Although HD has been employed in paediatric population, its use in adult patients has been limited. Aim: The aim of the study was to analyse our experience of patients who underwent laparoscopic excision of CDC and to compare the short term and long term outcomes following HD versus RYHJ as a method of reconstruction in adults. Methods: This is a retrospective analysis of prospectively collected data of 65 patients who underwent laparoscopic cyst excision from January 2016 to March 2021in a single surgical unit at GB Pant Institute of Post graduate Medical Education and Research, New Delhi. Following CDC excision HD was our preferred as method of biliary reconstruction. Patients with restricted duodenal mobility and thin friable duct underwent RYHJ.Short-term outcomes included operative time,blood loss, length of hospital stay and complications such as anastomotic leakage and post operative bleeding.Long-term outcomes included anastomotic stricture formation and need for redo biliary reconstruction. Results: Total 65 patient underwent laparoscopic CDC excision. Mean age was 31.66 ± 12.77years and male: female ratio was 1:5.4. Type I cyst was the most common (60/65=92.3%) with mean size of 2.59 ±0.78cm. Laparoscopic HD was feasible in 87% (57/65) of patients. RYHJ was done in 8 patients. Outcome in laparoscopic HD vs RYHJ group: Mean blood loss was 54.22±8.9ml vs 92±16 mL, mean operative time was 182±41.6 vs 240±52.2 mL, mean hospital stay was 4±2.1 vs 5±3.2 days. There was no difference in anastomotic leak rate (3 vs 1, p=0.42) or post-operative bleeding rate between the two groups.There was no perioperative mortality. Conclusion: Laparoscopic HD was feasible in most of the adult CDC patients with better short term and comparable long term results.It may be used as the preferred biliary reconstruction method during laparoscopic CDC excision in adults as it is technically easier, requires single anastomosis and also accessible for future endoscopic intervention.

Spectrum of Cholangiocarcinoma with Special Emphasis on Treatment Modalities and Outcome at a Rural Tertiary Care Centre.

Cholangiocarcinoma (CCA) is a heterogeneous group of aggressive malignancies emerging from the canals of Hering to the CBD. CCA are rare tumours accounting for 3% of gastrointestinal tumours with an incidence of <2/100000, with an increased incidence in Asia. They present late and have a grave prognosis. The only curative option is surgical resection. The aim was to study the demographic and clinical spectrum of CCA with special emphasis on practicable diagnostic modalities, treatment strategies and their outcome at our rural tertiary setup.METHODSThis was a single centre observational study with a longitudinal design conducted over a period of 2 years. 30 patients presenting with features or diagnosis of CCA to the Department of General Surgery and the Department of Radiotherapy of North Bengal Medical College and Hospital, were studied with special reference to treatment and outcome. Data was collected, compiled on Excel sheet and analysed using GraphPad QuickCalcs 2018 (San Diego, CA).RESULTSMean age of the patients was 52.36 years with a female: male ratio 1.5:1. They presented mainly with jaundice (90%), clay coloured stool (83.3%), pruritus (66.6%), anaemia (56.6%), abdominal lump (43.3%) and pain abdomen (33.6%) reflecting a late presentation. Diagnosis and staging were done by blood parameters and available imaging studies in our setup (abdominal ultrasound, CECT and MRCP). The most common type was Distal CCA (60%) followed by Perihilar CCA (33.3%) and Intra-hepatic CCA (6.6%). Pancreaticoduodenectomy was done in 26.6% of patients and resection with hepaticojejunostomy in 10% of patients; surgical biliary bypass in 20% of patients, chemotherapy in 6.6% and PTBD followed by chemotherapy in 36.6%. After 1 year 72.7% of those who underwent curative surgery were having disease free life and 26.3% of those who underwent palliative treatment were having improved quality of life.

Choledochal cysts in children: How to Diagnose and Operate on

OBJECTIVE: To identify the best mode for diagnosing and treating the patients with choledochal cysts. METHODS: A retrospective study was performed with medical records of patients diagnosed with choledochal cysts from January 1994 to December 2017. In all cases, the diagnosis was based on ultrasound examination. All the patients underwent cyst resection and were divided in two groups: bile enteric anastomosis in the high portion of the common hepatic duct or in the dilated lower portion. RESULTS: Eighty-one cases were studied. The age of presentation was 4 y 2 mo ± 4 y 1 mo, and the age for the surgical treatment was 5 y 5 mo ± 4 y 6 mo. In 61 cases, US was the only image examination performed. There were 67 cases of Todani type I (82.7%), 13 cases of type IV (16.0%) and one case of type III (1.2%). Nine patients (29.0%) in the first period and 2 patients (4.0%) in the second period presented with postoperative complications (p=0.016). CONCLUSION: In patients with choledochal cysts, US is the only necessary diagnostic imaging. Performing the bile enteric anastomosis in the lower portion of the common hepatic duct is safer and has a lower risk of complications.

Clinical application of laparoscopic radical resection of hilar cholangiocarcinoma:An analysis of 15 cases / 中国实用外科杂志

OBJECTIVE: To explore the feasibility and safety in the exploration of laparoscopic radical resection of hilar cholangiocarcinoma. METHODS: The clinical data of 15 patients who underwent radical surgery and confirmed pathologically as hilar cholangiocarcinoma from May 2013 to May 2018 at the Affiliated Hospital of North Sichuan Medical College were analyzed retrospectively. RESULTS: Operations were performed successfully in all patients. Among them,13 patients underwent pure laparoscopic surgery and 2 patients were converted to laparotomy. The operation time was(404.3±62.8) minutes. The intraoperative blood loss was(502.0±133.8) mL. The postoperative hospital stay was(9.6±2.7) days. The postoperative initial exhaust time was(3.2±0.8) days. The number of postoperative lymph nodes was detected(9.5±2.6),and 1 patient found lymph node metastasis at N2 station. Biliary leakage occurred after operation in1 patient. Large amount of ascites was found in 1 patient. Incision fat liquefaction happened in 1 patient. All of them were discharged after conservative treatments. All patients had been followed up for 6 to 60 months postoperatively until May 2018. Four patients died. CONCLUSION: Through fully preoperative evaluation and intraoperative exploration,the corresponding surgical strategy is formulated,and under the premise of strictly surgical indications,it will be relatively safe and feasible to apply laparoscopic technology to patients with hilar cholangiocarcinoma when the operation is performed by a rich-experienced surgeon.

Comparative study of Hepatico-duodenostomy Vs Hepatico-jejunostomy surgical procedures in the management of choledochal cyst in children

Background: Choledochal cyst is a congenital anomaly of the ducts of the extarhepaticbiliary tree. This condition is considered rare in the view of western population with an incidence of 1 in 100,000 to 150,000 births, while it defers in the Asian population where in the incidence is nearly 1 in 1000 live births. Aim: To compare and assess the advantages and disadvantages between the two standard procedures in the surgical management of choledochal cyst in children. Materials and methods: The required sample size was collected prospectively over a period of two years from November 2014 to October 2016. The decision for biliary-enteric anastomosis (Hepaticoduodenostomy Vs. Hepatico- jejunostomy) made was not influenced or directed by the study. The type of anastomosis was left to the surgeon’s personal preference in each case.15 cases of each type of biliary-enteric anastomosis – Hepatico-duodenostomy and Hepatico-jejunostomy were chosen. Results: The age distribution in cases undergoing hepatico-duodenostomy was almost near to equal, female to male ratio was of 1.25: 1. Out of 15 patients 5 in hepatico-duodenostomy group and 3 in hepatico-jejunostomy had a palpable mass in the right upper quadrant. This means that a palpable mass was seen in 26% of our patients who present for surgical correction of a CC. Second most important presenting complaint in CC was pain. Thirteen out of 30 children presented with bilious vomiting. On an average, we had initiation of feeds in the hepatico-duodenostomy group was of 5 K.V. Sathyanarayana, Sri Aparna Mummaneni. Comparative study of Hepatico-duodenostomy Vs. Hepatico-jejunostomy surgical procedures in the management of choledochal cyst in children. IAIM, 2018; 5(10): 127-137. Page 128 days and that of the hepatico-jejunostomy group was of 7 days. Average stay for the hepaticoduodenostomy group was around 7.6 days when compared to 10.5 days in the hepatico-jejunostomy group. One case in hepatico-jejunostomy group was seen to have bile leak on the 4 the post-operative day. No other early complications were seen in the hepatico-duodenostomy group. One child belonging to hepatio-duodenostomy group had been admitted three months post-operatively with the complaint of recurrent pain abdomen and fever. In cases of hepatico-duodenostomy, none of them presented with any symptoms of pain abdomen or recurrent vomiting. Conclusion: Our results also support HD as the preferred procedure for biliary reconstruction after resection of CC, in view of the advantages of relative simplicity, and low rate of complications.

Clinical features and surgical repair of posthepatectomy bile duct strictures / 中华肝胆外科杂志

Objective To analyze the clinical features and definitive repair strategies of bile duct strictures after hepatectomy.Methods The clinical data of patients undergoing definite repair for bile duct strictures after hepatectomy in the PLA General Hospital from 2000 to 2014 and Beijing Tsinghua Changgung Hospital from 2014 to 2017 were retrospectively collected.Results Twenty-one patients with bile duct stricture after hepatectomy were treated with reoperation.Among them,13 cases showed continuous bile leakage after operation.The types of hepatectomy include 10 cases of left or extended left hemihepatectomy,7 cases of right or extended right hemihepatectomy,2 cases of mesohepatectomy,and 2 cases of hepatic caudate labectomy.According to classification formulated by the Biliary Surgery Group of Chinese Medical Association,the types of injuries of the patients included four of Ⅱ 2,twelve of Ⅱ 3,and five of Ⅱ 4 respectively.19 of 21 patients underwent definitive repair with hepaticojejunostomy.The long-term follow-up success rate was 89.0％.Conclusions Biliary injury after hepatectomy in which the injury affects the secondary or below hepatic ducts requires surgical repair.Hepaticjejunostomy is an effective definitive repair method.Hepaticjejunostomy for bile duct stenosis after right hemihepatectomy always need to dissect the left intrahepatic bile duct by a hilar plate approach or UPV approach,due to the effect of hepatic portal transposition.Surgical repair for bile duct stenosis after the left hepatectomy,always need the incision of the right anterior and right posterior hepatic duct,due to extensive injuries of hepatic duct.

Resección y hepaticoyeyunostomía laparoscópicas en quiste de colédoco tipo 1 / Laparoscopic resection and hepaticojejunostomy for type 1 choledochal cyst

Los quistes del colédoco son dilataciones congénitas de la vía biliar que afectan fundamentalmente a la población pediátrica, de ellas, el tipo 1 es el más frecuente. Pueden producir graves complicaciones y el tratamiento quirúrgico de elección es la resección total de la lesión seguida de hepaticoenterostomía. Actualmente, este proceder se realiza por vía laparoscópica con buenos resultados. El objetivo del trabajo es reportar el tratamiento laparoscópico de un quiste de colédoco tipo 1 en un paciente de 5 años. No hubo complicaciones posoperatorias y los resultados estéticos y funcionales al año de seguimiento son excelentes. Se concluye que la resección laparoscópica en quistes de colédoco tipo 1 es posible y se sugiere continuar con su implementación(AU)

Choledochal cysts are congenital dilatation of the bile ducts that typically affect the pediatric population. Cases of its type 1 are the more frequent. Serious complications may occur and the surgical treatment of election is the lesions' total resection followed by hepaticoenterostomy. Today this procedure is carried out by laparoscopic way with good outcomes. The objective of this paper is to report a choledochal cyst type 1´s laparoscopic treatment in a 5-year-old patient. There were not postoperative complications and the aesthetic and functional results after one-year follow-up are excellent. The choledochal cysts´ laparoscopic resection is concluded to be possible and its implementation is suggested to follow(AU)

Síndrome de Mirizzi tipo V, entidad infrecuente y compleja / Mirizzi's syndrome type V, a rare and complex entity

El síndrome de Mirizzi es una inflamación poco frecuente y crónica ocasionada por un cálculo impactado en la bolsa de Hartmann con obstrucción parcial o completa del conducto biliar principal, que infiere un difícil diagnóstico preoperatorio y controversial manejo terapéutico. El objetivo del trabajo fue exponer el tratamiento de cinco pacientes con diagnóstico de síndrome de Mirizzi tipo V. Se realizó una revisión de las bases de datos Pubmed, Dynamed y Conchrane en busca de artículos relacionados. Se presentó el tratamiento de esta entidad en cinco pacientes teniendo en cuenta la experiencia del autor y los hallazgos de la revisión realizada. La cirugía convencional es la vía ideal de acceso para el tratamiento de esta entidad utilizando las derivaciones bilioentéricas en sus variantes. Un alto índice de sospecha se requiere para un diagnóstico preoperatorio e intraoperatorio certero, con una óptima planificación quirúrgica(AU)

Mirizzi's syndrome is a rare and chronic inflammation caused by a gallstone impacted in the Hartmann's pouch with partial or complete obstruction of the main bile duct, which results in difficult preoperative diagnosis and controversial therapeutic management. To present the treatment of five patients diagnosed with Mirizzi's syndrome type V. A search for articles was carried out in the databases Pubmed, Dynamed and Conchrane. The treatment of this entity was presented in five patients, taking into account the author´s experience of the review´s findings. Conventional surgery is the ideal access route for this entity´s treatment using bilioenteric bypass in its variants. A high index of suspicion is required for accurate preoperative and intraoperative diagnosis, with optimal surgical planning(AU)

La hepaticoyeyunostomía en el tratamiento de las afecciones hepatobiliopancreáticas / Hepaticojejunostomy in the treatment of affections

Introducción: el tratamiento de las afecciones del sistema hepatobiliopancreático dista mucho de ser el óptimo a pesar de los avances conseguidos con la incorporación de nuevos procedimientos diagnósticos y terapéuticos; sin embargo, las derivaciones bilioentéricas son consideradas una alternativa valiosa en el tratamiento. Objetivo: caracterizar el tratamiento de las afecciones del sistema hepatobiliopancreático con el uso de la hepaticoyeyunostomía, en el servicio de cirugía general del hospital Dr. Salvador Allende, desde enero de 2000 hasta diciembre de 2013. Métodos: estudio de corte transversal, retrospectivo-prospectivo y descriptivo. La muestra estuvo constituida por 77 pacientes. Resultados: las enfermedades del sistema hepatobiliopancreático malignas representaron el principal diagnóstico entre nuestros pacientes, con 31 por ciento de complicaciones posoperatoria y cuatro (5,19 por ciento) muertes asociadas al proceder. Conclusiones: la hepaticoyeyunostomía es una opción terapéutica segura en aquellos pacientes con enfermedad hepatobiliopancreática cuando no exista la adecuada factibilidad de métodos endoscópicos derivativos, ante el fallo de estos o el fracaso de la descompresión percutánea(AU)

Introduction: the treatment of disorders of the hepatobiliopancreatic system is far from being despite the progress made with the incorporation of new diagnostic and therapeutic procedures; however, biliary-enteric by-passes are considered a valuable alternative in the treatment. Objective: to characterize the treatment of hepatobiliopancreatic system affections using hepaticojejunostomy, in the Department of General Surgery Dr. of Salvador Allende Hospital, from January 2000 to December 2013. Methods: a cross-sectional, retrospective-prospective and descriptive study was carried out. The sample consisted of 77 patients. Results: the malignant disease of the hepatobiliopancreatic system were the main diagnosis among our patients, with 31 percent of postoperative complications and four (5.19 percent) deaths associated with the procedure. Conclusions: hepaticojejunostomy is a safe therapeutic option for patients with hepatobiliopancreatic disease, when there is no adequate feasibility of endoscopic derivative methods, in face of the failure of these or that of percutaneous decompression(AU)

El síndrome de Mirizzi, un desafío para el cirujano / Mirizzi syndrome, a challenge for the surgeon

El síndrome de Mirizzi es una inflamación poco frecuente y crónica ocasionada por un cálculo impactado en la bolsa de Hartmann con obstrucción parcial o completa del conducto biliar principal. Es una complicación prolongada de la enfermedad litiásica biliar e infiere un diagnóstico preoperatorio difícil, así como una compleja conducción terapéutica. El objetivo de este trabajo es realizar una actualización del tema sobre el diagnóstico y tratamiento de esta entidad. Se realizó una revisión de las bases de datos Pubmed, Dynamed y Conchrane (idioma inglés y español) en busca de los artículos relacionados con el síndrome de Mirizzi. Trabajos adicionales fueron identificados mediante búsqueda manual de las referencias de artículos relevantes. Se presentó una actualización detallada acerca del diagnóstico y tratamiento de esta entidad teniendo en cuenta la experiencia del autor y los hallazgos de la revisión realizada. Para lograr un diagnóstico preoperatorio e intraoperatorio certero se requiere un alto índice de sospecha, llevando a una óptima proyección quirúrgica para tratar esta entidad(AU)

Mirizzi syndrome is a rare and chronic inflammation, caused by a calculus stuck to the Hartmann bag, with partial or complete obstruction of the main bile duct. It is a lengthened complication of lithiasic biliary disease and effects a difficult preoperative diagnosis and a therapeutic complex treatment. To perform an updating about the of subject and to present the "state of art" diagnosis and treatment for this entity. A review of PubMed, Dynamed and Conchrane data was made (in both English and Spanish), looking for articles about Mirizzi syndrome. Additional papers were identified by manual search for references of relevant articles. A detailed updating on the diagnosis and treatment of this entity was presented, taking into account the experience of the author and the findings from the review. High suspicion index is required for an accurate preoperative and intraoperative surgical diagnoses leading to an optimal approach to treat this condition(AU)

Biodegradable biliary stents: a new approach for the management of hepaticojejunostomy strictures following bile duct injury. prospective study / Stent biliar biodegradável: uma nova abordagem para as estenoses hepaticojejunais após lesão do ducto biliar. estudo prospectivo

ABSTRACT Background: Once a biliary injury has occurred, repair is done by a hepaticojejunostomy. The most common procedure is to perform a dilatation with balloon with a success of 70 %. Success rates range using biodegradable stents is from 85% to 95%. Biodegradable biliary stents should change the treatment of this complication. Aim: To investigate the use of biodegradable stents in a group of patients with hepaticojejunonostomy strictures. Methods: In a prospective study 16 biodegradable stents were placed in 13 patients with hepaticojejunostomy strictures secondary to bile duct repair of a biliary surgical injury. Average age was 38.7 years (23-67), nine were female and four male. All cases had a percutaneous drainage before at the time of biodegradable stent placement. Results: In one case, temporary haemobilia was present requiring blood transfusion. In another, pain after stent placement required intravenous medication. In the other 11 patients, hospital discharge was the next morning following stent placement. During the patient´s follow-up, none presented symptoms during the first nine months. One patient presented significant alkaline phosphatase elevation and stricture recurrence was confirmed. One case had recurrence of cholangitis 11 months after the stent placement. 84.6% continued asymptomatic with a mean follow-up of 20 months. Conclusion: The placement of biodegradable stents is a safe and feasible technique. Was not observed strictures caused by the stent or its degradation. It could substitute balloon dilation in strictures of hepaticojejunostomy.

RESUMO Racional: Uma vez que lesão biliar ocorreu, o reparo é feito por hepaticojejunostomia. O procedimento mais comum é efetuar dilatação com balão com sucesso de 70%. As taxas de sucesso utilizando stents biodegradáveis ​​é de 85% a 95%. Stents biliares biodegradáveis ​​devem mudar o tratamento desta complicação. Objetivo: Investigar o uso de stents biodegradáveis em um grupo de pacientes com estenose hepaticojejunal Métodos: Em estudo prospectivo 16 stents biodegradáveis ​​foram colocados em 13 pacientes com estenose de hepaticojejunostomia secundárias usados para reparação do ductos biliares de lesão cirúrgica. A média de idade foi de 38,7 anos (23-67), nove pacientes eram homens e quatro mulheres. Todos os casos tiveram drenagem percutânea antes do momento da colocação de stent biodegradável. Resultados: Em um caso, haemobilia temporária estava presente com necessidade de transfusão de sangue. Em outro, dor após a colocação do stent necessitou de medicação intravenosa. Nos outros 11 pacientes, alta hospitalar foi na manhã seguinte após o procedimento. Durante o seguimento, nenhum apresentou sintomas durante os primeiros nove meses. Um paciente apresentou significativa elevação da fosfatase alcalina por recidiva da estenose. Um caso teve recorrência de colangite 11 meses após a colocação do stent. Continuaram assintomáticos 84,6% com média de acompanhamento de 20 meses. Conclusão: A colocação de stents biodegradáveis ​​é técnica segura e viável. Não foram observadas restrições causadas pelo stent ou pela sua degradação. Stent pode substituir dilatação com balão na estenose de hepaticojejunostomia.

Assessment of biliary complication after liver transplantation in Mongolia / Мэс засал

Introduction: A considerable proportionof adult living donor liver transplantation(LDLT) recipients experience biliarycomplication (BC), but there are few reportsregarding BC based on long-term studies ofa large LDLT population.Methods: The present study examinedBC incidence, from 16 adult and pediatricpatients (14 right liver and 2 left liver graft )between 2011 and 2016 First Central Hospitalof Mongolia.Results: The mean follow-up period was36±1 months. First Central Hospital has DDanastmosis (n=22) double DD (n=2) singlehepaticojejunostomy (n=3). There 3 caseshave biliary stricture after operation. One ofthe 3 cases has biliary laek 2 months laterafter the operation.Conclusion: Close surveillance for BCappears necessary for at least the first 3 yrafter LDLT. In terms of anastomotic stenosisrisk, HJ appears a better choice than DD forright liver grafts involving ducts less than 4mm in diameter.

Cluster hepaticojejunostomy with radial spreading anchoring traction technique for secure reconstruction of widely opened hilar bile ducts

Secure reconstruction of multiple hepatic ducts that are severely damaged by tumor invasion or iatrogenic injury is a challenge. Failure of percutaneous or endoscopic biliary stenting requires lifelong placement of one or more percutaneous transhepatic biliary drainage (PTBD) tubes. For such difficult situations, we devised a surgical technique termed cluster hepaticojejunostomy (HJ), which can be coupled with palliative bile duct resection. The cluster HJ technique consisted of applying multiple internal biliary stents and a single wide porto-enterostomy to the surrounding connective tissues. The technique is described in detail in the present case report. Performing cluster HJ benefits from three technical tips as follows: making the multiple bile duct openings wide and parallel after sequential side-to-side unification; radially anchoring and traction of the suture materials at the anterior anastomotic suture line; and making multiple segmented continuous sutures at the posterior anastomotic suture line. Thus, cluster HJ with radial spreading anchoring traction technique is a useful surgical method for secure reconstruction of severely damaged hilar bile ducts.

Nasogastric tube placement into the hepaticojejunostomy anastomosis in pancreaticoduodenectomy: a simple surgical technique for prevention of bile leak

Hepaticojejunostomy is an important part of many surgical procedures including pancreaticoduodenectomy. Biliary leakage from hepaticojejunostomy may be associated with intraabdominal abscess formation, biliary peritonitis, and even mortality. A 72-year-old female patient was admitted to our hospital with obstructive jaundice. After initial evaluation, she was diagnosed with distal common bile duct obstruction without accurate diagnosis. Before planned pancreaticoduodenectomy, biliary drainage with a T-tube was performed due to the presence of cholangitis. After the first operation, pancreaticoduodenectomy was performed. Postinflammatory changes around the hilar region made the hepaticojejunostomy risky. A bilio-digestive anastomosis was performed using a new technique. A nasogastric tube was placed into the common bile duct proximal to the anastomosis. The postoperative course of the patient was uneventful. The use of a nasogastric tube as a stent in risky hepaticojejunostomies is a simple technique that can be beneficial.