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A 39 year old gentleman complained of right upper abdominal pain. Ultrasonography revealed cholelithiasis with a cystic space occupying lesion in liver of around 14 cm. Computed tomograpy of whole abdomen was done which revealed a cystic lesion of 14.1×10.6×12.4 cm dimensions in right lobe of liver suggestive of simple cyst. Laparoscopic cholecystectomy was done along with de-roofing of cyst wall, bile leak was noted from a tiny orifice which was found communicating with biliary system by intraoperative cholangiography. Primary closure of opening done by suturing laparoscopically. Patient did well postoperatively and followed for 2 years with no complications and/or recurrence.A 39 year old gentleman complained of right upper abdominal pain. Ultrasonography revealed cholelithiasis with a cystic space occupying lesion in liver of around 14 cm. Computed tomograpy of whole abdomen was done which revealed a cystic lesion of 14.1×10.6×12.4 cm dimensions in right lobe of liver suggestive of simple cyst. Laparoscopic cholecystectomy was done along with deroofing of cyst wall, bile leak was noted from a tiny orifice which was found communicating with biliary system by intraop cholangiography. Primary closure of opening done by suturing laparoscopically. Patient did well postoperatively and followed for 2 years with no complications and/or recurrence. A 39 year old gentleman complained of right upper abdominal pain. Ultrasonography revealed cholelithiasis with acystic space occupying lesion in liver of around 14 cm. Computed tomograpy of whole abdomen was done whichrevealed a cystic lesion of 14.1×10.6×12.4 cm dimensions in right lobe of liver suggestive of simple cyst. Laparoscopiccholecystectomy was done along with de-roofing of cyst wall, bile leak was noted from a tiny orifice which was foundcommunicating with biliary system by intraoperative cholangiography. Primary closure of opening done by suturinglaparoscopically. Patient did well postoperatively and followed for 2 years with no complications and/or recurrence.
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Fluorescence intraoperative cholangiography (IOC) is a potential alternative for identifying anatomical variation and preventing iatrogenic bile duct injuries by using the near-infrared probe indocyanine green (ICG).However,the dynamic process and mechanism of fluorescenceIOC have not been elucidated in previous publications.Herein,the optical properties of the complex of ICG and bile,dynamic fluorescence cholangiography and iatrogenic bile duct injuries were investigated.The emission spectrum of ICG in bile peaked at 844 nm and ICG had higher tissue penetration.Extrahepatic bile ducts could fluoresce 2 min after intravenous injection,and the fluorescence intensity reached a peak at 8 min.Inaddition,biliary dynamics were observed owing to ICG excretion from the bile ducts into the duodenum.Quantitative analysis indicated that ICG-guided fluorescence IOC possessed a high signal to noise ratio compared to the surrounding peripheral tissue and the portal vein.Fluorescence IOC was based on rapid uptake of circulating ICG in plasma by hepatic cells,excretion of ICG into the bile and then its interaction with protein molecules in the bile.Moreover,fluorescence IOC was sensitive to detect bile duct ligation and acute bile duct perforation using ICG in rat models.All of the results indicated that fluorescence IOC using ICG is a valid alternative for the cholangiography of extrahepatic bile ducts and has potential for measurement of biliary dynamics.
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Introduction: In gallstone diseases, common bile duct stones and thickened bile could cause hepatitis or other difficulties. Therefore intraoperative cholangiography is helpful in many operations besides detecting and diagnosing the gallstones in common bile duct. Materials and Methods: Out of 266 patients who had undergone Laparoscopic Cholecystectomy surgery in GrandMed Hospital, 14 patients were found to have jaundice and cholestasis after undergoing laboratory and radiology tests. Results: These 14 patients have all undergone IOC. 7 out of 14 patients were found to have positive cholangiogram and the other 7 - negative. Biliary tract tumor and anatomic anomalies were not identified among these patients. Conclusion: Making analysis using only laboratory data is not adequate for directly detecting choledocholithiasis. IOC not only shows bile tract obstruction and determines cholestasis causes, but it also identifies the anatomy biliary tract, which is a procedure that facilitates dissection. Therefore IOCcan prevent the most serious complication of laparoscopic cholecystectomy - common bile duct injury. The sensitivity of IOC ensures the gathering of important information on time, so suggest to use it for every suspicious case.
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Introduction: In gallstone diseases,common bile duct stones and thickened bilecould cause hepatitis or other difficulties.Therefore intraoperative cholangiography ishelpful in many operations besides detectingand diagnosing the gallstones in commonbile duct.Materials and Methods: Out of 266patients who had undergone LaparoscopicCholecystectomy surgery in GrandMedHospital, 14 patients were found to havejaundice and cholestasis after undergoinglaboratory and radiology tests.Results: These 14 patients have allundergone IOC. 7 out of 14 patients werefound to have positive cholangiogram andthe other 7 - negative. Biliary tract tumorand anatomic anomalies were not identifiedamong these patients.Conclusion: Making analysis usingonly laboratory data is not adequate fordirectly detecting choledocholithiasis. IOCnot only shows bile tract obstruction anddetermines cholestasis causes, but it alsoidentifies the anatomy biliary tract, whichis a procedure that facilitates dissection.Therefore IOCcan prevent the most seriouscomplication of laparoscopic cholecystectomy- common bile duct injury. The sensitivityof IOC ensures the gathering of importantinformation on time, so suggest to use it forevery suspicious case.
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Objective To compare the diagnostic value of endoscopic ultrasonography (EUS) versus intraoperative cholangiography (IOC) for suspected common bile duct stones (CBDS).Methods 324 patients with suspected CBDS who were admitted to the Hepatobiliary Pancreatic Surgery Department of Shaoxing People's Hospital between June 2010 and June 2014 were retrospectively studied.Either EUS or IOC was used and the diagnostic value of these two imaging modalities was compared.Results The sensitivity, specificity, positive predictive value and negative predictive value of IOC in diagnosing suspected CBDS were 90.6％, 98.4％, 9.5％ and 97.7％ respectively.Its consistency rate was 96.9％.The sensitivity, specificity, positive predictive value and negative predictive value of EUS in diagnosing suspected CBDS were 97.1％, 100％, 100％ and 99.1％ respectively.Its consistency rate was 99.3％.Conclusions In diagnosing suspected CBDS, the sensitivity, specificity, positive predictive value and negative predictive value of EUS were significantly higher than IOC.When compared with IOC, EUS was more sensitive to detect occult CBDS and avoided unnecessary ERCP or bile duct exploration.Patients with negative EUS were less likely to have retained CBDS.
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Objective To investigate the clinical value of intraoperative cholangiography( IOC) by cystic duct during laparoscopic chol-ecystectomy( LC) . Methods The clinical data of 58 patients with LC received intraoperative cholangiography by cystic duct were analyzed retrospectively. Results In this group,Successful treatment of 55 cases(94. 83%),failed in 3 cases(5. 17%),no common bile duct calculi in 50 cases(90. 91%),small common bile duct calculi(0. 4 cm) in 5 cases(9. 09%). Among them 4 cases were received common bile duct exploration via laparotomy,1 case treated by laparoscopic transcystic biliary calculus extraction with Dormia basket. The cystic duct drained into the right hepatic duct in 1 patient. In all the cases,no bile duct injury,residual choledocholith,bile leakage,intra-abdominal infection and IOC related complications. Conclusion IOC during LC is simple and easy,with high success rate and good development effect,which can promptly discover the anatomical variations of biliary tract. It has important clinical application value to reduce biliary negative exploration,in-traoperative injury of biliary tract and postoperative common bile duct residual stone in basic hospital.
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Objetivo: Identificar las estrategias intraoperatorias para evitar las lesiones de la vía biliar en el curso de una colecistectomía laparoscópica. Diseño: Revisión Sistemática de la Literatura. Población: Búsqueda sistemática en el medline usando términos Mesh y Multi: [bile duct injury Multi], [laparoscopic cholecystectomy Mesh] Resultados: Se han identificado 7 técnicas intraoperatorias para evitar la lesión del ducto biliar durante la colecistectomía laparoscópica. La Visión Crítica de Seguridad (VCS) no solo es la mas usada, sino es parte de todas las guías clínicas y aceptada en la mayor parte de los cirujanos. La Colangiografía intraoperatoria (CIO) se asocia a menor lesión de vía biliar, pero su uso sistemático es bajo, aumenta el tiempo quirúrgico y los costos y requiere entrenamiento para su interpretación. La Ecografía laparoscópica intraoperatoria (ELI) aun es poco disponible y tienen una curva de aprendizaje muy larga. Otros sistemas de imágenes son poco prácticos y aún en periodo de prueba. Conclusión: La VCS es la forma más segura y difundida para disminuir la probabilidad de lesión de vía biliar durante la colecistectomía laparoscópica y debe ser asumida en forma sistemática y rutinaria.
Aim: Identify strategies to prevent intraoperative bile duct injury during laparoscopic cholecystectomy. Methodological disegn: Sistematic review of the literature. Population: Sistematic search of medline using Mesh and Multi terms: [bile duct injury Multi], [laparoscopic cholecystectomy Mesh]. Results: We have identified 7 methods to avoid intraoperative bile duct injury during laparoscopic cholecystectomy. Critical View of Safety (CVS) is not only the most used, is part of all clinical guidelines too and the method accepted for most of the surgeons. The intraoperative cholangiography (IOC) is associated with lower bile duct injury, but it is not use routinely, it increases operating time and costs and training required for their interpretation. The laparoscopic intraoperative ultrasonography (LIU) is still little available and have a long learning curve. Other imaging systems are impractical and still on probation. Conclusion: The CVS is the safest and released to reduce the chance ofbile duct injury during laparoscopic cholecystectomy and should be done and undertaken systematical and routinely.
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Cholecystectomy, LaparoscopicABSTRACT
Objective To determine the clinical value of intraoperative cholangiography in mini-cholecystectomy. Methods The clinical data of 506 patients receiving intraoperative cholangiography in minicholecystectomy from 1992 to 2006 in our hospital were analyzed retrospectively. Results Intr-aoperative cholangiography was successfully completed in 403 patients. The success rate was 97.4%.Stones in the bile duct in 49 patients,abnormal bite duet in 4 patients and bile duct injury in 4 patient were found. The cuts were extended in 16 patients. Conclusion Intraoperative cholangiography is of great value in inducing postoperative complications and improving the quality of MC. Therefore, it can be used to prevent residual stone after operation, avoid bile duct exploration or injury, decrease the chance of extending the cut and make sure of abnormal bile duct.
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Our objective is to report a case of laparoscopic cholecystectomy in a patient with duplicated cystic duct. A 34 year old male presented with episodic pain in the upper rigth quadrant of the abdomen. Murphy' s sign was not present. Ultrassonography showed gallbladder with multiple calculi and a thickened wall. At laparoscopic cholecystectomy, a duplicated cystic duct was found. Careful dissection and intraoperative cholangiography were performed to rule out common bile duct injury.
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Objective:To evaluate the value of intraoperative transcystic cholangiography(IOC) during laparoscopic cholecystectomy(LC).Methods:IOC was conducted in 56 patients who underwent LC because of cholelithiasis with chronic or acute cholecystitis and biliary pancreatitis.The results were analyzed.Results:Cannulation was successfully completed in 54 out of 56 patients,and the success rate was 96.4%.All 54 patients underwent satisfactory visualization.The common bile duct stones were detected in 5 patients by IOC,and 2 of them were converted to common bile duct exploration and T-tube drainage by open cholecystectomy;3 of them were converted to common bile duct exploration and T-tube drainage by laparoscopic cholecystectomy.2 cases were found to have abnormal cystic duct by IOC,and 4 cases were detected for the biliary anatomy by IOC.The average time of IOC was about(15.5?3.7)minutes.No complication occurred.Conclusion:IOC is a safe and convenient procedure with a high success rate,and it can provide clear films of biliary tree.The benefit of IOC is the detection of common bile duct and cystic duct stones and abnormal biliary anatomy.It can reduce the rate of retained common bile duct stones and bile duct injuries,and increase the early identification of bile duct injuries.Therefore IOC can improve quality and security of LC.
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Objective To evaluate the effects of Laparoscopic cholecystectomy (LC) combined with intraoperative cholanggiography (IOC)and intraoperative endoscopic sphincterotomy (IOEST) for the treatment of cholecystocholedocolithiasis. Methods 106 cases with cholecystocholedocolithiasis diagnosed and treated by LC combined with IOC and IOEST were reviewed retrospectively. Results 60 40%(64/106)patients diagnosed cholelithiasis pre-LC were found choledocholithisis; LC combined with IOC and IOEST was successfully performed on 99 of 106 cases(93 40%),and their CBD stones were completely cleared in 98 of 99 cases(99 00%). Six cases(6 1%) were complicated with mild acute pancreatitis, 1 case(0 01%) with duodenal perforation,1 case(0 01%) with bile leakage, and 2 cases(0 02%) with stomach stasis. Conclusions LC combined with IOC and IOEST was a safe ,effective approach to diagnosis and minimally invasive treatment of cholecystocholedocholithiasis.
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ObjectiveTo evaluate intraoperative cholangiography (IOC) and laparoscopic ultrasonography (LUS) for detection of occult common bile duct stones (CBDS) during laparoscopic cholecystectomy (LC). Methods From Jun. 2000 to Sep. 2001, 98 patients undergoing LUS and IOC during LC were analyzed prospectively.Results[The successful rate of LUS and IOC were 100% and 95% respectively, the time for LUS (7 7?2 1) min was significantly shorter than IOC (11 4?3 5) min ( P 0 05). The visualization of intrapancreatic portion of CBD by LUS was 62% vs 97% by IOC ( P
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Objective To investigate the curative effects of laparocopic treatment for cystiduodenal internal fistula. Methods All procedures were conducted under laparoscope. After the exposure of the cholecystic base, trans-cholecystic cholangiography was performed to detect the relations between the cholecyst and neighboring organs. Once the internal fistula was confirmed, the orifice of fistula was closed laparoscopically. Then abdominal drainage, gastrointestinal decompression, and administration of somatostatin were routinely employed. Results In a series of 327 cases of laparoscopic cholecystectomy (LC) with intraoperative cholangiography, a total of 6 cases of cystiduodenal internal fistula were detected, all of which were anatomized and closed successfully under laparoscope. No postoperative hemorrhage or duodenal bile leakage occurred. Conclusions Routine intraoperative cholangiography during LC is beneficial to the detection of the cystiduodenal internal fistula.Effective and reliable management rests upon skillful laparoscopic techniques of dissection and fistula closure, as well as the supportive treatment.
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Objective To summarize the clinical experience of laparoscopic cholecystectomy (LC) for acute cholecystitis. Methods Clinical records of 79 cases of acute cholecystitis treated by LC from September 2002 to August 2003 were respectively reviewed. Results Intraoperative cholangiography (IOC) was successfully conducted in 75 cases, 6 of which were found common bile duct stones. Of the 6 cases, 4 underwent LC combined with intraoperative endoscopic sphincterotomy and 2 underwent a conversion to open choledochotomy with T-tube drainage. The rest of 73 cases were diagnosed as simple gallbladder stones: LC was successfully accomplished in 70 cases and a conversion to open surgery was required in 3 cases because of serious inflammatory adhesion. In the study no severe complications occurred. Conclusions LC can be performed safely in the majority of cases of acute cholecystitis.
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Objective To summarize our experience in the management of stones impacted at cystic duct during laparoscopic cholecystectomy(LC). Methods There were 58 patients with stones impacted at cystic duct during LC from July 1997 to June 2001.Cystic duct was incised to remove stones first,then intraoperative cholangiography was performed.If stones were found in common bile duct,they would be taken out by intraoperative endoscopic sphincterotomy or open operation. Results All the impacted stones in 58 patients were removed successfully.51 coses underwent LC.Intraoperative cholangiography showed there were common bile duct stones in 7 cases.For these 7 coses,5 cases were treated by LC combined with intraoperative endoscopic sphincterotomy and other 2 cases were converted into open operation.No Severe complication occurred. Conclusions Nearly all cases with stones impacted at cystic duct can receive LC by removing impacted stones through incising the cystic duct and intraoperative cholangiography.If there are any stones in common bile duct,they can be removed by endoscopic sphincterotomy.