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1.
An. Fac. Cienc. Méd. (Asunción) ; 54(3): 161-166, Dec. 2021.
Article in Spanish | LILACS | ID: biblio-1352984

ABSTRACT

Mujer de 54 años sometida a colecistectomía laparoscópica programada por colecistolitiasis sintomática, el procedimiento fue convertido a abordaje abierto por presencia de bilirragia perioperatoria no localizada, tratada con sutura primaria del lecho vesicular bajo sospecha de un conducto aberrante de Luschka. Al vigésimo día postoperatorio se diagnostica una fístula biliar tras la aparición de bilirragia a través de la herida quirúrgica. Una colangiografía transhepática percutánea mostró una pérdida completa de continuidad con fuga a ese nivel, confirmando la lesión del conducto hepático derecho, con un extremo cortado retraído del conducto hepático. Debido a la compleja lesión de la vía biliar proximal, a los 3 meses de la primera cirugía se realiza una hepatectomía derecha. Aunque la hepatectomía no es un procedimiento estándar para pacientes con lesiones quirúrgicas de la via biliar, debe considerarse como parte del arsenal quirúrgico para la reparación de un grupo seleccionado de pacientes en lesiones postcolecistectomía


A 54-year-old female underwent a planned laparoscopic cholecystectomy due to a symptomatic cholecystolithiasis, the procedure was converted to an open approach due to the presence of a not located perioperative bilirhagia, treated with a primary suture of the gallbladder bed under the suspicion of an aberrant duct of Luschka. On the 20th postoperative day, the patient is diagnosed with a biliary fistula after the appearance of bilirhagia through the surgical wound. A percutaneous transhepatic cholangiography showed a complete loss of continuity with leakage at that level, confirming the right hepatic duct injury, with a retracted cut end from the hepatic duct. Due to the complex proximal bile duct injury, 3 months after the first surgery, a right hepatectomy is performed. Although an hepatectomy is not a standard procedure for patients with IBDI, it should be considered as a part of the surgical armamentarium for the repair of a selected group of patients in postcholecystectomy injuries


Subject(s)
Cholecystectomy , Hepatectomy , Bile Ducts
2.
Rev. argent. cir ; 113(1): 125-130, abr. 2021. graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1288183

ABSTRACT

RESUMEN La vesícula izquierda (VI) es una rara anomalía de la vía biliar que, cuando enferma, no suele dar sín tomas diferentes de aquella normoposicionada, haciendo infrecuente su diagnóstico preoperatorio. Presentamos el caso de una colecistitis aguda en un paciente con VI, resuelto en forma segura por vía laparoscópica. Un paciente ingresa por un cuadro típico de colecistitis aguda. Como hallazgo in traoperatorio se constata una vesícula biliar inflamada, ubicada en posición siniestra. Se modificó la ubicación de los puertos de trabajo y se realizó colangiografía transvesicular por punción, antes de iniciar la disección del hilio vesicular. Luego de identificar el conducto cístico, se realizó colangiografía transcística que confirmó la anatomía de la vía biliar completa y expedita. Se completó la colecistec tomía laparoscópica en forma segura. El hallazgo de una VI obliga al cirujano a cambiar la técnica de una colecistectomía laparoscópica. Esta anomalía incrementa el riesgo de lesiones de la vía biliar. La disección cuidadosa del hilio vesicular logrando una visión crítica de seguridad y el uso de colangiogra fía intraoperatoria son de extrema importancia para una colecistectomía segura.


ABSTRACT Left-sided gallbladder (LSGB) is a rare bile duct abnormality, usually found during a cholecystectomy. Symptoms usually do not differ from those of a normally positioned gallbladder, making the preoperative diagnosis extremely uncommon. We report the case of an acute cholecystitis in a patient whit LSGB, safely managed with laparoscopic surgery. A 24-year-old male patient was admitted to our institution with clinical and radiological signs of acute cholecystitis. The intraoperative finding of an acute cholecystitis in a LSGB made us modify ports positioning and a cholangiograhy was done by direct puncture of the gallbladder before hilum dissection. After the cystic duct was identified, a transcystic cholangiography was performed which confirmed a complete and clear bile duct anatomy and laparoscopic cholecystectomy was safely completed. The intraoperative finding of a LSGB makes the surgeon change some aspects of the usual technique to perform a safe cholecystectomy as LSGB significantly increases the risk of common bile duct injuries. Meticulous dissection of the gallbladder hilum to achieve a critical view of safety and the systematic use of intraoperative cholangiography are extremely important to perform a safe laparoscopic cholecystectomy.


Subject(s)
Humans , Male , Adult , Cholecystitis, Acute/diagnostic imaging , Gallbladder , Cholangiography , Monitoring, Intraoperative , Cholecystectomy, Laparoscopic , Laparoscopy
3.
Article in Chinese | WPRIM | ID: wpr-908446

ABSTRACT

Laparoscopic cholecystectomy (LC) is the first preferred treatment of benign gallbladder diseases such as gallbladder stones and gallbladder polyps, however bile duct injury is a serious complication of LC. Although bile duct injury is a rare complication, improper treatments will seriously affect the quality of life or even threaten life. Therefore, the prevention and correct treatments of bile duct injury in LC are crucial. Based on domestic and overseas researches, the authors investigate risk factors for bile duct injury in LC, share experiences of timely detection, diagnosis and treatment, so as to provide references for hepatic and biliary surgeons.

4.
Rev. argent. cir ; 112(4): 480-489, dic. 2020. graf, il, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1288160

ABSTRACT

RESUMEN Antecedentes: la lesión quirúrgica de la vía biliar representa un gran problema de salud y puede surgir ante cualquier cirujano que realice una colecistectomía. Objetivos: el objetivo del trabajo fue presentar nuestra experiencia en reparación de la vía biliar, ana lizando la morbimortalidad y la incidencia de dicha patología en nuestro Servicio. Material y métodos: estudio retrospectivo descriptivo; se tomaron las variables de las historias clínicas de los pacientes en un período de 8 años, de enero de 2011 a julio de 2019 donde fueron admitidos 19 pacientes que presentaron lesión quirúrgica de la vía biliar en el Hospital José Ramón Vidal de la provincia de Corrientes, Argentina. Resultados: 12 pacientes fueron tratados quirúrgicamente mediante hepático-yeyuno anastomosis, 2 por bihepático-yeyuno anastomosis y dos mediante sutura término-terminal bilio-biliar sobre tubo de Kehr. Tres pacientes fueron tratados mediante colocación de stent y dilatación posterior mediante colangiopancreatografia retrógrada endoscópica. Conclusión: los cirujanos deben entrenarse para disminuir al mínimo la posibilidad de una lesión. El objetivo de una colecistectomía debería ser no lesionar la vía biliar.


ABSTRACT Background: Bile duct injury represents a serious health problem and can occur after any cholecystectomy. Objectives: The aim of this study was to report our experience in repairing bile duct injuries analyzing morbidity, mortality and its incidence in our department. Material and Methods: We conducted a retrospective and descriptive study. The information was retrieved form the medical records of 19 patients with bile duct injury hospitalized at the Hospital José Ramón Vidal, Corrientes, Argentina, between January 2011 and July 2019. Results: A Roux-en-Y hepaticojejunostomy was performed in 12 patients, double hepaticojejunostomy in two patients, and two patients were treated with end-to-end ductal anastomosis with suture over a T tube. Three patients underwent endoscopic retrograde cholangiopancreatography with stent placement and dilation. Conclusion: Surgeons should be trained to avoid the possibility of bile duct injury. The main goal of cholecystectomy should be to avoid this complication.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Wounds and Injuries/surgery , Bile Ducts/injuries , Cholecystectomy, Laparoscopic/adverse effects , Argentina , Bile Ducts/surgery , Anastomosis, Surgical , Cholangiography , Indicators of Morbidity and Mortality , Epidemiology, Descriptive , Retrospective Studies , Computed Tomography Angiography , Hospitals, Public
5.
Article | IMSEAR | ID: sea-213223

ABSTRACT

Background: Laparoscopic cholecystectomy (LC), being one of the most common performed surgical procedure among the basic surgeries. Incidence of common bile duct (CBD) injury as high as 1.4-3% has been reported in some studies. The aim of this study was to estimate the incidence and predictors of CBD injury who underwent elective laparoscopic cholecystectomy.Methods: A retrospective observational study conducted at Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh India. Data was collected for a period of 1 year between March 2019 till 2020.Results: In majority of laparoscopic cholecystectomy we encountered moderate degree of difficulty. Extra hepatic bile duct injuries occurred in 1.4% of cases and were classified according to Strasberg classification. Type A injury was most common followed by type E2. Most major bile duct injuries were recognized intraoperatively. No mortality was noted in our study.Conclusions: Bile duct injuries is a major complication of laparoscopic cholecystectomy with significant morbidity and mortality, reduced survival impaired quality of life and subsequent litigations. Majority of bile duct injuries, results mainly from the surgeon’s inexperience, misinterpretation of anatomy and poor surgical techniques.

6.
Article in English | WPRIM | ID: wpr-762670

ABSTRACT

PURPOSE: This report describes the laparoscopic end-to-end biliary reconstruction with T-tube for transected bile duct injury (BDI) during laparoscopic cholecystectomy. METHODS: We performed a retrospective descriptive analysis for all patients with a transected BDI at a single institution. We collected and analyzed data for injury site and type, reconstruction methods, conversion rate, previous intervention, and outcomes. RESULTS: Between January 2014 and December 2017, 2,901 patients underwent laparoscopic cholecystectomy at a single institution. Among them, 8 patients experienced a transected BDI during laparoscopic cholecystectomy, so the surgeon performed laparoscopic end-to-end biliary reconstruction with T-tube. Our patient series consisted of 6 women (75%) and 2 men (25%) with a mean age of 48.3 years (median, 49 years; range, 29–77 years). Two cases were converted to open surgery. The most common injured site was the common bile duct (5 of 8, 62.5%). The most common injury type, using Bismuth's classification system, was type I (3 of 8, 37.5%). The mean operating time was 136.8 minutes (median, 135.0 minutes; range, 0–180.0 minutes). The mean hospital stay was 7.0 days (median, 4.5 days, range: 3.0–21.0 days). The mean follow-up was 36.4 months (median, 34.0 months; range, 16.0–63.0 months). We observed one postoperative complication during the follow-up period. The patient had an anastomosis site leakage and was cured after reoperation. CONCLUSION: Laparoscopic end-to-end biliary reconstruction with T-tube for transected BDI during laparoscopic cholecystectomy seems to be safe and feasible in selected patients. However, long-term follow-up to identify complications from bile duct stricture remains important.


Subject(s)
Bile Ducts , Bile , Cholecystectomy , Cholecystectomy, Laparoscopic , Classification , Common Bile Duct , Constriction, Pathologic , Female , Follow-Up Studies , Humans , Laparoscopy , Length of Stay , Male , Postoperative Complications , Reoperation , Retrospective Studies
7.
Article in Chinese | WPRIM | ID: wpr-800305

ABSTRACT

Objective@#To investigate the effects of definitive repair surgery on health-related quality of life (HRQOL) in patients with bile duct injury after laparoscopic cholecystectomy (LC).@*Methods@#The retrospective case-control study was conducted. The clinicopathological data of 181 patients with bile duct injury caused by LC for benign gallbladder diseases who underwent definitive repair surgery and 50 patients without complications after LC for benign gallbladder diseases in the Mianyang Central Hospital from January 2000 to December 2017 were collected. There were 82 males and 99 females of 181 patients with bile duct injury, aged from 31 to 68 years, with an average age of 47 years. Definitive repair surgery was performed according to different types of bile duct injury, and questionnaire of HRQOL was conducted preoperatively and one year after operation. There were 18 males and 32 females of 50 patients without complications after LC, aged from 35 to 69 years, with an average age of 41 years. Questionnaire of HRQOL was conducted on LC patients without complications one year after operation. Observation indicators: (1) classification of bile duct injury; (2) intraoperative situations of definitive repair surgery; (3) postoperative situations of definitive repair surgery; (4) follow-up; (5) results of the SF-36 scale assessment. Follow-up was conducted by outpatient examination and telephone interview up to December 2018. Patients were reexamined liver function and color Doppler ultrasonography once every 6-12 months, and further magnetic resonance cholangiopancreatography (MRCP) or computed tomography examination to detect recurrence of anastomotic biliary stricture and cholangitis. Measurement data with normal distribution were expressed as Mean±SD, and comparison between groups was analyzed by the paired t test. Measurement data with skewed distribution were described as M (range), and count data were described as absolute numbers.@*Results@#(1) Classification of bile duct injury: of the 181 patients with bile duct injury, there were 64 cases of E1 type, 70 cases of E2 type, 35 cases of E3 type, 9 cases of E4 type, and 3 cases of E5 type. (2) Intraoperative situations of definitive repair surgery: all the 181 patinets with bile duct injury underwent definitive repair surgery successfully, including 61 undergoing end-to-end biliary anastomosis, 109 undergoing Roux-en-Y choledojejunostomy, 11 undergoing hemi-hepatectomy combined with Roux-en-Y anastomosis. There were 52 patients combined with hilar cholangioplasty. The operation time and volume of intraoperative blood loss of 181 patients were (190±126) minutes and 601.5 mL (range, 150.0-2 100.0 mL). There were 24 cases with blood transfusion and 18 cases with T-tube stent. (3) Postoperative situations of definitive repair surgery: 40 of 181 patients had complications, including 14 cases of incisional infection, 10 cases of bile leakage, 8 cases of perihepatic effusion, 7 cases of pulmonary infection, and 1 case of abdominal hemorrhage. The patient with postoperative abdominal hemorrhage underwent reoperation for hemostasis, and other patients with complications were cured after ultrasound-guided puncture and drainage or conservative treatment. Duration of postoperative hospital stay of 181 patients with bile duct injury was 12.6 days (range, 6.0-34.0 days). There was no perioperative death occurred. (4) Follow-up: 157 of 181 patients were followed up for 8.2-201.3 months, with a median follow-up time of 92.7 months. Twenty-eight patients had anastomotic stricture recurred, 16 of which were treated with reoperation, 10 were treated with endoscopic stent implantation, and 2 cases were treated with balloon dilatation in interventional department; the stricture was repaired again in all cases. Thirteen patients had recurrent cholangitis, showing no obvious anastomotic stricture on MRCP, and symptoms can be effectively controlled after conservative treatment. (5) Results of the SF-36 scale assessment: 181 patients with bile duct injury completed the SF-36 scales before definitive repair surgery, and 157 completed one year after definitive repair surgery. All the 50 patients without complications completed SF-36 scales one year after LC. The scores of HRQOL in physiological function, role functioning, somatic pain, general health, vitality, social function, emotional function, mental health, the scores of physical component summary, and mental component summary of 181 patients with bile duct injury before surgery were 79±15, 65±12, 40±17, 42±14, 59±20, 27±15, 48±23, 56±22, 60±11, and 56±11, respectively. The above indices one year after definitive repair surgery were 87±10, 78±15, 71±20, 64±20、68±19, 70±25, 67±21, 69±23, 71±13, 68±15, respectively. The above indices of 50 patients without complications one year after LC were 90±13, 81±20, 87±16, 72±20, 73±15, 86±17, 79±22, 77±19, 82±18, 79±18, respectively. The 181 patients with bile duct injury had significant elevation in above indices one year after definitive repair surgery (t=2.051, 2.016, 3.875, 3.014, 2.563, 3.225, 2.964, 2.357, 2.150, 2.203, P<0.05). The 50 patients without complications also had significant elevation in above indices one year after definitive repair surgery (t=2.817, 2.206, 3.641, 3.112, 3.202, 3.310, 3.011, 2.899, 2.150, 2.118, P<0.05). There were significant differences in the general health and mental health one year after definitive repair surgery between 181 patients with bile duct injury and 50 patients without complications (t=2.014, 2.011, P<0.05), and no significant difference in the physiological function, role functioning, somatic pain, vitality, social function, or emotional function between the two groups (t=0.852, 0.915, 0.907, 1.102, 1.284, 1.120, 0.863, 1.109, P>0.05).@*Conclusion@#Definitive repair surgery can significantly improve HRQOL in patients with bile duct injury caused by LC.

8.
Article in Chinese | WPRIM | ID: wpr-849858

ABSTRACT

Objective To investigate the protective effect of salvianolate against bile duct injury after donation after cardiac death (DCD) liver transplantation and its clinical application prospect. Methods Sixty recipients of DCD liver transplantation were randomly divided into two groups with 30 cases in each group. Salvianolate (250mg/d) was given daily for 14 days after operation in treatment group, and the same amount of normal saline was given in control group. The therapeutic regimen of anti-rejection and anti-infection is the same between the two groups. The incidence of early graft dysfunction (EAD), and the serous levels of total bilirubin (TB), alkaline phosphatase (ALP), γ-glutamyltransferase (GGT), total bile acid (TBA) 1 month, 6 months and 12 months after liver transplantation were compared between the two groups. Also, the platelets (PLT), prothrombin time (PT), activated partial prothrombin time (APTT) and fibrinogen (FIB) were compared between the two groups at 2 weeks after operation. Results There was no significant difference in baseline parameters between the two groups (P>0.05). Compared with the control group, the incidence of EAD was decreased in treatment group, but there was no significant difference [10.0%(3/30) vs. 23.3%(7/30), P=0.166]. The serous levels of TB, ALP, GGT and TBA in treatment group were lower than those in control group 1 month, 6 months and 12 months after operation: [TB: 1 month, (28.5±17.0)μmol/L vs. (39.8±20.1)μmol/L, P=0.025; 6 months, (24.5±10.6)μmol/L vs. (33.3±16.4) μmol/L, P=0.018; 12 months, (19.8±9.5)μmol/L vs. (26.4±14.1)μmol/L, P=0.037, ALP: 1 month, (147.3±76.9)U/L vs. (187.6±70.9)U/L, P=0.039; 6 months, (163.0±61.4)U/L vs. (198.1±51.6)U/L, P=0.020; 12 months, (167.9±59.9)U/L vs. (200.2±56.2)U/L, P=0.036, GGT: 1 month, (83.9±49.5)U/L vs. (113.6±61.1)U/L, P=0.043; 6 months, (130.9±48.7)U/L vs. (169.7±77.0)U/L, P=0.023; 12 months, (154.7±45.1)U/L vs. (182.5±59.8)U/L, P=0.047, TBA: 1 month, (6.6±2.1)μmol/L vs. (8.0±2.4)μmol/L, P=0.016; 6 months, (9.5±2.2)μmol/L vs. (12.1±3.4)μmol/L, P=0.001; 12 months, (12.5±2.7)μmol/L vs. (5.6±3.8)μmol/L, P=0.001]. However, there was no significant difference in PLT, PT, APTT and FIB between two groups [PLT: (148.6±88.6)×109/L vs. (152.8±74.4)×109/L, P=0.843; PT: (12.9±1.1)s vs. (13.0±1.1)s, P=0.617; APTT: (34.6±3.7)s vs. (34.9±3.4)s, P=0.716; FIB: (3.4±0.6)g/L vs. (3.2±0.6)g/L, P=0.270, repectively]. Conclusions Salvianolate has a protective effect against bile duct injury after DCD liver transplantation, and does not increase the risk of postoperative bleeding.

9.
Article in Chinese | WPRIM | ID: wpr-823835

ABSTRACT

Objective To investigate the effects of definitive repair surgery on health-related quality of life (HRQOL) in patients with bile duct injury after laparoscopic cholecystectomy (LC).Methods The retrospective case-control study was conducted.The clinicopathological data of 181 patients with bile duct injury caused by LC for benign gallbladder diseases who underwent definitive repair surgery and 50 patients without complications after LC for benign gallbladder diseases in the Mianyang Central Hospital from January 2000 to December 2017 were collected.There were 82 males and 99 females of 181 patients with bile duct injury,aged from 31 to 68 years,with an average age of 47 years.Definitive repair surgery was performed according to different types of bile duct injury,and questionnaire of HRQOL was conducted preoperatively and one year after operation.There were 18 males and 32 females of 50 patients without complications after LC,aged from 35 to 69 years,with an average age of 41 years.Questionnaire of HRQOL was conducted on LC patients without complications one year after operation.Observation indicators:(1) classification of bile duct injury;(2) intraoperative situations of definitive repair surgery;(3) postoperative situations of definitive repair surgery;(4) follow-up;(5) results of the SF-36 scale assessment.Follow-up was conducted by outpatient examination and telephone interview up to December 2018.Patients were reexamined liver function and color Doppler ultrasonography once every 6-12 months,and further magnetic resonance cholangiopancreatography (MRCP) or computed tomography examination to detect recurrence of anastomotic biliary stricture and cholangitis.Measurement data with normal distribution were expressed as Mean±SD,and comparison between groups was analyzed by the paired t test.Measurement data with skewed distribution were described as M (range),and count data were described as absolute numbers.Results (1) Classification of bile duct injury:of the 181 patients with bile duct injury,there were 64 cases of E1 type,70 cases of E2 type,35 cases of E3 type,9 cases of E4 type,and 3 cases of E5 type.(2) Intraoperative situations of definitive repair surgery:all the 181 patinets with bile duct injury underwent definitive repair surgery successfully,including 61 undergoing end-to-end biliary anastomosis,109 undergoing Roux-en-Y choledojejunostomy,11 undergoing hemi-hepatectomy combined with Roux-en-Y anastomosis.There were 52 patients combined with hilar cholangioplasty.The operation time and volume of intraoperative blood loss of 181 patients were (190±126) minutes and 601.5 mL (range,150.0-2 100.0 mL).There were 24 cases with blood transfusion and 18 cases with T-tube stent.(3) Postoperative situations of definitive repair surgery:40 of 181 patients had complications,including 14 cases of incisional infection,10 cases of bile leakage,8 cases of perihepatic effusion,7 cases of pulmonary infection,and 1 case of abdominal hemorrhage.The patient with postoperative abdominal hemorrhage underwent reoperation for hemostasis,and other patients with complications were cured after ultrasound-guided puncture and drainage or conservative treatment.Duration of postoperative hospital stay of 181 patients with bile duct injury was 12.6 days (range,6.0-34.0 days).There was uo perioperative death occurred.(4) Follow-up:157 of 181 patients were followed up for 8.2-201.3 months,with a median follow-up time of 92.7 months.Twenty-eight patients had anastomotic stricture recurred,16 of which were treated with reoperation,10 were treated with endoscopic stent implantation,and 2 cases were treated with balloon dilatation in interventional department;the stricture was repaired again in all cases.Thirteen patients had recurrent cholangitis,showing no obvious anastomotic stricture on MRCP,and symptoms can be effectively controlled after conservative treatment.(5) Results of the SF-36 scale assessment:181 patients with bile duct injury completed the SF-36 scales before definitive repair surgery,and 157 completed one year after definitive repair surgery.All the 50 patients without complications completed SF-36 scales one year after LC.The scores of HRQOL in physiological function,role functioning,somatic pain,general health,vitality,social function,emotional function,mental health,the scores of physical component summary,and mental component summary of 181 patients with bile duct injury before surgery were 79±15,65±12,40±17,42±14,59±20,27±15,48±23,56±22,60±11,and 56±11,respectively.The above indices one year after definitive repair surgery were 87±10,78±15,71±20,64±20、68± 19,70 ± 25,67 ± 21,69 ± 23,71 ± 13,68 ± 15,respectively.The above indices of 50 patients without complications one year after LC were 90±13,81±20,87±16,72±20,73±15,86±17,79±22,77±19,82±18,79 ± 18,respectively.The 181 patients with bile duct injury had significant elevation in above indices one year after definitive repair surgery (t=2.051,2.016,3.875,3.014,2.563,3.225,2.964,2.357,2.150,2.203,P<0.05).The 50 patients without complications also had significant elevation in above indices one year after definitive repair surgery (t=2.817,2.206,3.641,3.112,3.202,3.310,3.011,2.899,2.150,2.118,P<0.05).There were significant differences in the general health and mental health one year after definitive repair surgery between 181 patients with bile duct injury and 50 patients without complications (t =2.014,2.011,P<0.05),and no significant difference in the physiological function,role functioning,somatic pain,vitality,social function,or emotional function between the two groups (t=0.852,0.915,0.907,1.102,1.284,1.120,0.863,1.109,P>0.05).Conclusion Definitive repair surgery can significantly improve HRQOL in patients with bile duct injury caused by LC.

10.
Article | IMSEAR | ID: sea-194129

ABSTRACT

Background: Gallstone disease is a significant health problem world over (in both developing and developed nations). The incidence of gallstone disease increases after age of 40years and it becomes 4-10 times more common in old age. As many as 16% and 29% of women above the age of 40-49 years and 50-59 years, respectively, had gall stones. Laparoscopic cholecystectomy introduced in 1985 has become the procedure of choice for surgical removal of the gallbladder. The aim is to compare laparoscopic cholecystectomy and open cholecystectomy in patients of cholelithiasis by measuring parameters such as use of post-operative analgesia, operative time, post-operative hospital stays, morbidity, mortality and patient satisfaction.Methods: It is a prospective randomized study of 120 patients of cholelithiasis aged between 20years to 80years operated during 2015-2018 at of Anugrah Narayan Magadh Medical College and Hospital, Gaya, Bihar, India. They were divided into open and laparoscopic Cholecystectomy groups by drawing a lottery.Results: The median (range) operation time for laparoscopic cholecystectomy was 55-155 min (mean=102 min) and 40-105 min (mean=72 min) for open cholecystectomy (p <0.001). Form LC group 5 cases had to be converted to OC. Rate of conversion was 5/60=8.3% which is within limits of worldwide laparoscopic cholecystectomy conversion rate of 5% to 10%. LC was found to be superior to OC.Conclusions: Laparoscopic cholecystectomy is better than open cholecystectomy However, open cholecystectomy is preferable in cases of complicated cholecystectomy.

11.
Rev. argent. cir ; 110(1): 1-10, mar. 2018. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-897359

ABSTRACT

Antecedentes: El drenaje biliar percutáneo (DBP) se ha utlizado para tratar lesiones quirúrgicas de la vía biliar y como complemento de la cirugía de reparación. Objetivo: Presentar los resultados del drenaje biliar percutáneo en una serie consecutiva de pacientes con lesiones quirúrgicas o secuelas de reparaciones quirúrgicas de la vía biliar. Material y Métodos: Se analizaron los pacientes tratados inicialmente mediante DBP. Se utlizó la cla-sificación de Strasberg y se registró: tpo de operación, vía de abordaje, número de reintervenciones, intentos de reparación biliar y presentación clínica. En los pacientes con continuidad bilioentérica, la primera opción fue el tratamiento percutáneo. Se evaluó el DBP en el pre, intra y postoperatorio y pre dilatación percutánea Resultados: En el hospital Argerich, período 2000 a 2014, se incluyeron 76 enfermos, 68.4% mujeres y post colecistectomía 97%. El 77,6% fueron lesiones Tipo E2 a E5. El porcentaje de enfermos con control de síntomas pre cirugía o dilatación percutánea fue: ictericia 59%, colestasis 5%, colangits 91%, fistula biliar 87%, prurito 90%, retro del hepaticostoma o Kehr 91%. En 13 de 16 pacientes con fistula biliar externa se internalizó el catéter biliar a la cavidad abdominal. En el 70% de 52 pacientes operados, el catéter facilitó la identificación de la vía biliar proximal. En el postoperatorio, no hubo fistulas biliares de la anastomosis bilioentérica, y se detectaron 3 pacientes con estenosis biliar residual y 2 con segmentos biliares aislados que fueron tratados. Conclusión: El DBP resulta útl en el preoperatorio, intraoperatorio y postoperatorio de los pacientes con lesiones quirúrgicas biliares.


Background: Percutaneous biliary drainage (PtibD) has been used to treat surgical bile duct injuries and as an adjunct to repair surgery. Objective: To present the results of PtidB in a consecutive series of patents with surgical injuries or sequelae of surgical repairs of the bile duct. Material and methods: Patents initally treated with PtibD were analyzed. Strasberg classificaton was used and recorded: type of operaton, surgical approach, number of reoperatons, biliary repair atempts and clinical presentaton. In patents with bilioenteric continuity, percutaneous biliary treatment was the frst opton. PtibD was evaluated in the pre, intra and postoperative period and in the pre dilataton period. Results: At the Hospital Argerich, from 2000 to 2014, 76 patents were included, 68.4% women and 97% post cholecystectomy. The lesions were Type E2 to E5 in 77% of cases. The percentage of patents with controlled symptoms before surgery or percutaneous dilataton was: jaundice 59%, cholestasis 5%, cholangits 91%, biliary fistula 87%, pruritus 90%, withdrawal hepaticos-toma or T-Kehr 91%. In 13 of 16 patents with external biliary fistula, the catheter could be internalized to abdominal cavity. In 70% of 52 operated patents, the catheter facilitated the identificaton of the proximal biliary duct. In the postoperative period, there were no biliary fistulas of the bilioenteric anastomoses and 3 patents with residual biliary stenosis and 2 with isolated biliary segments were detected and treated. Conclusion: PtibD is helpful in the pre, intra and postoperative treatment of patents with surgical bile duct injuries.

12.
Article in Chinese | WPRIM | ID: wpr-699192

ABSTRACT

Objective To summarize the clinicopathological characteristic,diagnosis and treatment of iatrogenic biliary tree destruction.Methods The retrospective cross-sectional study was conducted.The clinical data of 11 patients with iatrogenic biliary tree destruction who were admitted to the Chinese PLA General Hospital (9 patients) between January 1990 and December 2013 and Beijing Tsinghua Changgung Hospital (2 patients) between December 2014 and May 2017 were collected.Observation indicators:(1) causes and parts of destruction;(2) clinical manifestation;(3) imaging performance;(4) treatment;(5) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect long-term prognosis of patients up to April 2018.Measurement data with skewed distribution were described as M (range).Results (1) Causes and parts of iatrogenic biliary tree destruction:causes of iatrogenic biliary tree destruction in 11 patients:transcatheter arterial embolization for hepatic hemangioma was performed in 7 patients,high intensity focused ultrasound for hepatic hemangioma in 1 patient,arterial embolization for false aneurysm in 1 patient,sclerosant injection for hepatic echinococcosis in 1 patient,and cyberknife radiotherapy for hepatocellular carcinoma in 1 patient.Parts of biliary tree destruction of 11 patients:5,3,2 and 1 respectively involved bilateral biliary tree,right biliary tree,bilateral main biliary ducts in hepatic port and left biliary tree.(2) Clinical manifestation:11 patients had symptoms of recurrent chills and fever,and combined with different degrees of jaundice.The initial symptom occurred in 2 weeks to 3 months after iatrogenic biliary tree destruction.Of 11 patients,7 were complicated by different degrees of hepatic abscess,and abscess involving left and right half liver were detected in 4 patients,aggregating in right half liver in 2 patients and aggregating in left half liver in 1 patient.Eight patients had secondary biliary cirrhosis,portal hypertension,splenomegaly and hypersplenism during the late course of disease.(3) Imaging performance:magnetic resonanced cholangio-pancreatography (MRCP) and cholangiography examinations showed missing bile duct in necrosis area,beading-like stricture and dilation of damaged biliary tree,reducing proximal bile duct branches and associated gallbladder necrosis.CT and MRI examinations showed that structure of distribution area of damaged biliary tree disappeared or bile duct wall was thickened,and hepatic abscesses of patients were scattered and multiple.Five patients had significantly secondary liver atrophy-hypertrophic syndrome,showing atrophy of right liver and hyperplasia of left liver.Radiotherapy-induced biliary tree destruction showed a characteristic of continued progress,localized abnormality in the early stage and typical imaging changes after the damage stability in the late stage.(4) Treatment:of 11 patients,4 didn't undergo surgery,and 7 underwent 18 intentional and conclusive surgeries (1-4 times / per case).(5) Follow-up:11 patients were followed up for 2-132 months,with a median time of 73 months.During the follow-up,2,1 and 8 patients had respectively excellent,good and poor prognoses.Among 11 patients,4 died (2 died of severe infection and 2 died of biliary cirrhosis),and 7 survived.Conclusions Iatrogenic biliary tree destruction is easy to cause hepatic abscess,liver atrophy-hypertrophic syndrome or biliary cirrhosis,and it can be diagnosed by imaging examination.The definitive treatment should be followed by liver resection or liver transplantation of involving area according to the extent of damage.

13.
Article in Chinese | WPRIM | ID: wpr-710503

ABSTRACT

Objective To evaluate the function of Rouviere's sulcus with posterior cystohepatic triangle in prevention of bile duct injury in laparoscopic cholecystectomy.Methods The clinical data of 170 patients undergoing laparoscopic cholecystectomy through Rouviere's sulcus approach with posterior cystohepatic triangle from May 2016 to June 2017 in the Department of General Surgery,the Second People's Hospital of Wuhu were retrospectively analyzed.The incidences and types of Rouviere's sulcus were documented.Results The open type of Rouviere's sulcus was visualized in 108 patients(63.53%),the fused type in 44 patients(25.88%),and the deficient type in 18 patients (10.59%).Hence in a total of 152 (89.41%) patients had Rouviere's sulcus.All patients underwent laparoscopic cholecystectomy safely.There was no bile duct injury or mortality.Four patients (2.35%) were converted to open operation,all were deficient type of Rouviere's sulcus for chronic inflammation of the gallbladder triangle.Conclusion Rouviere's sulcus are present and visible in most patients.Guided by Rouviere's sulcus with posterior cystohepatic triangle it could be safely and effectively to expose the anatomical structure of Calot's triangle and prevent bile duct injury in laparoscopic cholecystectomy.

14.
Cir. parag ; 41(2): 25-26, ago. 2017. ilus
Article in Spanish | LILACS, BDNPAR | ID: biblio-972612

ABSTRACT

La lesión quirúrgica de vías biliares es un accidente que puede ocurrir durante una cirugía del árbol biliar. Su incidencia aumentó en la última década con la extensión del uso de la cirugía laparoscópica. Su frecuencia llega hasta el 0,2% de todas las colecistectomías según varias series. El diagnóstico precoz favorece las chances de una reparación rápida y con mejor pronóstico para el paciente. Presentamos el caso de una mujer de 44 años que presentó ictericia obstructiva en el curso de su post operatorio de colecistectomía convencional. A la CRMN se constató sección completa de la vía biliar a la altura de la confluencia. En la reintervención se realizó una derivación hepático yeyunal termino lateral en Y de Roux con sutura manual con buena evolución.


Surgical injury of the bile ducts is an accident that can occur during a bile tree surgery. Its incidence increased in the last decade with the extension of the use of laparoscopic surgery. Its frequency reaches 0.2% of all cholecystectomies according to several series. The early diagnosis favors the chances of a quick repair and with a better prognosis for the patient. We present the case of a 44-year-old woman who presented jaundice in the course of her post-operative conventional cholecystectomy. A complete section of the biliary tract was found at IMR at the confluence level. We performed reintervention with jejunal hepatic bypass with manual suture with good evolution.


Subject(s)
Female , Humans , Adult , Bile Ducts/injuries , Cholecystectomy , Jaundice
15.
Article in Chinese | WPRIM | ID: wpr-662923

ABSTRACT

Objective To study the combined used of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic surgery in the treatment of Mirizzi syndrome and in the prevention of bile duct injury in minimally invasive surgery.Methods A retrospective analysis was conducted on patients who suffered from Mirizzi syndrome treated with ERCP and laparoscopic surgery from March 2011 to February 2016 at the Center Hospital of Xianyang City,Southern Medical University.Results Of 1762 patients who underwent ERCP,56 patients were diagnosed to suffer from Mirizzi syndrome (3.2%).Thirty-six patients with type Ⅰ disease successfully completed LC.The adjacent tissues were used to repair the defects in the first stage for type Ⅱ disease in 12 patients and for type Ⅲ disease in 4 patients.T tube was not used.The bile was drained with a ENBD drainage tube.After LC,a bile duct to jejunum Roux-en-Y anastomosis was carried out for the type Ⅱ disease in 2 patients and for the type Ⅲ disease in 2 patients.There was no perioperative death for the whole group of patients.Two patients developed symptoms of cholangitis,and the disease was stable after non-operative treatment.For the other patients,follow-up for more than 2 years showed good results.Conclusions ERCP was useful in the diagnosis of Mirizzi syndrome and in the Csendes typing before operation.ENBD could be used as a guide to find the hepatic duct,thus avoiding bile duct injury during laparoscopic surgery and for the placement of T tube drainage.ERCP combined with laparoscopic surgery in the treatment of Mirizzi syndrome was safe and effective.It is an operation which has the advantage of minimal trauma,less pain and rapid recovery.

16.
Article in Chinese | WPRIM | ID: wpr-661023

ABSTRACT

Objective To study the combined used of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic surgery in the treatment of Mirizzi syndrome and in the prevention of bile duct injury in minimally invasive surgery.Methods A retrospective analysis was conducted on patients who suffered from Mirizzi syndrome treated with ERCP and laparoscopic surgery from March 2011 to February 2016 at the Center Hospital of Xianyang City,Southern Medical University.Results Of 1762 patients who underwent ERCP,56 patients were diagnosed to suffer from Mirizzi syndrome (3.2%).Thirty-six patients with type Ⅰ disease successfully completed LC.The adjacent tissues were used to repair the defects in the first stage for type Ⅱ disease in 12 patients and for type Ⅲ disease in 4 patients.T tube was not used.The bile was drained with a ENBD drainage tube.After LC,a bile duct to jejunum Roux-en-Y anastomosis was carried out for the type Ⅱ disease in 2 patients and for the type Ⅲ disease in 2 patients.There was no perioperative death for the whole group of patients.Two patients developed symptoms of cholangitis,and the disease was stable after non-operative treatment.For the other patients,follow-up for more than 2 years showed good results.Conclusions ERCP was useful in the diagnosis of Mirizzi syndrome and in the Csendes typing before operation.ENBD could be used as a guide to find the hepatic duct,thus avoiding bile duct injury during laparoscopic surgery and for the placement of T tube drainage.ERCP combined with laparoscopic surgery in the treatment of Mirizzi syndrome was safe and effective.It is an operation which has the advantage of minimal trauma,less pain and rapid recovery.

17.
Journal of Clinical Surgery ; (12): 476-477, 2017.
Article in Chinese | WPRIM | ID: wpr-620715

ABSTRACT

Complicated bile duct injury greatly affects quality of patients' life and even threatens their life safety because it is difficult to be recognized and reconstructed,also with the poor surgical effect.Regarding to the surgical timing of complicated bile duct injury,it still have a big controversy.Here we would discuss the timing of surgeries for bile duct injury.We consider that it should be reconstructed when it is recognized during operation,even converted to laparotomy for laparoscopic surgeries.About postoperative cases,we think that it should be operated to explore damage range and reconstruct for those cases found within 48 hours and without obvious infection.However,reconstruction should be performed after 6 weeks for those found after 48 hours or with biliary duct infection.

18.
Article in Chinese | WPRIM | ID: wpr-618702

ABSTRACT

Objective To study the long-term results of using an autologous vascularized pedicled flap of gastric tissues in the repair of traumatic bile duct strictures.Methods From 2002 to 2016,38 patients with traumatic bile duct strictures underwent repair using an autologous vascularized pedicled flap of stomach tissues.The postoperative morbidity,mortality,long-term clinical results,liver function and the rate of biliary stricture recurrence were studied.Results The overall complication rate was 18.4% (7/38).A delay in healing of the incision wound occurred in 4 patients,biliary fistula in 2,and ascites in 1.Two patients died of malignant tumor.The median follow-up was 92 (61 ~ 107) months and the follow-up rate was 100%.Excellent results were obtained in 97.2% (35/36) of patients.Abnormal liver function was detected in 1 patient which improved with treatment using choleretic drugs.The remaining 35 patients had normal liver functions with absence of abdominal pain.Conclusions To repair traumatic bile duct strictures using an autologous vascularized pedicled flap of stomach tissues was safe and reliable,and good long-term outcomes are available.

19.
Article in Chinese | WPRIM | ID: wpr-609688

ABSTRACT

Objective To investigate the type,clinical and imaging features of iatrogenic bile duct injury and the efficacy and safety of endoscopic and interventional radiology therapy.Methods A total of 48 patients with iatrogenic bile duct injury who have undergone endoscopic and/or interventional therapy from January 1st 2013 to June 30th 2016 were enrolled.Patients' general information,causes of injury,clinical manifestations,treatment methods,efficacy and complications were retrospectively analyzed.Results The causes of iatrogenic bile duct injury were cholecystectomy(45.8%,22/48),liver transplantation (35.4%,17/48),transjugular intrahepatic portosystemic shunt (8.3%,4/48),Roux-en-Y anastomosis (6.3%,3/48) and endoscopic retrograde cholangiopancreatography (4.2%,2/48).The most common type of iatrogenic bile duct injury was stenosis of intra/extra bile ducts (66.7%,32/48).Other types included biliary fistula(18.8%,9/48),hemobilia (10.4%,5/48) and stenosis of anastomotic stoma (4.2%,2/48).The most common clinical manifestations were jaundice (37.5%,18/48) and abdominal pain (29.2%,14/48).Other clinical manifestations were fever (14.6%,7/48),hematemesis or melena (8.3%,4/48) and abnormal drainage fluid (8.3%,4/48).Diagnosis was confirmed by angiography,cholangiography or endoscopy.The overall effective rate of minimally invasive therapy was 91.7% (44/48) and the most common complications were fever (16.7%,8/48) and pancreatitis (10.4%,5/48).Other complications were hemobilia (2.1%,1/48),cardia dilaceration (2.1%,1/48) and biliary fistula caused by catheter shedding(2.1%,1/48).Conclusion Iatrogenic bile duct injury could occur after upper abdominal surgeries,endoscopic or interventional procedures.Early diagnosis and treatment with endoscopic or vascular interventional methods can achieve satisfying efficacy and safety.

20.
Article in Chinese | WPRIM | ID: wpr-607847

ABSTRACT

Objective To investigate the application value of Calot triangle hollowing-out maneuver in laparoscopic cholecystectomy (LC) for preventing bile duct injury.Methods The retrospective cross-sectional study was conducted.The clinical data of 537 patients who underwent LC in the Dexing People's Hospital between January 2011 and December 2015 were collected.The tissues in Calot triangle were hollowed out,and cystic ducts were cut off and then gall bladders were resected.Observation indicators:(1) operation situations:anatomy of the Calot triangle and operation time;(2) postoperative recovery situations:postoperative complications and bile duct injury;(3) follow-up situation.The follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and occurrence of cholangitis up to May 2016.Results (1) Operation situations:of 537 patients with LC,anatomical relation among cystic duct,common hepatic duct and common bile duct (three-duct relation for short) could be seen in 165 patients without dissection,and three-duct relation cannot be seen in other 372 patients.Of 372 patients,16 were operated on with the gallbladder open due to the difficult dissection of Calot triangle,7 were converted to open surgery due to local severe adhesion and unclear structure,1 was converted to open surgery due to intraoperative varices induced bleeding in Calot triangle,and other 348 patients underwent successful LC using Calot triangle hollowing-out maneuver.Operation time was 15-190 minutes,with an average time of 28 minutes.(2) Postoperative situations:2 patients were complicated with biliary colic pain,showing stones in the distal common bile duct via magnetic resonance imaging scans,and then received endoscopic sphincterotomy (EST);3 had subxyphoid puncture hole infection,1 had a small amount of postoperative bleeding due to hepatocirrhosis,3 had pulmonary infection,and they were improved by symptomatic treatment;1 had chylous fistula and were improved through drainage and low fat diet intake for 1 week;2 with mild bile leakage was improved through peritoneal drainage.No bile duct injury was detected.(3) Follow-up situation:348 patients were followed up for 12-18 months,with a median time of 16 months.During the followup,348 patients with follow-up had survival without manifestation of cholangitis.Conclusion Calot triangle hollowing-out maneuver could effectively prevent bile duct injury in LC.

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