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Objective:To investigate the application value of Da Vinci robotic surgical system in radical resection of perihilar cholangiocarcinoma (pCCA).Methods:The retrospective and descrip-tive study was conducted. The clinicopathological data of 10 patients undergoing Da Vinci robotic radical resetion of pCCA in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from September 2018 to March 2021 were collected. There were 6 males and 4 females, aged (58±7)years. Observtaion indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. The patients were followed up by telephone interview and outpatient service to detect survival of patients and tumor recurrence up to June 2021. Measurement data with normal distribution were expressed as Mean± SD, and measurement data with skewed distribu-tion were represented as M(range). Count data were represented as absolute numbers. Results:(1) Surgical situations: 10 patients underwent Da Vinci robotic radical resection of pCCA succe-ssfully, without conversion to laparotomy or intraoperative blood transfusion. The operation time of 10 patients was (465±87)minutes, and the volume of intraoperative blood loss was (167±81)mL. Of the 10 patients, 1 case of Bismuth type Ⅲb had a positive surgical margin and the remaining 9 cases had R 0 resection. (2) Postoperative situations: the time to gastric tube extraction was (2.3±1.9)days, and the duration of postoperative hospital stay of the 10 patients was (19.9±9.0)days. Among the 10 patients, there was no second operation or perioperative death. Of the 10 patients, 6 cases had perioperative complications, including 5 cases wth pleural effusion, 3 cases with peritoneal effusion, and 1 case with intestinal obstruction, some patients had multiple complications. After symptomatic conservative treatment, pleural effusion and peritoneal effusion disappeared and intestinal obstruction was improved. None of the 10 patients had serious complica-tions such as bleeding, biliary fistula or intestinal fistula. (3) Follow-up: 10 patients were followed up for 3-20 months, with a median follow-up time of 11 months. During the follow-up, 3 of 10 patients had tumor recurrence which occurred in intrahepatic bile duct of residual liver, and no implantation metastasis was found in the rest of abdominal cavity. Of the 7 unrecurrent patients, 1 case died of gastrointestinal bleeding and multiple organ failure. Nine of 10 patients survived well. Conclusion:The Da Vinci robotic surgical system used for radical operation of pCCA is feasible.
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Resumen Introducción: Se define como quiste de colédoco gigante aquel con un diámetro ≥ 10 cm. A pesar de que el abordaje laparoscópico ha sido contraindicado, se presenta el caso de un adolescente con un quiste de colédoco gigante resuelto por laparoscopía. Caso clínico: Paciente de sexo masculino de 14 años con un quiste de colédoco gigante tratado con anastomosis hepático-duodenal laparoscópica. Conclusiones: El tamaño promedio de los quistes de colédoco tratados por laparoscopía es de 40 mm. No se recomienda la resección de quistes gigantes por mínima invasión debido a adherencias y restricción del campo visual. En este caso se realizó un tratamiento laparoscópico de manera exitosa.
Abstract Background: The giant choledochal cyst has a diameter ≥ 10 cm. Although laparoscopy has been contraindicated, we present the case of a teenager with a giant choledochal cyst resolved by laparoscopy. Case report: A 14-year-old male patient with a giant choledochal cyst treated with hepatic-duodenum laparoscopic anastomosis. Conclusions: The average size of bile duct cysts treated by laparoscopy is 40 mm. Giant cysts should not be resected through minimal invasion due to adhesions and a restricted visual field. We report a case of a giant cyst successfully treated by laparoscopy.
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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.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Ferimentos e Lesões/cirurgia , Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Argentina , Ductos Biliares/cirurgia , Anastomose Cirúrgica , Colangiografia , Indicadores de Morbimortalidade , Epidemiologia Descritiva , Estudos Retrospectivos , Angiografia por Tomografia Computadorizada , Hospitais PúblicosRESUMO
Bile duct injury is the most common complications of biliary surgery.With the development of tissue engineering,using artificial bile duct to treat the biliary tract disease has become the focus for the treatment of bile duct injury.This article summarizes the applications in clinical work and animal experiment of artificial bile ducts made of biological material,autologous tissue,non-absorbable polymer materials,as well as absorbable polymer materials in the clinical application and animal experiments.The advantageof each material is also discussed here.
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Objective To review the techniques used in biliary reconstruction for adult-adult living donor liver transplantation using a right lobe graft. Methods The clinical data of 21 pairs of donor and recipient who underwent right lobe living donor liver transplantation from April 2007 to May 2009 at Beijing Youan Hospital were analyzed retrospectively. Biliary anastomoses consisted of 10 single right hepatic duct to common hepatic duct anastomoses, 5 donor double branched ducts to recipient double branched ducts anastomoses, 5 single anastomoses between a donor double branched duct which had been converted to a single duct by ductoplasty to a single recipient bile duct, and 1 hepaticojejunostomy. A T-tube was inserted through the anterior wall of the common hepatic duct and splinted across the anastomosis in 2 recipients and a Y-tube was used in 1 recipient. Results 4 recipients died during the first post-transplant month. Another recipient received a retransplantation for acute liver necrosis. The remaining recipients were alive. The 1-year survival rate of the recipients was 77.65 %.5 patients developed biliary leakage and 2 patients developed biliary stricture. The 7 biliary complications were treated and cured by further surgical procedures. There was no significant difference in the biliary complications among the three different types of biliary anastomotic groups (x2 = 0. 659,P=0. 719). Conclusion The different types of biliary anastomoses can be used in living donor liver transplantation depending on the situations found in the donors and recipients. Continuous suturing on the posterior wall of the bile duct, interrupted suturing on the anterior wall and microsurgical techniques in biliary reconstruction are effective modalities to minimize biliary complications.
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Objective To investigate the clinical application of the distance of biliary duct measured by MRCP in bile duct resection of the donor and biliary reconstruction of recipients in living donor liver transplantation (LDLT) using right lobe graft.Methods Seventy-six living donors received preoperative MRCP after fat meal,who underwent right lobe resection and all had intraoperative cholangiography (IOC) for comparison.The accuracy of preoperative MRCP for biliary types in LDLT donors was analyzed and compared to that of IOC findings.The length of biliary duct between the junction of the right posterior hepatic duct (RPHD) and the junction of the right and left hepatic ducts was measured in MRCP images.The reconstruction of intraoperative data and the length,the diameter were compared,and binary logistic regression and Receiver Operating Characteristic (ROC) curves were calculated.The result included the limitation.Results In comparison to IOC,the accuracy of MRCP after fat meal was 97.4 ％.The length of biliary duct between the junction of RPHD and the junction of the right and left hepatic ducts measured by MRCP and the biliary type were the influencing factor of intraoperative reconstruction of biliary duct; while the diameter of biliary duct had no influence ROC curves showed that when the length of biliary duct of type Ⅰ was smaller or equal to 4.2 mm,or the biliary anatomy had variation,the number of biliary anastomotic stomas was more than one,and plasty was selected in 95 ％ of donors intraoperatively.The corresponding length of biliary duct of type Ⅲ and type Ⅳ was 3.8 mm,which was the limitation whether biliary plasty was done intraoperatively.Conclusion The type of bile duct in MRCP can reflect the biliary anatomy structure accurately.The length of biliary duct between the junction of RPHD and the junction of the right and left hepatic ducts measured by MRCP after fat meal can guide the biliary reconstruction intraoperatively and offer reliable basis for optimizing the clinical operation program in adult LDLT.
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To systematically summarize the current status of surgical techniques in biliary reconstruction and biliary complications following living donor liver transplantation and analyze the biliary reconstruction techniques and difficulties in the prevention of biliary complications.The refinements of surgical techniques and successful prevention and therapeutic strategies for reducing biliary complications after living donor liver transplantation are discussed.
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PURPOSE: Biliary complication (BC) is known as the most common and intractable complication after adult living donor liver transplantation (LDLT), but there is lack of large-volume studies with long-term follow-up. To assess the patterns of BC and their treatment results in adult recipients of LDLT. METHODS: 182 adult patients who received 156 right and 26 left liver grafts from January 2001 to December 2002 were selected after exclusion of dual-graft LDLT and short-term survivors. Methods of biliary reconstruction, types of BC, and treatment results of BC were analyzed. RESULTS: The median follow-up period was 38 months. Biliary reconstruction was done as single duct-to-duct anastomosis (DD, n=109), double DD (n=22), single hepaticojejunostomy (HJ, n=31), double HJ (n=16), and combination of DD and HJ (n=4). Overall patient or graft survival rate was 96.2% at 1 year and 93.3% at 3 years. BC-free survival rate was 83.4% at 1 year and 76.5% at 3 years. BC occurred much more often in right liver grafts. There were no statistical differences of BC between DD and HJ groups, and between single and double anastomoses groups. Most of anastomotic leak occurred during the first 1 month, but anastomotic stenosis occurred till 3 years. Small right graft duct around 3 mm in diameter became a significant risk factor of BC. Anastomotic leak occurred in 8 recipients, and 7 recovered after radiological, endoscopic, and surgical treatments. Anastomotic stenosis occurred in 34, and most of them were resolved by radiological intervention. CONCLUSION: The incidence of early BC could be reduced to below 10% by technical refinements, but additional late BC occurred till 3 years. Most of BC were successfully controlled by endoscopic and radiological treatments. DD seems to be avoided in small graft duct around 3 mm in diameter. Close surveillance for BC seems to be mandatory for the first 3 years.
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Adulto , Humanos , Fístula Anastomótica , Constrição Patológica , Seguimentos , Sobrevivência de Enxerto , Incidência , Transplante de Fígado , Fígado , Doadores Vivos , Fatores de Risco , Taxa de Sobrevida , Sobreviventes , TransplantesRESUMO
BACKGROUND/AIMS: Biliary complication after orthotopic liver transplantation(OLT) continue to be a significant cause of surgical morbidity, occurring in 10~50% of patients. Bile duct obstruction and biliary leaks account for the majority of these complications. An end-to-end choledochocholedochostomy(CD) with or without T-tube or a Roux-en-Y choledochojejunostomy(CDJ) have been the standard methods of biliary reconstruction following OLT. We reviewed our experiences of OLT to assess whether or not use of the T-tube leads to increased biliary tract complications. MATERIALS AND METHODS: From May 1996 to Feb 1998, 34 consecutive liver transplantation in 33 patients were performed at our hospital, including 12 living related liver transplantaiton. Nineteen patients were male and twenty-two patients were adult. The main indication of OLT was hepatitis B virus related cirrhosis(14 cases)in adult and biliary atresia(7 cases) in child. Four ABO incompatible cases were included in living related liver transplant. Biliary tract complications were categorized as bile leak, stenosis, or obstruction that required therapeutic intervention. Retrospective review of clinical recordings and laboratory findings were done. The median follow up periods was 10 months(range: 3~24 month). RESULTS: The methods of biliary reconstruction in cadaveric liver transplant were CD with T-tube(n=2), CD without T-tube(n=18) and Roux-en-Y HJ(n=2), respectively. In living related liver transplant(LRLT), all 12 cases were reconstructed by Roux-en-Y CDJ without stent. Biliary tract complications were observed in one case of child LRLT patient that biliary fistula occurred at exposed bile duct on cut surface of liver. This patient underwent reoperation for constructed another HJ and progressed without complication. T-tube related complication was observed in one adult patient. T-tube was impinged at cystic duct that obstructed bile flow, intermittently. This patient was treated with insertion of PTBD catheter and removal of T-tube. No other biliary complications were detected in our series. CONCLUSION: Performing an end-to-end CD without T-tube was a safe and effective method of reconstructing the biliary tract following hepatic transplantation in adult patients, comparing with T-tube splintage method. We concluded that routine placement of the T-tube at hepatic transplantation was considered to some selective cases, but more large scale and long -term studies were needed.
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Adulto , Criança , Humanos , Masculino , Ductos Biliares , Bile , Fístula Biliar , Sistema Biliar , Cadáver , Catéteres , Colestase , Constrição Patológica , Ducto Cístico , Seguimentos , Vírus da Hepatite B , Transplante de Fígado , Fígado , Reoperação , Estudos Retrospectivos , StentsRESUMO
BACKGROUND/AIMS: Biliary complication after orthotopic liver transplantation(OLT) continue to be a significant cause of surgical morbidity, occurring in 10~50% of patients. Bile duct obstruction and biliary leaks account for the majority of these complications. An end-to-end choledochocholedochostomy(CD) with or without T-tube or a Roux-en-Y choledochojejunostomy(CDJ) have been the standard methods of biliary reconstruction following OLT. We reviewed our experiences of OLT to assess whether or not use of the T-tube leads to increased biliary tract complications. MATERIALS AND METHODS: From May 1996 to Feb 1998, 34 consecutive liver transplantation in 33 patients were performed at our hospital, including 12 living related liver transplantaiton. Nineteen patients were male and twenty-two patients were adult. The main indication of OLT was hepatitis B virus related cirrhosis(14 cases)in adult and biliary atresia(7 cases) in child. Four ABO incompatible cases were included in living related liver transplant. Biliary tract complications were categorized as bile leak, stenosis, or obstruction that required therapeutic intervention. Retrospective review of clinical recordings and laboratory findings were done. The median follow up periods was 10 months(range: 3~24 month). RESULTS: The methods of biliary reconstruction in cadaveric liver transplant were CD with T-tube(n=2), CD without T-tube(n=18) and Roux-en-Y HJ(n=2), respectively. In living related liver transplant(LRLT), all 12 cases were reconstructed by Roux-en-Y CDJ without stent. Biliary tract complications were observed in one case of child LRLT patient that biliary fistula occurred at exposed bile duct on cut surface of liver. This patient underwent reoperation for constructed another HJ and progressed without complication. T-tube related complication was observed in one adult patient. T-tube was impinged at cystic duct that obstructed bile flow, intermittently. This patient was treated with insertion of PTBD catheter and removal of T-tube. No other biliary complications were detected in our series. CONCLUSION: Performing an end-to-end CD without T-tube was a safe and effective method of reconstructing the biliary tract following hepatic transplantation in adult patients, comparing with T-tube splintage method. We concluded that routine placement of the T-tube at hepatic transplantation was considered to some selective cases, but more large scale and long -term studies were needed.
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Adulto , Criança , Humanos , Masculino , Ductos Biliares , Bile , Fístula Biliar , Sistema Biliar , Cadáver , Catéteres , Colestase , Constrição Patológica , Ducto Cístico , Seguimentos , Vírus da Hepatite B , Transplante de Fígado , Fígado , Reoperação , Estudos Retrospectivos , StentsRESUMO
Choledochal cyst is rare in the Western countries, but common in the Oriental countries. The reported complicatioins of choledochal cyst are ascending cholangitis, recurrent pancreatities, progressive biliary cirrhosis, portal hypertension, stone in the cyst, and malignant in the biliary tract. Bile peritonitis secondary to rupture is one of the rarest complications of choledochal cyst, and its reported incidence was 1.8% (Yamaguci, 1980) to 18% (Karnak et al, 1997). The exact cause of perforation of choledochal cyst is unknown, but an anomalous arrangement of the pancreatobiliary ductal system with a long common channel may contribute to the formation of choledochal cyst and even perforation of cyst.Authors reviewed 4 cases (14.2%) of bile peritonitis among 28 cases of choledochal cyst in infants from Jan. 1983 to Jan. 1998. Their ages ranged from 6 months to 3 years and three of them were female. Abdominal distension, pain, and vomiting were common symptoms, and clinical jandice and palpable mass were present in one case. Pre-operative laboratory investigations showed elevated serum bilirubin, serum AST and serum ALT in 3 cases, and elevated serum amylase in one case. The perforation sites were located on the common bile duct at its junction with the cystic duct in 2 cases, distal cyst wall in 1 case and left hepatic duct at its junction with cyst in 1 case. The types of choledochal cysts according to Todani's classification (1977) were as follows;Type IVa was in 3 cases, type I was in 1 case. The results of operative cholangiogram according to new Komi's classification (1992) were as follows;Type Ia was 2 cases, type IIb 1 case, and type III 1 case. One stage primary cyst excision and hepaticojejunostomy(Roux-en Y type) was done in 3 cases, and two staged operation in 1 case. All patients have recovered unevenfully after surgery and discharged at post -operative 9.8th day averagely. Authors concluded that the primary choledochal cyst excision with biliary recontinuity was a safe surgical procedure in ruptured choledochal cyst in infants.