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1.
Langenbecks Arch Surg ; 406(4): 1139-1147, 2021 Jun.
Article in English | MEDLINE | ID: mdl-33389115

ABSTRACT

PURPOSE: Echinococcosis, also known as hydatidosis, is a zoonosis that is endemic in many countries worldwide. Liver hydatid cysts have a wide variety of clinical manifestations, among which obstructive jaundice is one of the rarer forms. The aims of the study were to analyze the preoperative management of these patients and to record the kind of surgical treatment performed and the short- and long-term postoperative results. METHODS: A retrospective two-center observational study of patients operated upon for liver hydatidosis with initial symptoms of obstructive jaundice. Preoperative characteristics, surgical data, and postoperative complications, including biliary fistula, were recorded. RESULTS: Of 353 patients operated upon for liver hydatidosis, 44 were included in the study. Thirty-five patients (79.6%) were defined as CE2 or CE3 in the World Health Organization (WHO) classification. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) was performed in 25 patients (56.8%) and identified intrabiliary communication in 29. Radical surgery was carried out in 29 of the total sample (65.9%). Severe postoperative complications (Clavien-Dindo grade IIIA or higher) were recorded in 25% of patients. The factors associated with greater postoperative morbidity were age above 65 (HR 8.76 [95% CI 0.78-97.85]), cyst location (HR 4.77 [95% CI 0.93-24.42]), multiple cysts (HR 14.58 [95% CI 1.42-149.96]), and cyst size greater than 5 cm (HR 6.88 [95% CI 0.95-50]). CONCLUSION: The presentation as obstructive jaundice causes greater postoperative morbidity. The main postoperative complication in these cases, despite radical surgery, is biliary fistula. In our series, routine preoperative ERCP did not show any benefit.


Subject(s)
Biliary Fistula , Echinococcosis , Jaundice , Biliary Fistula/epidemiology , Biliary Fistula/etiology , Biliary Fistula/surgery , Cholangiopancreatography, Endoscopic Retrograde , Humans , Liver , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Retrospective Studies
4.
Cir. Esp. (Ed. impr.) ; 96(7): 429-435, ago.-sept. 2018. tab, graf
Article in Spanish | IBECS | ID: ibc-176455

ABSTRACT

INTRODUCCIÓN: A pesar de la experiencia existente con la exploración laparoscópica de la vía biliar principal (ELVBP) en el tratamiento de la coledocolitiasis y de su eficacia bien demostrada, hay un riesgo de aparición de fístulas biliares de entre un 5 y un 15% tras el cierre de la coledocotomía. Evaluamos la utilidad de los sellantes de fibrina-colágeno para reducir la incidencia de fístulas biliares tras la coledocorrafia laparoscópica. MÉTODOS: Presentamos un análisis retrospectivo de 96 pacientes diagnosticados de coledocolitiasis sometidos a ELVBP desde marzo de 2009 a marzo de 2017. El cierre de la vía biliar se completó mediante coledocorrafia tras colocación de stent plástico transpapilar (CS) o realizando una sutura primaria (CP). La población de estudio fue dividida en dos grupos: pacientes con coledocorrafia cubierta con una lámina de colágeno-fibrina (GL) y pacientes con coledocorrafia sin cubrir (GSL). Se presenta el análisis de incidencia de aparición de fístulas biliares postoperatorias. RESULTADOS: Treinta y nueve pacientes (41%) fueron incluidos en el grupo GL, mientras que el grupo GSL fue formado por los 57 pacientes restantes (59%). Se demostró la homogeneidad de los grupos. La incidencia de fístulas biliares fue del 7,7% (3 pacientes) en el primer grupo y del 14% (8 pacientes) en el segundo (p = 0,338). La lámina de fibrina-colágeno redujo la incidencia de fístulas biliares de forma significativa en el subgrupo de los pacientes con CP (4,5% vs 33%, p = 0,020), siendo un factor protector con una odds ratio de 10,5. CONCLUSIÓN: La lámina de fibrina-colágeno aplicada sobre la coledocorrafia tras un cierre primario de la vía biliar puede tener un papel importante en la reducción significativa de la incidencia de fístulas biliares postoperatorias


INTRODUCTION: In spite of the acquired experience with laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis management, there is still a risk of biliary leakage of 5% to 15% following choledochotomy closure. We evaluate the usefulness of fibrin-collagen sealants to reduce the incidence of biliary fistula after laparoscopic choledochorrhaphy. METHODS: We report a retrospective analysis of 96 patients undergoing LCBDE from March 2009 to March 2017, whose closure of the bile duct was completed by antegrade stenting and choledochorraphy or by performing a primary suture. The study population was divided into two groups according to whether they received a collagen-fibrin sealant covering the choledochorrhaphy or not, analyzing the incidence of postoperative biliary fistula in each group. RESULTS: Thirty-nine patients (41%) received a fibrin-collagen sponge while the bile duct closure was not covered in the remaining 57 patients (59%). The incidence of biliary fistula was 7.7% (3 patients) in the first group and 14% (8 patients) in the second group (P = .338). In patients who underwent primary choledochorraphy, the fibrin-collagen sealant reduced the incidence of biliary leakage significantly (4.5% vs. 33%, P = .020), which was a protective factor with an odds ratio of 10.5. CONCLUSION: Fibrin-collagen sealants may decrease the incidence of biliary fistula in patients who have undergone primary bile duct closure following LCBDE


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Biliary Fistula/epidemiology , Biliary Fistula/prevention & control , Choledocholithiasis/complications , Treatment Outcome , Collagen/therapeutic use , Choledocholithiasis/surgery , Retrospective Studies , Bile Ducts/surgery , Laparoscopy , Odds Ratio , Biliary Tract Surgical Procedures
5.
Int J Surg ; 49: 62-67, 2018 Jan.
Article in English | MEDLINE | ID: mdl-29258887

ABSTRACT

BACKGROUND: Biliary fistula (BF) is a major surgical complication that can develop after pancreaticoduodenectomy (PD) whose risk factors remain unclear. Substantial atherosclerotic celiac axis stenosis (SACAS) has not been reported to be one of them. METHODS: Data from 507 patients undergoing PD between Jan 1, 2013 and Dec 31, 2015 were retrospectively collected. Clinical data from patients with SACAS were studied, and the independent risk factors for BF underwent multivariate logistic regression analysis, including SACAS. RESULTS: BF occurred in 22 (4.3%) patients, and the incidence of BF was significantly higher in patients with SACAS than in those without it (27.0% vs 2.6%, P < .001). In the univariate analysis, BF was significantly related to SACAS, older age, a higher ASA score, history of coronary disease, greater blood loss and RBC transfusion during surgery, smaller CBD diameter and higher POD 1 BUN level. The multivariate analysis showed that only SACAS (OR 8.91, 95% CI 2.36-33.69, P = .001), older age (OR 1.08, 95% CI 1.01-1.15, P = .028) and smaller preoperative CBD (OR 0.79, 95% CI 0.69-0.92, P = .002) were independent risk factors for postoperative BF. CONCLUSION: Older age and a smaller preoperative CBD diameter are independent risk factors for BF after PD, which is consistent with the literature. In addition, SACAS is a new independent risk factor for BF. For patients with SACAS, postoperative drainage should be carefully managed to precisely observe the potential for BF.


Subject(s)
Arteriosclerosis/complications , Biliary Fistula/etiology , Celiac Artery/pathology , Pancreaticoduodenectomy/adverse effects , Postoperative Complications/etiology , Age Factors , Aged , Arteriosclerosis/pathology , Biliary Fistula/epidemiology , Biliary Fistula/surgery , Constriction, Pathologic/complications , Databases, Factual , Drainage/adverse effects , Female , Humans , Incidence , Logistic Models , Male , Middle Aged , Multivariate Analysis , Postoperative Complications/epidemiology , Postoperative Complications/surgery , Postoperative Period , Preoperative Period , Retrospective Studies , Risk Factors
6.
Trop Doct ; 48(1): 20-24, 2018 Jan.
Article in English | MEDLINE | ID: mdl-28662605

ABSTRACT

Biliary fistulation from a hepatic hydatid cyst is its most frequent complication. If unrecognised, this may cause difficulties during and after surgical intervention. Our study looked into its incidence and also the possible risk factors in a retrospective investigation of 60 patients (34 women) who had undergone surgery or percutaneous treatment. Demographics and anatomical characteristics, such as cyst type, location, number, diameter and laboratory findings were examined. A full 50% had biliary fistulation, with increased risk if the cyst diameter was ≥8.8 cm.


Subject(s)
Biliary Fistula/epidemiology , Biliary Tract Diseases/epidemiology , Echinococcosis, Hepatic/surgery , Adult , Female , Humans , Incidence , Male , Retrospective Studies , Risk Factors
7.
Rev Gastroenterol Mex ; 82(4): 287-295, 2017.
Article in English, Spanish | MEDLINE | ID: mdl-28389051

ABSTRACT

INTRODUCTION: Bilioenteric fistulas are the abnormal communication between the bile duct system and the gastrointestinal tract that occurs spontaneously and is a rare complication of an untreated gallstone in the majority of cases. These fistulas can cause diverse clinical consequences and in some cases be life-threatening to the patient. AIM: To identify the incidence of bilioenteric fistula in patients with gallstones, its clinical presentation, diagnosis through imaging study, surgical management, postoperative complications, and follow-up. MATERIALS AND METHODS: A retrospective study was conducted to search for bilioenteric fistula in patients that underwent cholecystectomy at our hospital center due to cholelithiasis, cholecystitis, or cholangitis, within a 3-year time frame. RESULTS: Four patients, 2 men and 2 women, were identified with cholecystoduodenal fistula. Their mean age was 81.5 years. Two of the patients presented with acute cholangitis and 2 presented with bowel obstruction due to gallstone ileus. All the patients underwent surgical treatment and the diagnostic and therapeutic management of each of them was analyzed. CONCLUSIONS: The incidence of cholecystoduodenal fistula was similar to that reported in the medical literature. It is a rare complication of gallstones and its diagnosis is difficult due to its nonspecific symptomatology. It should be contemplated in elderly patients that have a contracted gallbladder with numerous adhesions.


Subject(s)
Biliary Fistula/surgery , Cholecystectomy , Cholelithiasis/complications , Intestinal Fistula/surgery , Aged , Aged, 80 and over , Biliary Fistula/diagnosis , Biliary Fistula/epidemiology , Biliary Fistula/etiology , Female , Follow-Up Studies , Humans , Incidence , Intestinal Fistula/diagnosis , Intestinal Fistula/epidemiology , Intestinal Fistula/etiology , Male , Retrospective Studies , Treatment Outcome
8.
Am Surg ; 83(1): 30-35, 2017 Jan 01.
Article in English | MEDLINE | ID: mdl-28234119

ABSTRACT

Biliary leakage (BL) is the most common cause of postoperative morbidity after conservative liver hydatid cyst surgery. The objective of this study was to determine incidence of BL and related risk factors in patients with solitary liver hydatid cyst who underwent conservative surgery. A total of 186 patients were included in this study. Age, gender, cyst recurrence, diameter, and localization, World Health Organization Informal Working Group on Echinococcosis (WHO-IWGE) classification, cavity management techniques, cyst content, and alkaline phosphatase (ALP) levels were evaluated with univariate and multivariate analyses. Of these patients 104 were female and 82 were male. The mean age was 43.5 ± 14.7 years. Postoperative BL was detected in 36 (19.4%) patients. Cyst diameter (P = 0.019), cyst localization (P = 0.007), WHO-IWGE classification (P = 0.017), and ALP level (P = 0.001) were the most significant risk factors for BL. Independent risk factors for BL were perihilar localization, large cyst diameter, high ALP level, and advanced age according to WHO-IWGE classification.


Subject(s)
Biliary Fistula/etiology , Echinococcosis, Hepatic/surgery , Postoperative Complications/etiology , Adult , Age Factors , Alkaline Phosphatase/blood , Analysis of Variance , Anthelmintics/administration & dosage , Biliary Fistula/epidemiology , Echinococcosis, Hepatic/pathology , Female , Humans , Incidence , Male , Middle Aged , Recurrence , Risk Factors
9.
Surg Endosc ; 31(4): 1986-1992, 2017 04.
Article in English | MEDLINE | ID: mdl-28078460

ABSTRACT

BACKGROUND: LPD has been cautiously regarded as feasible and safe for resection and reconstruction. However, anastomosis of the remnant pancreas is still thought to be a critical obstacle to the dissemination of LPD in general practice. This study presents a new technique of pancreaticojejunostomy for nondilated pancreatic duct and evaluates its safety and reliability. METHODS: From July 2014 to June 2015, a total of 52 patients underwent LPD with the new technique. A modified technique of duct-to-mucosa PJ was performed with transpancreatic interlocking mattress sutures, named the imbedding duct-to-mucosa PJ. Then the morbidity and mortality was calculated. RESULTS: This technique was applied in 52 patients after LPD all with nondilated pancreatic duct (1-3 mm). The mean operation time was 4.6 h (range, 3.5-8.3 h) and the median time for the anastomosis was 37 min (range, 24-53 min). Operative mortality was zero, and morbidity was 21.2 % (n = 11), including hemorrhage (n = 3, 5.8 %), biliary fistula (n = 1, 1.9 %), pulmonary infection (n = 1, 1.9 %), delayed gastric emptying (n = 2, 3.8 %), abdominal abscess caused by biliary fistula or PF formation (n = 2, 3.8 %), and POPF (n = 2, 3.8 %). Two patients developed a pancreatic fistula (one type A, one type B) classified according to the International Study Group on Pancreatic Fistula. CONCLUSIONS: The described technique is a simple and safe reconstruction procedure after LPD, especially for patients with nondilated pancreatic duct.


Subject(s)
Adenocarcinoma/surgery , Biliary Fistula/epidemiology , Duodenal Neoplasms/surgery , Pancreatic Ducts/surgery , Pancreatic Fistula/epidemiology , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy/methods , Pancreaticojejunostomy/methods , Postoperative Hemorrhage/epidemiology , Abdominal Abscess/epidemiology , Adult , Aged , Ampulla of Vater , Anastomosis, Surgical/methods , Bile Duct Neoplasms/surgery , Crohn Disease/surgery , Cystadenoma, Mucinous/surgery , Female , Gastrointestinal Stromal Tumors/surgery , Gastroparesis/epidemiology , Humans , Laparoscopy/methods , Lymphoma/surgery , Male , Middle Aged , Operative Time , Pancreas/surgery , Postoperative Complications/epidemiology , Reproducibility of Results , Suture Techniques , Sutures
10.
HPB (Oxford) ; 19(3): 264-269, 2017 03.
Article in English | MEDLINE | ID: mdl-28087319

ABSTRACT

BACKGROUND: Biliary fistula (BF) occurs in 3-8% of patients following pancreaticoduodenectomy (PD). It usually pursues a benign course, but rarely may represent a life-threatening event. STUDY DESIGN: Data from 1618 PDs were collected prospectively. BF was defined as the presence of bile stained fluid from drains by post-operative day 3 and confirmed by sinogram in the majority of cases. Three classifications were validated. RESULTS: BF occurred in 58 (3.6%) patients. In 22 cases was associated with pancreatic fistula (POPF). POPF, PPH, operative time and a smaller common bile duct (CBD) were significantly associated with BF. Only CBD diameter (HR 0.55, CI 95% 0.44-0.7, p < 0.01) was an independent predictor of BF. Patients with smaller CBDs developing concomitant BF and POPF carried the highest mortality rate (34.8%, n = 8/22). All the existing classifications resulted in discrete categories of BFs when considering hospital stay and total cost as dependent variables. CONCLUSIONS: Biliary fistula is rare, but it can be life threatening when associated with POPF. As the sole independent risk factor is the CBD diameter, surgical technique is crucial. Regardless of the existing classification systems, further studies must assess the additive burden of BF when a concomitant POPF is present.


Subject(s)
Biliary Fistula/epidemiology , Pancreaticoduodenectomy/adverse effects , Aged , Biliary Fistula/diagnosis , Biliary Fistula/mortality , Databases, Factual , Drainage , Female , Hospitals, High-Volume , Humans , Incidence , Italy/epidemiology , Male , Middle Aged , Pancreaticoduodenectomy/mortality , Prospective Studies , Risk Factors , Time Factors , Treatment Outcome
11.
Minerva Chir ; 71(6): 353-359, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27787479

ABSTRACT

BACKGROUNDː Despite notable advances in surgical skills and technology, incidence of biliary fistula after hepatic resection remains an issue. Aim of this study was to assess the role of intraoperative perihepatic drain in diagnosis and treatment of this complication. METHODSː The study included 641 patients who underwent hepatic resection without hepaticojejunostomy between Jan-2003 and Jan-2016. Data were obtained from our single-institution perspective database. RESULTSː Biliary fistula occurred in 3.4% (22/641). Major hepatic resection (P<0.001), S4-involving resection (P=0.006), cholangiocarcinoma (P<0.001) and intraoperative blood losses >375 mL (P<0.001) were associated with biliary fistula. At multivariate analysis, among patients with effective intraoperative perihepatic drain ("D" group) (16/22) onset of biliary fistula (mean, 5.1 vs. 31.5 days, P=0.12) and healing time (mean, 26.5 vs. 82.3 days, P=0.033) were more favorable compared with biloma group (B). Moreover, conservative treatment was more effective in D group (75% of cases). B group developed increased morbidity in terms of jaundice (83.3% vs. 18.7%, P=0.005), abscess (66.7% vs. 6.2%, P=0.003) and a trend of prolonged hospital stay (mean, 25.7 vs. 19.2 days, P=0.51) and mortality (16.7% vs. 6.2%, P=0.449). Difference in biliary fistula severity rate according to ISGLS classification between the two groups was statistically significant (P=0.003). CONCLUSIONSː This study confirms that the wider is the resection the higher the risk for biliary fistula. A correct drainage of bile leakage is the crucial requisite for early healing, providing a milder postoperative course. In our experience, intraoperative perihepatic drain positioning plays a key-role, as well as postoperative patency monitoring.


Subject(s)
Biliary Fistula/etiology , Drainage/methods , Hepatectomy , Intraoperative Care/methods , Postoperative Complications/etiology , Aged , Bile Duct Neoplasms/surgery , Biliary Fistula/epidemiology , Biliary Fistula/prevention & control , Blood Loss, Surgical , Cholangiocarcinoma/surgery , Cholangiopancreatography, Endoscopic Retrograde , Conservative Treatment , Female , Humans , Intraoperative Care/instrumentation , Jaundice/epidemiology , Jaundice/etiology , Length of Stay/statistics & numerical data , Liver Abscess/epidemiology , Liver Abscess/etiology , Liver Diseases/surgery , Male , Middle Aged , Postoperative Complications/epidemiology , Postoperative Complications/prevention & control , Postoperative Complications/therapy , Prospective Studies , Risk
12.
Surg Endosc ; 30(3): 876-82, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26092013

ABSTRACT

BACKGROUND: The incidence of bile duct injuries (BDI) after cholecystectomy, which is a life-threatening condition that has several medical and legal implications, currently stands at about 0.6%. The aim of this study is to describe our experience as the first center to use a laparoscopic approach for BDI repair. METHODS: A prospective study between June 2012 and September 2014 was developed. Twenty-nine consecutive patients with BDI secondary to cholecystectomy were included. Demographics, comorbidities, presenting symptoms, details of index surgery, type of lesion, preoperative and postoperative diagnostic work-up, and therapeutic interventions were registered. Videos and details of laparoscopic hepaticojejunostomy (LHJ) were recorded. Injuries were staged using Strasberg classification. A side-to-side anastomosis with Roux-en-Y reconstruction was always used. In patients with E4 and some E3 injuries, a segment 4b or 5 section was done to build a wide anastomosis. In E4 injuries, a neo-confluence was performed. Complications, mortality, and long-term evolution were recorded. RESULTS: Twenty-nine patients with BDI were operated. Women represented 82.7% of the cases. The median age was 42 years (range 21-74). Injuries at or above the confluence occurred in 62%, and primary repair at our institution was performed at 93.1% of the cases. Eight neo-confluences were performed in all E4 injuries (27.5%). The median operative time was 240 min (range 120-585) and bleeding 200 mL (range 50-1100). Oral intake was started in the first 48 h. Bile leak occurred in 5 cases (17.2%). Two patients required re-intervention (6.8%). No mortality was recorded. The maximum follow-up was 36 months (range 2-36). One patient with E4 injury developed a hepaticojejunostomy (HJ) stenosis after 15 months. This was solved with endoscopic dilatation. CONCLUSIONS: The benefits of minimally invasive approaches in BDI seem to be feasible and safe, even when this is a complex and catastrophic scenario.


Subject(s)
Bile Ducts/injuries , Biliary Fistula/epidemiology , Cholecystectomy, Laparoscopic/adverse effects , Postoperative Complications/epidemiology , Adult , Aged , Anastomosis, Roux-en-Y , Bile Ducts/surgery , Biliary Fistula/etiology , Biliary Fistula/surgery , Female , Humans , Male , Mexico/epidemiology , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/surgery , Prospective Studies , Reoperation , Retrospective Studies , Risk Factors , Treatment Outcome , Young Adult
13.
Chirurg ; 86(8): 776-80, 2015 Aug.
Article in German | MEDLINE | ID: mdl-25234505

ABSTRACT

BACKGROUND: The International Study Group of Liver Surgery (ISGLS) defined posthepatectomy liver failure as pathological values for the international normalized ratio (INR) and bilirubin 5 days after liver resection. The occurrence of biliary leakage was defined as a drainage bilirubin to serum bilirubin ratio > 3 at day 3 or later after resection or interventional surgical revision due to biliary peritonitis. A confirmatory explorative analysis was carried out. PATIENTS AND METHODS: The study involved an evaluation of primary liver resection from the years 2009 and 2010. Primary endpoints were the incidence of posthepatectomy liver failure and biliary leakage in accordance with the ISGLS definition. Secondary endpoints were complications and 90-day mortality. Results are displayed as median values (minimum and maximum). RESULTS: A total of 214 liver resections were included from the years 2009 and 2010. Patients were an average of 61.5 years old (min. 18, max. 83 years). The incidence of liver failure was 7.4 % (16 out of 214) and fatal in 7 patients. In 31 % (65 out of 214) a biliary leakage occurred, 14 (23 %) patients developed a type B, 1 patient(5 %) a type C leakage and 50 leakages were clinically inapparent. The incidence of clinically relevant biliary leakages was 7 % (15 out of 214). The sensitivity of the definition was 100 % and the specificity 75 %. The incidence of Dindo-Calvien complications > 3b was 10.2 %, of sepsis 5.6 % and the 90-day mortality was 6.5 %. Multivariate analysis did not reveal independent predictive factors for biliary leakage or liver failure. CONCLUSION: The definition for posthepatectomy liver failure was found to be valid in this cohort. The incidence of postoperative biliary leakage is over-estimated with the current definition and delivers a large number of false positive results without clinical relevance.


Subject(s)
Biliary Fistula/epidemiology , Hepatectomy/methods , Liver Failure/epidemiology , Postoperative Complications/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Biliary Fistula/etiology , Biliary Fistula/mortality , Bilirubin/blood , Cross-Sectional Studies , Female , Follow-Up Studies , Humans , Incidence , International Normalized Ratio , Liver Failure/etiology , Liver Failure/mortality , Male , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/mortality , Survival Analysis , Young Adult
14.
Ann Surg ; 259(2): 329-35, 2014 Feb.
Article in English | MEDLINE | ID: mdl-23295322

ABSTRACT

INTRODUCTION: Gallstone ileus is a mechanical bowel obstruction caused by a biliary calculus originating from a bilioenteric fistula. Because of the limited number of reported cases, the optimal surgical method of treatment has been the subject of ongoing debate. METHODS: A retrospective review of the Nationwide Inpatient Sample from 2004 to 2009 was performed for gallstone ileus cases treated surgically by enterotomy with stone extraction alone (ES), enterotomy and cholecystectomy with fistula closure (EF), bowel resection alone (BR), and bowel resection with fistula closure (BF). Patient demographics, hospital factors, comorbidities, and postoperative outcomes were reported. Multivariate analysis was performed comparing mortality, morbidity, length of stay, and total cost for the different procedure types. RESULTS: Of the estimated 3,452,536 cases of mechanical bowel obstruction from 2004 to 2009, 3268 (0.095%) were due to gallstone ileus-an incidence lower than previously reported. The majority of patients were elderly women (>70%). ES was the most commonly performed procedure (62% of patients) followed by EF (19% of cases). In 19%, a bowel resection was required. The most common complication was acute renal failure (30.44% of cases). In-hospital mortality was 6.67%. On multivariate analysis, EF and BR were independently associated with higher mortality than ES [(odds ratio [OR] = 2.86; confidence interval [CI]: 1.16-7.07) and (OR = 2.96; CI: 1.26-6.96) respectively]. BR was also associated with a higher complication rate, OR = 1.98 (CI: 1.13-3.46). CONCLUSIONS: Gallstone ileus is a rare surgical disease affecting mainly the elderly female population. Mortality rates appear to be lower than previously reported in the literature. Enterotomy with stone extraction alone appears to be associated with better outcomes than more invasive techniques.


Subject(s)
Biliary Fistula/complications , Digestive System Surgical Procedures/trends , Gallstones/complications , Intestinal Fistula/complications , Intestinal Obstruction/surgery , Intestine, Small/surgery , Aged , Aged, 80 and over , Biliary Fistula/epidemiology , Biliary Fistula/mortality , Biliary Fistula/surgery , Cholecystectomy/statistics & numerical data , Cholecystectomy/trends , Databases, Factual , Digestive System Surgical Procedures/methods , Digestive System Surgical Procedures/statistics & numerical data , Female , Gallstones/epidemiology , Gallstones/mortality , Gallstones/surgery , Hospital Mortality , Humans , Incidence , Intestinal Fistula/epidemiology , Intestinal Fistula/mortality , Intestinal Fistula/surgery , Intestinal Obstruction/epidemiology , Intestinal Obstruction/etiology , Intestinal Obstruction/mortality , Logistic Models , Male , Multivariate Analysis , Postoperative Complications/epidemiology , Retrospective Studies , Treatment Outcome , United States/epidemiology
15.
World J Gastroenterol ; 19(3): 355-61, 2013 Jan 21.
Article in English | MEDLINE | ID: mdl-23372357

ABSTRACT

AIM: To determine the outcome of patients with biliary fistula (BF) after treatment for hydatid disease of the liver. METHODS: Between January 2000 and December 2010, out of 301 patients with a diagnosis of hydatid cyst of the liver, 282 patients who underwent treatment [either surgery or puncture, aspiration, injection and reaspiration (PAIR) procedure] were analysed. Patients were grouped according to the presence or absence of postoperative biliary fistula (PBF) (PBF vs no-PBF groups, respectively). Preoperative clinical, radiological and laboratory characteristics, operative characteristics including type of surgery, peroperative detection of BF, postoperative drain output, morbidity, mortality and length of hospital stays of patients were compared amongst groups. Multivariate analysis was performed to detect factors predictive of PBF. Receiver operative characteristics (ROC) curve analysis were used to determine ideal cutoff values for those variables found to be significant. A comparison was also made between patients whose fistula closed spontaneously (CS) and those with intervention in order to find predictive factors associated with spontaneous closure. RESULTS: Among 282 patients [median (range) age, 23 (16-78) years; 77.0% male]; 210 (74.5%) were treated with conservative surgery, 33 (11.7%) radical surgery and 39 (13.8%) underwent percutaneous drainage with PAIR procedure A PBF developed in 46 (16.3%) patients, all within 5 d after operation. The maximum cyst diameter and preoperative alkaline phosphatase levels (U/L) were significantly higher in the PBF group than in the no-PBF group [10.5 ± 3.7 U/L vs 8.4 ± 3.5 U/L (P < 0.001) and 40.0 ± 235.1 U/L vs 190.0 ± 167.3 U/L (P = 0.02), respectively]. Hospitalization time was also significantly longer in the PBF group than in the no-PBF group [37.4 ± 18.0 d vs 22.4 ± 17.9 d (P < 0.001)]. A preoperative high alanine aminotransferase level (> 40 U/L) and a peroperative attempt for fistula closure were significant predictors of PBF development (P = 0.02, 95%CI: -0.03-0.5 and P = 0.001, 95%CI: 0.1-0.4), respectively. Comparison of patients whose PBF CS or with biliary intervention (BI) revealed that the mean diameter of the cyst was not significantly different between CS and BI groups however maximum drain output was significantly higher in the BI group (81.6 ± 118.1 cm vs 423.9 ± 298.4 cm, P < 0.001). Time for fistula closure was significantly higher in the BI group (10.1 ± 3.7 d vs 30.7 ± 15.1 d, P < 0.001). The ROC curve analysis revealed cut-off values of a maximum bilious drainage < 102 mL and a waiting period of 5.5 postoperative days for spontaneous closure with the sensitivity and specificity values of (83.3%-91.1%, AUC: 0.90) and (97%-91%, AUC: 0.95), respectively. The multivariate analysis demonstrated a PBF drainage volume < 102 mL to be the only statistically significant predictor of spontaneous closure (P < 0.001, 95%CI: 0.5-1.0). CONCLUSION: Patients with PBF after hydatid surgery often have complicated postoperative course with serious morbidity. Patients who develop PBF with an output < 102 mL might be managed expectantly.


Subject(s)
Bile Duct Diseases/epidemiology , Bile Duct Diseases/therapy , Biliary Fistula/epidemiology , Biliary Fistula/therapy , Echinococcosis, Hepatic/surgery , Adolescent , Adult , Aged , Disease Management , Female , Humans , Incidence , Length of Stay , Male , Middle Aged , Multivariate Analysis , Retrospective Studies , Survival Rate , Treatment Outcome , Young Adult
16.
Chirurgia (Bucur) ; 107(4): 454-60, 2012.
Article in English | MEDLINE | ID: mdl-23025111

ABSTRACT

UNLABELLED: Cholecystectomy is one of the most performed surgical interventions in general surgery. Laparoscopic cholecystectomy was associated with an increasing occurrence of biliary ducts lesions. The aim of this study is to draw the attention towards the permanent risk of these kind of complications, the curative difficulties and identifying the best therapeutic solution in order to obtain favorable results on long term. METHOD: There were retrospectively and prospectively analysed all the cases with diagnosis of iatrogenic biliary ducts lesion hospitalized and operated during 1987-2008 in the Surgical Clinic No 3 Cluj Napoca. RESULTS: The yearly distribution showed an increasing number of biliary lesions operated in the Surgical Clinic No 3 Cluj-Napoca. 81% of the iatrogenic lesions in our study occurred postlaparoscopic cholecystectomy, and 19% secondary to an open cholecystectomy. One hundred thirty-six patients had major biliary lesions (D, E classes according to Strasberg Soper) and 47 patients had minor lesions (A-C classes). The medium hospitalization range was 17 days. Eighty - three patients (45.3%) needed one, two or three surgical interventions before the complete cure of the lesions. The most frequent complication was plague suppuration (12.5%). The cardio-renal-pulmonary complications were present in 8.7% of the patients and the intra-abdominal abscess in 3.8% of the patients. The anastomotic fistula was present in 11% of the operated patients and 6% global mortality. CONCLUSIONS: The iatrogenic lesions of the biliary ducts are characterized by a complicated evolution, with series of interventions and progressive evolution to biliary stenosis. Delaying the final biliary treatment and the high number of interventions performed before patients were referred to hepato-biliary specialised centres lead to an increasing morbidity and hospitalization costs.


Subject(s)
Bile Ducts/injuries , Biliary Fistula/etiology , Biliary Fistula/surgery , Cholecystectomy, Laparoscopic/adverse effects , Adult , Aged , Aged, 80 and over , Anastomosis, Surgical/adverse effects , Bile Ducts/surgery , Biliary Fistula/diagnosis , Biliary Fistula/epidemiology , Cholecystectomy/adverse effects , Cholecystectomy, Laparoscopic/methods , Female , Humans , Incidence , Length of Stay , Male , Middle Aged , Prospective Studies , Reoperation , Retrospective Studies , Romania/epidemiology , Survival Rate
17.
World J Surg ; 36(11): 2692-8, 2012 Nov.
Article in English | MEDLINE | ID: mdl-22855215

ABSTRACT

BACKGROUND: For tumors deeply located in segment VIII (S8), right hepatectomy (RH) often is thought to solve the issue of technical accessibility. Yet, the common existence of an associated underlying diseased liver raises the question of parenchymal-sparing resection. METHODS: From 2002 to 2011, 34 patients underwent isolated S8 resection, and their operative and postoperative characteristics were compared to 34 matched patients who underwent RH for lesions located in S8. RESULTS: Indications and preoperative characteristics were comparable between the two groups except for larger tumors in RH patients compared with S8 patients (48 vs. 40 mm; p = 0.001). Achieving S8 resection required significantly longer clamping time (45 vs. 37 min, p = 0.011), more additional biliostasis because of obvious biliary leak (65 vs. 18 %, p < 0.001), and subsequently increased application of sealant material (56 vs. 9 %, p < 0.001) compared with RH. The overall complication rate was similar between the two groups (59 vs. 62 %, p = 0.804), although a trend toward a higher rate of biliary fistula was observed in S8 patients (20 vs. 6 %, p = 0.07). Routine CT scan performed on postoperative day 7 found significantly more subphrenic collections in S8 patients compared with RH patients (53 vs. 9 %, p = 0.003). On pathological examination, surgical margin width was comparable between the two groups. CONCLUSIONS: Anatomical S8 resection remains a technically demanding procedure with an elevated risk of postoperative biliary fistula but allows achieving adequate carcinologic resection. Increasing consideration for parenchymal sparing resection should lead to favor this approach as a treatment of choice for small and medium-sized tumors located in this segment.


Subject(s)
Biliary Fistula/etiology , Hepatectomy/adverse effects , Hepatectomy/methods , Liver Neoplasms/surgery , Adult , Aged , Biliary Fistula/epidemiology , Female , Humans , Liver Neoplasms/pathology , Male , Middle Aged , Retrospective Studies , Risk
18.
Rev Pneumol Clin ; 67(6): 380-3, 2011 Dec.
Article in French | MEDLINE | ID: mdl-22137285

ABSTRACT

Bilio-bronchial fistula due to hydatid disease is a rare but severe condition. Three levels, abdominal, diaphragmatic and thoracic, may be involved, with high perioperative mortality. We report a case of bilio-bronchial fistula successfully managed by thoracotomy. Thoracotomy is the best approach for surgical treatment at all three levels.


Subject(s)
Biliary Fistula/etiology , Biliary Tract Diseases/etiology , Bronchial Fistula/etiology , Echinococcosis, Hepatic/complications , Adult , Biliary Fistula/epidemiology , Biliary Tract Diseases/epidemiology , Bronchial Fistula/epidemiology , Echinococcosis, Hepatic/diagnosis , Echinococcosis, Hepatic/epidemiology , Echinococcosis, Pulmonary/complications , Echinococcosis, Pulmonary/diagnosis , Echinococcosis, Pulmonary/epidemiology , Humans , Male
19.
Fertil Steril ; 95(2): 804.e15-8, 2011 Feb.
Article in English | MEDLINE | ID: mdl-20817157

ABSTRACT

OBJECTIVE: To report the case and surgical therapy of a patient with bilioptysis after vaginal delivery, caused by bronchobiliary fistula. Histologic analysis revealed endometrial glands embedded in the decidual stroma neighboring the liver and the lung. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 39-year-old patient, 7 days after vaginal delivery, without endometrial history. INTERVENTION(S): Synchronous liver and lung resection of a bronchobiliary fistula by laparotomy and a transdiaphragmatic approach. MAIN OUTCOME MEASURE(S): For complicated brochobiliary fistula caused by endometriosis, radical surgical treatment is mandatory. RESULT(S): Histopathologic analyses confirmed the presence of clusters of endometrial glands embedded in the decidual stroma that were neighboring the liver, and perifistulous lung tissue was shown to contain biliary pigment absorbed by macrophages and their derivatives. CONCLUSION(S): Hepatic and perihepatic endometriosis can cause a bronchobiliary fistula. Exacerbation of the symptoms can be triggered by high estrogen levels, physiologically dominating the last trimester. For such a rare case, surgery is mandatory.


Subject(s)
Biliary Fistula/etiology , Biliary Tract Diseases/etiology , Bronchial Fistula/etiology , Endometriosis/complications , Liver Diseases/complications , Adult , Biliary Fistula/diagnosis , Biliary Fistula/epidemiology , Biliary Fistula/surgery , Biliary Tract Diseases/diagnosis , Biliary Tract Diseases/epidemiology , Biliary Tract Diseases/surgery , Bronchial Fistula/diagnosis , Bronchial Fistula/epidemiology , Bronchial Fistula/surgery , Endometriosis/diagnosis , Endometriosis/epidemiology , Endometriosis/surgery , Female , Humans , Incidence , Liver Diseases/diagnosis , Liver Diseases/epidemiology , Liver Diseases/surgery , Postpartum Period
20.
JOP ; 11(1): 18-24, 2010 Jan 08.
Article in English | MEDLINE | ID: mdl-20065547

ABSTRACT

CONTEXT: Tropical calcific pancreatitis is unique to developing countries with of unknown origin. OBJECTIVE: We evaluated the pattern of pancreaticobiliary ductal union in patients with tropical calcific pancreatitis. PATIENTS: Twenty-one patients with tropical calcific pancreatitis were compared to 174 control subjects with no pancreaticobiliary disease and 35 patients with alcohol-induced chronic pancreatitis. MAIN OUTCOME MEASURE: Two experienced people, blinded to the results, evaluated the pattern of pancreaticobiliary ductal union. Pancreaticobiliary ductal unions were classified as: separate ducts (no union), a short common-channel (length less than 6 mm), a long common-channel (length ranging 6-15 mm) and anomalous pancreaticobiliary ductal union (length greater than 15 mm). Anomalous union was defined as P-B type when the pancreatic duct appeared to join the bile duct and B-P type when the bile duct appeared to join the pancreatic duct. Any disparities between the two investigators were sorted out by mutual discussion. RESULTS: Pancreaticobiliary ductal union in tropical calcific pancreatitis patients as compared to those in the control group was as follows: separate ducts, 23.8% vs. 49.4% (P=0.036); a short common-channel, 4.8% vs. 28.7% (P=0.017); a long common channel, 33.3% vs. 18.4% (P=0.144) and anomalous pancreaticobiliary ductal union, 38.1% vs. 3.4% (P<0.001). The B-P pattern of anomalous pancreaticobiliary ductal union was more frequent in tropical calcific pancreatitis than in the control group but there was no statistical significance (P=0.103). The angle of the pancreaticobiliary ductal union in the tropical calcific pancreatitis group was 88.1 + or - 36.2 degrees as compared to 20.0 + or - 11.5 degrees in control group (P<0.001). Alcohol-induced chronic pancreatitis (No. 35) predominantly had either separate ducts (65.7%) or a short common channel (25.7%). CONCLUSION: We concluded that patients with tropical calcific pancreatitis in Kashmir had anomalous pancreaticobiliary ductal union, predominantly of B-P type with a wide angle of ductal union more frequently. This may be related to the etiology of tropical calcific pancreatitis in such regions.


Subject(s)
Biliary Fistula/epidemiology , Pancreatic Fistula/epidemiology , Pancreatitis/epidemiology , Adolescent , Adult , Bile Ducts/abnormalities , Biliary Fistula/complications , Biliary Fistula/diagnostic imaging , Calcinosis/complications , Calcinosis/diagnostic imaging , Calcinosis/epidemiology , Case-Control Studies , Cholangiopancreatography, Endoscopic Retrograde , Female , Humans , India/epidemiology , Male , Middle Aged , Pancreatic Fistula/complications , Pancreatic Fistula/diagnostic imaging , Pancreatitis/complications , Pancreatitis/diagnostic imaging , Young Adult
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