Background:Bile duct injury(BDI)after cholecystectomy remains a significant surgical challenge.No guideline exists to guide the timing of repair,while few studies compare early versus late repair BDI.This study aimed ...Background:Bile duct injury(BDI)after cholecystectomy remains a significant surgical challenge.No guideline exists to guide the timing of repair,while few studies compare early versus late repair BDI.This study aimed to analyze the outcomes in patients undergoing immediate,intermediate,and delayed repair of BDI.Methods:We retrospectively analyzed 412 patients with BDI from March 2015 to January 2020.The patients were divided into three groups based on the time of BDI reconstruction.Group 1 underwent an immediate reconstruction(within the first 72 hours post-cholecystectomy,n=156);group 2 underwent an intermediate reconstruction(from 4 days to 6 weeks post-cholecystectomy,n=75),and group 3 underwent delayed reconstruction(after 6 weeks post-cholecystectomy,n=181).Results:Patients in group 2 had significantly more early complications including anastomotic leakage and intra-abdominal collection and late complications including anastomotic stricture and secondary liver cirrhosis compared with groups 1 and 3.Favorable outcome was observed in 111(71.2%)patients in group 1,31(41.3%)patients in group 2,and 157(86.7%)patients in group 3(P=0.0001).Multivariate analysis identified that complete ligation of the bile duct,level E1 BDI and the use of external stent were independent factors of favorable outcome in group 1,the use of external stent was an independent factor of favorable outcome in group 2,and level E4 BDI was an independent factor of unfavorable outcome in group 3.Transected BDI and level E4 BDI were independent factors of unfavorable outcome.Conclusions:Favorable outcomes were more frequently observed in the immediate and delayed reconstruction of post-cholecystectomy BDI.Complete ligation of the bile duct,level E1 BDI and the use of external stent were independent factors of a favorable outcome.展开更多
BACKGROUND Chylothorax is an uncommon condition in which chyle leaks into the pleural cavity,and biliary peritonitis is a rare complication of thoracic duct embolization in clinical practice.CASE SUMMARY We describe t...BACKGROUND Chylothorax is an uncommon condition in which chyle leaks into the pleural cavity,and biliary peritonitis is a rare complication of thoracic duct embolization in clinical practice.CASE SUMMARY We describe the case of a 50-year-old woman who presented with chylothorax and underwent thoracic duct embolization using a coil and a mixture of histoacryl glue and lipiodol.The patient developed upper abdominal pain and fever after the intervention.She was diagnosed with biliary peritonitis and treated with cholecystectomy at Hanoi Medical University Hospital.CONCLUSION Although thoracic duct embolization is considered a safe and minimally invasive procedure,it is not without risk.Following thoracic duct embolization,severe or persistent abdominal pain should be explored utilizing imaging data and laboratory results to determine problems as soon as possible.展开更多
文摘Background:Bile duct injury(BDI)after cholecystectomy remains a significant surgical challenge.No guideline exists to guide the timing of repair,while few studies compare early versus late repair BDI.This study aimed to analyze the outcomes in patients undergoing immediate,intermediate,and delayed repair of BDI.Methods:We retrospectively analyzed 412 patients with BDI from March 2015 to January 2020.The patients were divided into three groups based on the time of BDI reconstruction.Group 1 underwent an immediate reconstruction(within the first 72 hours post-cholecystectomy,n=156);group 2 underwent an intermediate reconstruction(from 4 days to 6 weeks post-cholecystectomy,n=75),and group 3 underwent delayed reconstruction(after 6 weeks post-cholecystectomy,n=181).Results:Patients in group 2 had significantly more early complications including anastomotic leakage and intra-abdominal collection and late complications including anastomotic stricture and secondary liver cirrhosis compared with groups 1 and 3.Favorable outcome was observed in 111(71.2%)patients in group 1,31(41.3%)patients in group 2,and 157(86.7%)patients in group 3(P=0.0001).Multivariate analysis identified that complete ligation of the bile duct,level E1 BDI and the use of external stent were independent factors of favorable outcome in group 1,the use of external stent was an independent factor of favorable outcome in group 2,and level E4 BDI was an independent factor of unfavorable outcome in group 3.Transected BDI and level E4 BDI were independent factors of unfavorable outcome.Conclusions:Favorable outcomes were more frequently observed in the immediate and delayed reconstruction of post-cholecystectomy BDI.Complete ligation of the bile duct,level E1 BDI and the use of external stent were independent factors of a favorable outcome.
文摘BACKGROUND Chylothorax is an uncommon condition in which chyle leaks into the pleural cavity,and biliary peritonitis is a rare complication of thoracic duct embolization in clinical practice.CASE SUMMARY We describe the case of a 50-year-old woman who presented with chylothorax and underwent thoracic duct embolization using a coil and a mixture of histoacryl glue and lipiodol.The patient developed upper abdominal pain and fever after the intervention.She was diagnosed with biliary peritonitis and treated with cholecystectomy at Hanoi Medical University Hospital.CONCLUSION Although thoracic duct embolization is considered a safe and minimally invasive procedure,it is not without risk.Following thoracic duct embolization,severe or persistent abdominal pain should be explored utilizing imaging data and laboratory results to determine problems as soon as possible.
