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Bile leakage after loop closure vs clip closure of the cystic duct during laparoscopic cholecystectomy:A retrospective analysis of a prospective cohort 被引量:4
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作者 Sandra C Donkervoort Lea M Dijksman +4 位作者 Aafke H van Dijk Emile A Clous Marja A Boermeester Bert van Ramshorst Djamila Boerma 《World Journal of Gastrointestinal Surgery》 SCIE CAS 2020年第1期9-16,共8页
BACKGROUND Laparoscopic cholecystectomy(LC)is one of the most frequently performed surgical procedures.Cystic stump leakage is an underestimated,potentially life threatening complication that occurs in 1%-6%of the pat... BACKGROUND Laparoscopic cholecystectomy(LC)is one of the most frequently performed surgical procedures.Cystic stump leakage is an underestimated,potentially life threatening complication that occurs in 1%-6%of the patients.With a secure cystic duct occlusion technique during LC,bile leakage becomes a preventable complication.AIM To investigate the effect of polydioxanone(PDS)loop closure of the cystic duct on bile leakage rate in LC patients.METHODS In this retrospective analysis of a prospective cohort,the effect of PDS loop closure of the cystic duct on bile leakage complication was compared to patients with conventional clip closure.Logistic regression analysis was used to develop a risk score to identify bile leakage risk.Leakage rate was assessed for categories of patients with increasing levels of bile leakage risk.RESULTS Of the 4359 patients who underwent LC,136(3%)underwent cystic duct closure by a PDS loop.Preoperatively,loop closure patients had significantly more complicated biliary disease compared to the clipped closure patients.In the loop closure cohort,zero(0%)bile leakage occurred compared to 59 of 4223(1.4%)clip closure patients.For patients at increased bile leakage risk(risk score≥1)rates were 1.6%and up to 13%(4/30)for clip closure patients with a risk score≥4.This risk increase paralleled a stepwise increase of actual bile leakage complication for clip closure patients,which was not observed for loop closure patients.CONCLUSION Cystic duct closure with a PDS loop during LC may reduce bile leakage in patients at increased risk for bile leakage. 展开更多
关键词 Laparoscopic cholecystectomy Cystic duct occlusion bile leak Endo-loop
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Non-image diagnosis of bile duct injury during laparoscopic cholecystectomy 被引量:7
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作者 Ding Luo Xun-Ru Chen +2 位作者 Shen-Hong Li Jing-Xi Mao Shao-Ming Yu From the Department of Hepatobiliary Surgery, Kunming General Hospital, Kunming 650032, China 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2002年第1期106-110,共5页
Objective: To evaluate the role of simple non-imagetechnique in intraoperative diagnosis of bile duct in-jury (BDI).Methods: BDI was highly suspected at the original la-paroscopic cholecystectomy (LC) when the followi... Objective: To evaluate the role of simple non-imagetechnique in intraoperative diagnosis of bile duct in-jury (BDI).Methods: BDI was highly suspected at the original la-paroscopic cholecystectomy (LC) when the following 3abnormal findings were noted: the 'cystic duct' stump(the common bile duct stump actually) markedly re-tracted down to the duodenum; bile leakage from theporta hepatis; abnormal mucosal patch attached to the'cystic duct' stump of the removed gallbladder. Allcases of suspected BDI were converted to have laparo-tomy. Image techniques such as intraoperative cholan-giography or ultrasonography were not utilized forrecognition of BDI in all 9 patients.Results: BDI in 4 of the 9 patients was suspected ac-cording to 1-3 abnormal intraoperative findings de-scribed above. The four patients were subjected imme-diately to converted laparotomy. Abnormal findingswere not observed or misinterpreted in the other 5misdiagnosed patients.Conclusions: Timely recognizing whether BDI occursshould be considered as a routine procedure ofLC. Negligence of operators to the abnormalities of theoriginal LC, is the main cause of misdiagnosis forBDL. Simple non-image approaches such as close ob-servation of these abnormalities can make timely diag-nosis for most BDIs during the original LC. 展开更多
关键词 laparoscopic cholecystectomy bile duct injury DIAGNOSIS
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The Clinical Analysis of Bile Duct Injury during Laparoscopic Cholecystectomy
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作者 Zhenfeng Gao Peizhi Li +1 位作者 Fangzhang Chen Dingyong Tan 《International Journal of Clinical Medicine》 2015年第11期825-830,共6页
The study was to improve surgical safety and reduce the incidence of bile duct injury (BDI) during laparoscopic cholecystectomy. The clinical information of 31 cases with bile duct injury during Laparoscopic Cholecyst... The study was to improve surgical safety and reduce the incidence of bile duct injury (BDI) during laparoscopic cholecystectomy. The clinical information of 31 cases with bile duct injury during Laparoscopic Cholecystectomy (LC) was analyzed retrospectively. Thirty patients with bile duct injury were divided into 5 types according to Bismuth typing, including: type I 9 cases, type II 12 cases, type III 4 cases, type IV 3 cases, type V 3 cases. After median follow-up of 48 months, 30 (97%) patients are alive and 29 (94%) remain in good general condition with normal liver function. One patient died from acute obstructive suppurative cholangitis (AOSC). One patient appeared to have pain under the xiphoid that was resolved after 3 months. Recurrent strictures following repair have developed in two (6%) patients with high injuries combined with right hepatic arterial injury. Appropriate surgical indications, handling Calot triangle carefully and correctly, and conversion to open surgery at the right moment are the keys of prevention and treatment of bile duct injury during LC. 展开更多
关键词 laparoscopy cholecystectomy bile duct injury TREATMENT
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Isolated right posterior bile duct injury following cholecystectomy:Report of two cases 被引量:5
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作者 Maciej Wojcicki Waldemar Patkowski +5 位作者 Tomasz Chmurowicz Andrzej Bialek Anna Wiechowska-Kozlowska Rafal Stankiewicz Piotr Milkiewicz Marek Krawczyk 《World Journal of Gastroenterology》 SCIE CAS 2013年第36期6118-6121,共4页
Anatomic variations of the right biliary system are one of the most common risk factors for sectoral bile duct injury(BDI)during cholecystectomy.Isolated right posterior BDI may in particular be a challenge for both d... Anatomic variations of the right biliary system are one of the most common risk factors for sectoral bile duct injury(BDI)during cholecystectomy.Isolated right posterior BDI may in particular be a challenge for both diagnosis and management.Herein we describe two cases of isolated right posterior sectoral BDI that took place during laparoscopic cholecystectomy.Despite effective external biliary drainage from the liver hilum in both cases,there was a persistent biliary leak observed which was not visible on endoscopic retrogradecholangiogram.Careful evaluation of images from both endoscopic and magnetic resonance cholangiograms revealed the diagnosis of an isolated right posterior sectoral BDI.These were treated with a delayed bisegmental(segments 6 and 7)liver resection and a Roux-en-Y hepaticojejunostomy respectively with good outcomes at 24 and 4 mo of follow-up.This paper discusses strategies for prevention of such injuries along with the diagnostic and therapeutic challenges it offers. 展开更多
关键词 cholecystectomy bile duct injury Sectoral bile duct HEPATICOJEJUNOSTOMY Liver RESECTION
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Timing of surgical repair of bile duct injuries after laparoscopic cholecystectomy: A systematic review 被引量:2
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作者 Patryk Kambakamba Sinead Cremen +1 位作者 Beat Möckli Michael Linecker 《World Journal of Hepatology》 2022年第2期442-455,共14页
BACKGROUND The surgical management of bile duct injuries(BDIs)after laparoscopic cholecystectomy(LC)is challenging and the optimal timing of surgery remains unclear.The primary aim of this study was to systematically ... BACKGROUND The surgical management of bile duct injuries(BDIs)after laparoscopic cholecystectomy(LC)is challenging and the optimal timing of surgery remains unclear.The primary aim of this study was to systematically evaluate the evidence behind the timing of BDI repair after LC in the literature.AIM To assess timing of surgical repair of BDI and postoperative complications.METHODS The MEDLINE,EMBASE,and The Cochrane Library databases were systematically screened up to August 2021.Risk of bias was assessed via the Newcastle Ottawa scale.The primary outcomes of this review included the timing of BDI repair and postoperative complications.RESULTS A total of 439 abstracts were screened,and 24 studies were included with 15609 patients included in this review.Of the 5229 BDIs reported,4934(94%)were classified as major injury.Timing of bile duct repair was immediate(14%,n=705),early(28%,n=1367),delayed(28%,n=1367),or late(26%,n=1286).Standardization of definition for timing of repair was remarkably poor among studies.Definitions for immediate repair ranged from<24 h to 6 wk after LC while early repair ranged from<24 h to 12 wk.Likewise,delayed(>24 h to>12 wk after LC)and late repair(>6 wk after LC)showed a broad overlap.CONCLUSION The lack of standardization among studies precludes any conclusive recommendation on optimal timing of BDI repair after LC.This finding indicates an urgent need for a standardized reporting system of BDI repair. 展开更多
关键词 bile duct injury Major bile duct injury Laparoscopic cholecystectomy Surgical repair Immediate repair Early repair Delayed repair Late repair Biliary reconstruction Standardization of bile duct injury repair reporting
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Classification of iatrogenic bile duct injury 被引量:6
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作者 Wan-Yee Lau Eric C.H.Lai 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2007年第5期459-463,共5页
BACKGROUND: Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. The ease of management, operative risk, and outcome of bile... BACKGROUND: Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly dependent on the type of injury and its location. This article reviews the various classification systems of bile duct injury. DATA SOURCES: A Medline, PubMed database search was performed to identify relevant articles using the keywords 'bile duct injury', 'cholecystectomy', and 'classification'. Additional papers were identified by a manual search of the references from the key articles. RESULTS: Traditionally, biliary injuries have been classified using the Bismuth's classification. This classification, which originated from the era of open surgery, is intended to help the surgeons to choose the appropriate technique for the repair, and it has a good correlation with the final outcome after surgical repair. However, the Bismuth's classification does not encompass the whole spectrum of injuries that are possible. Bile duct injury during laparoscopic cholecystectomy tends to be more severe than those with open cholecystectomy. Strasberg's classification made Bismuth's classification much more comprehensive by including various other types of extrahepatic bile duct injuries. Our group, Bergman et al, Neuhaus et al, Csendes et al, and Stewart et al have also proposed other classification systems to complement the Bismuth's classification. CONCLUSIONS: None of the classification system is universally accepted as each has its own limitation. Hopefully, a universally accepted comprehensive classification system will be published in the near future. 展开更多
关键词 laparoscopic cholecystectomy bile duct injury bile duct stricture bile leak CLASSIFICATION
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Management of aberrant bile duct during laparoscopic cholecystectomy 被引量:4
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作者 Ji-Hui Li Cheng-Zhu Zheng +1 位作者 Chong-Wei Ke Kai Yin the Center of Minimal Invasive Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2002年第3期438-441,共4页
Objective: To investigate the incidence of aberrant bile duct and its management during laparoscopic cholecystectomy (LC). Methods: In 10 000 patients undergoing laparoscopic cholecystectomy from 1992 to July 2001, 3 ... Objective: To investigate the incidence of aberrant bile duct and its management during laparoscopic cholecystectomy (LC). Methods: In 10 000 patients undergoing laparoscopic cholecystectomy from 1992 to July 2001, 3 had the involvement of the right accessory hepatic duct. In patient 1, the aberrant duct drained into the cystic duct was confirmed by open operation. In patient 2, the aberrant duct, which drained to the common bile duct (CBD), was injured and treated with suture and ligature under laparoscopy. In patient 3, the ab- errant duct, which also drained to the CBD, was confirmed and preserved. Results: All patients recovered well except patient 1 who had a transient elevation of ALT. No bile leak- age or other complication occurred. Conclusions: Only variation near the confluence and the entrance of the cystic duct into the bile duct is discovered during laparoscopic cholecystectomy. Right accessory hepatic duct is common and should be preserved during the operation. The accidentally injured small accessory hepatic duct can be treated with ligature without severe disturbance to liver func- tion. 展开更多
关键词 aberrant bile duct accessory hepatic duct laparoscopy cholecystectomy
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Management of bile duct injuries combined with accessory hepatic duct during laparoscopic cholecystectomy 被引量:4
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作者 Pei-Tu Ren Bao-Chun Lu +1 位作者 Jian-Hua Yu Xin Zhu 《World Journal of Gastroenterology》 SCIE CAS 2014年第34期12363-12366,共4页
Bile duct injuries(BDIs)are difficult to avoid absolutely when the biliary tract has a malformation,such as accessory hepatic duct.Here,we investigated the management strategies for BDI combined with accessory hepatic... Bile duct injuries(BDIs)are difficult to avoid absolutely when the biliary tract has a malformation,such as accessory hepatic duct.Here,we investigated the management strategies for BDI combined with accessory hepatic duct during laparoscopic cholecystectomy. 展开更多
关键词 bile duct injuries Accessory hepatic duct Laparoscopic cholecystectomy Management strategies Hepatoenterostomy
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Alterations in fibrinolytic system proteins PAI-1,MMP-3,MMP-8,TIMP-1 and TIMP-2 in post-cholecystectomy bile duct injury
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作者 Jose Manuel Hermosillo-Sandoval Luis Miguel Román-Pintos +4 位作者 Adolfo Daniel Rodriguez-Carrizález Ernesto Germán Cardona-Munoz Fermin Paul Pacheco-Moisés Genaro Gabriel Ortiz Alejandra Guillermina Miranda-Diaz 《Journal of Biomedical Science and Engineering》 2013年第8期58-67,共10页
Introduction: In bile duct injuries (BDI), cholestasis and cholangitis can alter the fibrinolytic system by promoting an increase of extracellular matrix depositions which favor an imbalance between metalloproteinases... Introduction: In bile duct injuries (BDI), cholestasis and cholangitis can alter the fibrinolytic system by promoting an increase of extracellular matrix depositions which favor an imbalance between metalloproteinases (MMPs) and their tissue inhibitors (TIMPs). Materials and Methods: Levels of PAI-1, MMP-3, MMP-8, TIMP-1 and TIMP-2 in 35 patients with post-cholecystectomy BDI by complete biliary obstruction were measured and compared to a healthy control group. Sirius red staining and immune staining for MMP-3 and MMP-8 were also undertaken in liver biopsies. Results: Levels of PAI-1, TIMP-1, TIMP-2 and MMP-8 were higher in BDI than healthy controls: 15 ± 2 ng/mL vs 7.1 ± 2 ng/mL (p 0.024);539 ± 64 ng/mL vs 256 ± 13 ng/mL (p p p 2 vs. 22865.7 ± 3865 μm2 in healthy controls (p 2 vs. 30744.2 ± 5810.2 μm2 (p 2 vs. 116337.9 ± 24803.3 μm2 (p 0.55). These results suggest an imbalance between fibrogenic/fibrinolytic protein levels. Interestingly, expression of the fibrinolytic protein MMP-8 was increased in serum and liver biopsies in BDI. Conclusion: We found an imbalance of profibrogenic molecules which promote extracellular matrix deposition. The over-expression of fibrinolytic proteins such as MMP-8 could limit liver fibrosis, preventing hepatic dysfunction in post-cholecystectomy BDI. 展开更多
关键词 cholecystectomy bile duct injury(BDI) Plasminogen Activator Inhibitor Type 1(PAI-1) Tissue Inhibitors of Metalloproteinases(TIMP’s) Metalloproteinases(MMP’s)
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Iatrogenic Bile Duct Injuries after Cholecystectomy, Is the Laparoscopic Approach a Good Idea?
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作者 Renam Tinoco Augusto Tinoco +2 位作者 Matheus P. S. Netto Luciana J. El-Kadre Júlia M. L. C. Rocha 《Surgical Science》 2022年第7期343-351,共9页
Objective: The treatment of iatrogenic bile duct injuries is still a challenge for hepatobiliary and general surgeons. Roux-en-Y hepaticojejunostomy, one of the most appropriate techniques for the treatment of circumf... Objective: The treatment of iatrogenic bile duct injuries is still a challenge for hepatobiliary and general surgeons. Roux-en-Y hepaticojejunostomy, one of the most appropriate techniques for the treatment of circumferential lesions, either occurring less than 2 cm from the bifurcation or in the bifurcation of the common hepatic duct, requires experience in advanced laparoscopy and hepatobiliary surgery. This study aims to present the results of laparoscopic hepaticojejunostomy (LHJ) for the treatment of iatrogenic bile duct injuries (IBDI). Methods: A retrospective study analyzing the medical records of patients diagnosed with IBDI and treated using LHJ of patients at the Hospital S?o José do Avaí (HSJA). Sex, age, previous cholecystectomy technique, signs and symptoms, postoperative complications, length of stay, injury classification, and time elapsed from injury to diagnosis were analyzed. Magnetic resonance cholangiography (MRC), endoscopic retrograde cholangiopancreatography (ERCP) or intraoperative cholangiography. Results: From March 2006 to December 2018, six patients underwent LHJ. In five cases (83.33%), the primary operation was a laparoscopic cholecystectomy (LC) and in one patient (13.66%) open cholecystectomy. The most frequent clinical sign was jaundice. The mean surgical time was 153.2 minutes (range: 115 to 206 minutes), and the hospital stay was 3 to 7 days (mean: 4.16 days). One patient had infection of the umbilical trocar incision and one patient presented with stenosis of the hepaticojejunal anastomosis and was treated with radioscopic pneumatic dilatation. Conclusion: LHJ for circumferential and total IBDI either diagnosed early (during surgery) or late, may be a safe and effective option, with similar results to the conventional technique, a low complication rate and all the known advantages of minimally invasive surgery. 展开更多
关键词 cholecystectomy bile duct injury Iatrogenic bile duct injury Laparoscopic Hepaticojejunostomy
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Factors influencing the results of treatment of bile duct injuries during laparoscopic cholecystectomy 被引量:2
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作者 Li-Bo Li, Xiu-Jun Cai, Yi-Ping Mou, Qi Wei and Xian-Fa Wang Hangzhou, China Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University Medical College, Hangzhou 310016, China 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2005年第1期113-116,共4页
BACKGROUND: The short-term results of repair of lapa- roscopic bile duct injuries have been well discussed, but the long-term results have been rarely reported. This study was undertaken to evaluate the factors influe... BACKGROUND: The short-term results of repair of lapa- roscopic bile duct injuries have been well discussed, but the long-term results have been rarely reported. This study was undertaken to evaluate the factors influencing the outcome of repair of bile duct injuries caused by laparoscopic chole- cystectomy. METHODS: The outcomes of repair of bile duct injuries caused by laparoscopic cholecystectomy in 31 patients were reviewed retrospectively, and the effects of injury recogni- tion, cholangiography, repair modality and techniques on the long-term results were analyzed. RESULTS: Bile duct injuries were repaired successfully in 19 (95%) of 20 patients with injuries who had been recog- nized intraoperatively, and in 10 (90%) of 11 patients with injuries who had been recognized postoperatively. Repair was successful in 29 (93% ) of the 31 patients after complete cholangiography. Closure of partial division, laceration, or small perforation of the bile duct with or without T tube drainage was satisfactory in the 23 patients. End to end re- pair over T tube was successful in 2 transection patients, who were detected intraoperatively. Roux-en-Y hepatico- jejunostomy was used successfully to repair transection, ex- cision or stricture of the bile duct in 4 of 5 patients (80% ). CONCLUSION: Early detection of bile duct injuries caused by laparoscopy, complete evaluation of the biliary duct, and appropriate surgical modality and techniques are help- ful to improve the results of repair for laparoscopic bile duct injuries. 展开更多
关键词 cholecystectomy LAPAROSCOPIC INJURIES bile duct
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Iatrogenic extrahepatic bile duct injury in 182 patients: causes and management 被引量:1
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《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2002年第2期265-269,共5页
Objective: To describe the causes and treatment ofiatrogenic bile duct injury caused by cholecystecto-my.Methods: 182 patients with iatrogenic extrahepaticbile duct injury from 4 university hospitals of Chinawere revi... Objective: To describe the causes and treatment ofiatrogenic bile duct injury caused by cholecystecto-my.Methods: 182 patients with iatrogenic extrahepaticbile duct injury from 4 university hospitals of Chinawere reviewed. Details of primary cholecystectomy,biliary reconstruction as well as postoperative ma-nagement were recorded. All patients were followedup for at least 6 months (6 months to 9 years, medi-an 3.5 years). The adequacy of repair was assessedby regular evaluation of the patients clinical statusand liver function variables. Hepatobiliary B-ultra-sonography was used routinely in the follow up of pa-tients, and magnetic resonance cholangiopancreatog-raphy was applied in the patients suggestive of abnor-mality.Results: In 152 patients, bile duct injury happenedduring open cholecystectomy, and in 30 patients dur-ing laparoscopic cholecystectomy. All the injuries de-veloped during anterograde cholecystectomy (at theCalot’s triangle). All the patients with these injuriesunderwent choledochocholedochostomy or Roux-en-Ycholedochojejunostomy with good results (161 pa-tients), recurrent stricture (11), and death (10).Conclusions: During cholecystectomy, the Calot’s tri-angle should be identified anatomically, but retro-grade cholecystectomy is the optimal choice. Bileduct injury should be discovered as soon as possibleand be managed timely. Different operative methodsare optional according to the degree of injury and thepostoperative period. 展开更多
关键词 IATROGENIC injury bile duct laparoscopic cholecystectomy CHOLEDOCHOJEJUNOSTOMY magnetic resonance CHOLANGIOPANCREATOGRAPHY biliary hepatic cirrhosis
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Blunt Dissection: A Solution to Prevent Bile Duct Injury in Laparoscopic Cholecystectomy 被引量:8
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作者 Xiu-Jun Cai Han-Ning Ying Hong Yu Xiao Liang Yi-Fan Wang Wen-Bin Jiang Jian-Bo Li Lin Ji 《Chinese Medical Journal》 SCIE CAS CSCD 2015年第23期3153-3157,共5页
Background: Laparoscopic cholecystectomy (LC) has been a standard operation and replaced the open cholecystectomy (OC) rapidly because the technique resulted in less pain, smaller incision, and faster recovery. T... Background: Laparoscopic cholecystectomy (LC) has been a standard operation and replaced the open cholecystectomy (OC) rapidly because the technique resulted in less pain, smaller incision, and faster recovery. This study was to evaluate the value of blunt dissection in preventing bile duct injury (BDI) in laparoscopic cholecystectomy (LC). Methods: From 2003 to 2015, LC was performed on 21,497 patients, 7470 males and 14,027 females, age 50.3 years (14-84 years). The Calot's triangle was bluntly dissected and each duct in Calot's triangle was identified before transecting the cystic duct. Results: Two hundred and thirty-nine patients (1.1%) were converted to open procedures. The postoperative hospital stay was 2.1 (0-158) days, and cases (46%) had hospitalization days of 1 day or less, and 92.8% had hospitalization days of 3 days or less; BDI was occurred in 20 cases (0.09%) including 6 cases of common BDI, 2 cases of common hepatic duct injury, l case of fight hepatic duct injury, I case of accessory fight hepatic duct, 1 case of aberrant BDI l case ofbiliary stricture, 1 case ofbiliary duct perforation, 3 cases ofhemobilia, and 4 cases of bile leakage. Conclusion: Exposing Calot's triangle by blunt dissection in laparoscopic cholecystectomy could prevent intraoperative BD1. 展开更多
关键词 bile duct injury Blunt Dissection Laparoscopic cholecystectomy
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Near-infrared cholangiography with intragallbladder indocyanine green injection in minimally invasive cholecystectomy
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作者 Savvas Symeonidis Ioannis Mantzoros +9 位作者 Elissavet Anestiadou Orestis Ioannidis Panagiotis Christidis Stefanos Bitsianis Vasiliki Bisbinas Konstantinos Zapsalis Trigona Karastergiou Dimitra Athanasiou Stylianos Apostolidis Stamatios Angelopoulos 《World Journal of Gastrointestinal Surgery》 SCIE 2024年第4期1017-1029,共13页
Laparoscopic cholecystectomy(LC)remains one of the most commonly performed procedures in adult and paediatric populations.Despite the advances made in intraoperative biliary anatomy recognition,iatrogenic bile duct in... Laparoscopic cholecystectomy(LC)remains one of the most commonly performed procedures in adult and paediatric populations.Despite the advances made in intraoperative biliary anatomy recognition,iatrogenic bile duct injuries during LC represent a fatal complication and consist an economic burden for healthcare systems.A series of methods have been proposed to prevent bile duct injury,among them the use of indocyanine green(ICG)fluorescence.The most commonly reported method of ICG injection is the intravenous administration,while literature is lacking studies investigating the direct intragallbladder ICG injection.This narrative mini-review aims to assess the potential applications,usefulness,and limitations of intragallbladder ICG fluorescence in LC.Authors screened the available international literature to identify the reports of intragallbladder ICG fluorescence imaging in minimally invasive cholecystectomy,as well as special issues regarding its use.Literature search retrieved four prospective cohort studies,three case-control studies,and one case report.In the three case-control studies selected,intragallbladder near-infrared cholangiography(NIRC)was compared with standard LC under white light,with intravenous administration of ICG for NIRC and with standard intraoperative cholangiography(IOC).In total,133 patients reported in the literature have been administered intragallbladder ICG administration for biliary mapping during LC.Literature includes several reports of intragallbladder ICG administration,but a standardized technique has not been established yet.Published data suggest that NIRC with intragallbladder ICG injection is a promising method to achieve biliary mapping,overwhelming limitations of IOC including intervention and radiation exposure,as well as the high hepatic parenchyma signal and time interval needed in intravenous ICG fluorescence.Evidence-based guidelines on the role of intragallbladder ICG fluorescence in LC require the assessment of further studies and multicenter data collection into large registries. 展开更多
关键词 Minimally invasive cholecystectomy Laparoscopic cholecystectomy Biliary tract mapping Indocyanine green Near-infrared fluorescent cholangiography Intracystic indocyanine green Intragallbladder indocyanine green bile duct injury
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Diagnosis and management of cystic duct leakage after laparoscopic cholecystectomy: report of 3 cases
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作者 Ji-Hui Li and Hang-Tao Liu Shanghai, China Minimally Invasive Surgery Center, Shanghai Chang- hai Hospital, Second Military Medical University, Shanghai 200433 , China 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2005年第1期147-151,共5页
BACKGROUND; Operative complications after laparo- scopic cholecystectomy (LC) vary. Abdominal pain and other symptoms caused by fluid accumulation in the opera- tive area are not uncommon. Cystic duct (CD) leakage is ... BACKGROUND; Operative complications after laparo- scopic cholecystectomy (LC) vary. Abdominal pain and other symptoms caused by fluid accumulation in the opera- tive area are not uncommon. Cystic duct (CD) leakage is one of the main sources of the fluid. This study was to eva- luate the procedures used in the diagnosis and management of CD leakage after LC. METHOD: The clinical materials of 3 patients with CD leakage after LC were studied retrospectively. RESULTS: Three female patients underwent LC for chronic cholecystitis associated with stones. Their clinical symp- toms were worsened of pre-existed cardiac arrhythmia, bile draining out from drainage tube, and biliary spillage from umbilical incision, respectively. Final diagnosis was made at the 1st, 2nd and 20th post-operative day. Two of the 3 patients were treated laparoscopically. Their opened CD stumps were closed with an endo-loop, with the abdomen irrigated and drained. The other patient was drained with the percutaneous technique, and a biliary stent was inserted under endoscopy. All patients recovered well. CONCLUSIONS: The clinical manifestations of CD leakage are different. Ascites can be found by B-ultrasound. Final diagnosis is dependent on magnetic resonance cholangiog- raphy and/or endoscopic retrograde cholangiopancreatog- raphy. Minimally invasive techniques can be applied to this complication safely and effectively. Reoperarion for closure of the opened CD stump can be fulfilled under laparosco- py. Endoscopic drainage must be accompanied with effec- tive abdominal drainage. 展开更多
关键词 cystic duct leakage bile leakage cholecystectomy laparoscopy
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Initial management of suspected biliary injury after laparoscopic cholecystectomy
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作者 Antti Siiki Reea Ahola +2 位作者 YrjöVaalavuo Anne Antila Johanna Laukkarinen 《World Journal of Gastrointestinal Surgery》 SCIE 2023年第4期592-599,共8页
Although rare,iatrogenic bile duct injury(BDI)after laparoscopic cholecystectomy may be devastating to the patient.The cornerstones for the initial management of BDI are early recognition,followed by modern imaging an... Although rare,iatrogenic bile duct injury(BDI)after laparoscopic cholecystectomy may be devastating to the patient.The cornerstones for the initial management of BDI are early recognition,followed by modern imaging and evaluation of injury severity.Tertiary hepato-biliary centre care with a multidisciplinary approach is crucial.The diagnostics of BDI commences with a multiphase abdominal computed tomography scan,and when the biloma is drained or a surgical drain is put in place,the diagnosis is set with the help of bile drain output.To visualize the leak site and biliary anatomy,the diagnostics is supplemented with contrast enhanced magnetic resonance imaging.The location and severity of the bile duct lesion and concomitant injuries to the hepatic vascular system are evaluated.Most often,a combination of percutaneous and endoscopic methods is used for control of contamination and bile leak.Generally,the next step is endoscopic retrograde cholangiography(ERC)for downstream control of the bile leak.ERC with insertion of a stent is the treatment of choice in most mild bile leaks.The surgical option of re-operation and its timing should be discussed in cases where an endoscopic and percutaneous approach is not sufficient.The patient's failure to recover properly in the first days after laparoscopic cholecystectomy should immediately raise suspicion of BDI and this merits immediate investigation.Early consultation and referral to a dedicated hepatobiliary unit are essential for the best outcome. 展开更多
关键词 cholecystectomy laparoscopy bile duct injury IATROGENIC Adverse event COMPLICATION
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Three-dimensional identification of the cystic infundibulum-cystic duct junction: a technique for identification of the cystic duct in laparoscopic cholecystectomy 被引量:5
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作者 Ding Luo Xun-Ru Chen +3 位作者 Jing-Xi Mao Sheng-Hong Li Zheng-Dong Zhou Shao-Ming Yu the Department of Hepatobiliary Surgery, Kunming General Hospital of PLA, Kunming 650032, China 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS 2003年第3期441-444,共4页
OBJECTIVE: The main cause of bile duct injury (BDI) at laparoscopic cholecystectomy is misidentification of the common bile duct as the cystic duct (CD). The aim of this article is to introduce a modified technique, i... OBJECTIVE: The main cause of bile duct injury (BDI) at laparoscopic cholecystectomy is misidentification of the common bile duct as the cystic duct (CD). The aim of this article is to introduce a modified technique, i. e., three-dimensional identification of the cystic infundibulum (CI)-CD junction, to prevent misidentification-induced BDI during laparoscopic cholecystectomy. METHODS: The Cl was extensively dissected to expose its anterior, interior-superior and inferior-dorsal aspects. With the CI nearly circularly dissected out, the CI and the appearance-indicated CI-CD junction might be three-dimensionally identified and the reality of the CI-CD junction as well as the reality of the CD could be precisely judged. RESULTS: Overall 10 BDIs were documented in this group. Since BDI occurred in 8 of 4382 patients receiving laparoscopic cholecyxtectomy, the technique for prevention of mixidentification-induced BDI was established. Among the late batch of 7618 patients, only two BDIs were noted. CONCLUSIONS: Three-dimensional identification of the CI-CD junction is a reliable, feasible and relatively low experience-dependent technique to prevent most of misidentification-induced BDI. 展开更多
关键词 laparoscopic cholecystectomy common bile duct bile duct injury
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Pattern of Presentation of Iatrogenic Biliary Injury Following Laparoscopic Cholecystectomy
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作者 Fahmid-Uz-Zaman Mohammad Aminul Islam +7 位作者 Md. Saba Al Galib Md. Mashkurul Alam Md. Shamsuddoha Khan Muhammad Tanvir Alam Akhanda Sania Hossain Laila Siddika Mohammad Emrul Hasan Khan Abul Bashar Md. Jamal 《Open Journal of Clinical Diagnostics》 2022年第4期55-62,共8页
Background: Cholecystectomy is one of the most now common abdominal surgeries performed every day. The incidence of bile duct injury (BDI) following open cholecystectomy is only 0.1% - 0.2%. After the introduction of ... Background: Cholecystectomy is one of the most now common abdominal surgeries performed every day. The incidence of bile duct injury (BDI) following open cholecystectomy is only 0.1% - 0.2%. After the introduction of laparoscopic cholecystectomy, the incidence has gone up to 0.4% - 0.7%. The present study is a prospective analysis of all patients with bile duct injury who were admitted to Dhaka Medical College Hospital during or at a variable period following cholecystectomy. Methods: To determine the pattern of presentation of iatrogenic biliary injury following cholecystectomy in the department of surgery of Dhaka Medical College Hospital, a total of 30 patients were purposively selected from May 2018 to November 2018. Patient particulars, records of physical and clinical evaluation, and operative details were collected by individual researchers. Data analysis was done by SPSS for windows version 21. Results: BDI was found very common among the age group 21 - 30 yrs (36%) and female dominant (60%). Majority of the patients presented with abdominal pain (96%), intra-abdominal collection (88%), biliary peritonitis (68%), cholangitis (60%), and obstructive jaundice (40%), and biliary fistula (40%). Laparoscopic cholecystectomy (84%) was the principal cause of biliary injury in our study. 48% of patients experienced clinical features within 7 days post-cholecystectomy. Per-operative diagnosis was done in only 12% of cases. 44% of patients in this study were recognized as Bismuth grade-3, followed by 36%, grade-2 patients. Management outcomes included wound infection (41.66%), minor bile leak (25%), peritonitis (8.33%), and renal impairment (8.33%). Conclusion: The effect of BDI is an extremely distressful clinical condition for the patients and their family members, hence proper care and management protocol should be followed. 展开更多
关键词 bile duct injury Laparoscopic cholecystectomy Post-Operative Complications BANGLADESH
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Post-cholecystectomy iatrogenic bile duct injuries:Emerging role for endoscopic management 被引量:1
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作者 Mohamed H Emara Mohammed Hussien Ahmed +4 位作者 Mohamed I Radwan Emad Hassan Emara Magdy Basheer Ahmed Ali Asem Ahmed Elfert 《World Journal of Gastrointestinal Surgery》 SCIE 2023年第12期2709-2718,共10页
Post-cholecystectomy iatrogenic bile duct injuries(IBDIs),are not uncommon and although the frequency of IBDIs vary across the literature,the rates following the procedure of laparoscopic cholecystectomy are much high... Post-cholecystectomy iatrogenic bile duct injuries(IBDIs),are not uncommon and although the frequency of IBDIs vary across the literature,the rates following the procedure of laparoscopic cholecystectomy are much higher than open cholecystectomy.These injuries caries a great burden on the patients,physicians and the health care systems and sometime are life-threatening.IBDIs are associated with different manifestations that are not limited to abdominal pain,bile leaks from the surgical drains,peritonitis with fever and sometimes jaundice.Such injuries if not witnessed during the surgery,can be diagnosed by combining clinical manifestations,biochemical tests and imaging techniques.Among such techniques abdominal US is usually the first choice while Magnetic Resonance Cholangio-Pancreatography seems the most appropriate.Surgical approach was the ideal approach for such cases,however the introduction of Endoscopic Retrograde Cholangio-Pancreatography(ERCP)was a paradigm shift in the management of such injuries due to accepted success rates,lower cost and lower rates of associated morbidity and mortality.However,the literature lacks consensus for the optimal timing of ERCP intervention in the management of IBDIs.ERCP management of IBDIs can be tailored according to the nature of the underlying injury.For the subgroup of patients with complete bile duct ligation and lost ductal continuity,transfer to surgery is indicated without delay.Those patients will not benefit from endoscopy and hence should not do unnecessary ERCP.For low–flow leaks e.g.gallbladder bed leaks,conservative management for 1-2 wk prior to ERCP is advised,in contrary to high-flow leaks e.g.cystic duct leaks and stricture lesions in whom early ERCP is encouraged.Sphincterotomy plus stenting is the ideal management line for cases of IBDIs.Interventional radiologic techniques are promising options especially for cases of failed endoscopic repair and also for cases with altered anatomy.Future studies will solve many unsolved issues in the management of IBDIs. 展开更多
关键词 Iatrogenic bile duct injuries cholecystectomy Surgical repair Endoscopic Retrograde Cholangio-Pancreatography Interventional radiology
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Robotic-assisted cholecystectomy: Current status and future application 被引量:2
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作者 Simran Chandhok Phillip Chao +1 位作者 Jonathan Koea Sanket Srinivasa 《Laparoscopic, Endoscopic and Robotic Surgery》 2022年第3期85-91,共7页
Robotic-assisted cholecystectomy(RC)is increasingly common.However,its exact role remains unde-fined,with multiport conventional laparoscopic cholecystectomy(LC)being regarded as the established gold standard.This rev... Robotic-assisted cholecystectomy(RC)is increasingly common.However,its exact role remains unde-fined,with multiport conventional laparoscopic cholecystectomy(LC)being regarded as the established gold standard.This review aims to provide an overview of the evidence for RC and to define its current and future role.A literature search was performed on the PubMed and Medline databases to identify relevant articles published between 1994 and February 2022.The evidence obtained was summarised in a narrative style.Greater emphasis was placed on recent 10-year articles and studies of higher meth-odological quality.RC is noninferior to LC.The robotic platform facilitates the application of minimally invasive surgery in a way conventional laparoscopy cannot.LC remains appropriate for the majority of patients requiring cholecystectomy.The advantages of RC include inherent technical benefits,facilitating the learning of new surgical technology and its potential to reduce the risk of open conversion and bile leakage in certain populations(Mirizzi syndrome,complicated calculous disease,chronic liver disease and possibly malignancy).It also has increasing applicability to related biliary surgery.The limitations include cost,loss of tactile feedback and the learning curve associated with initial implementation.Future applications of robotic surgical systems include utilisation in difficult cholecystectomy,cases of biliary malignancy,telerobotic surgery and telementoring. 展开更多
关键词 Robotic-assisted cholecystectomy Laparoscopic cholecystectomy bile duct injury repair
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