Hepatobiliary Surgery Research Articles

Impact of fast-track surgery on perioperative care in patients undergoing hepatobiliary surgery

Impact of fast-track surgery on perioperative care in patients undergoing hepatobiliary surgery

Endoscopic management of postcholecystectomy complications at a Nigerian tertiary health facility

BackgroundCholecystectomy and common bile duct exploration for biliary stone disease are common hepatobiliary surgeries performed by general surgeons in Nigeria. These procedures can be complicated by injury to the biliary tree or retained stones, requiring repeat surgical intervention. This study presents the experience of using endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary surgery complications at the academic referral center of Obafemi Awolowo University Teaching Hospital (OAUTHC) Ile-Ife, Nigeria.MethodsAll patients with postcholecystectomy complications referred to the endoscopy unit at OAUTHC from March 2018 to April 2023 were enrolled. Preoperative imaging included a combination of abdominal ultrasound, CT, MRI, magnetic resonance cholangiopancreatography (MRCP), and T-tube cholangiogram. All ERCP procedures were performed under general anesthesia.ResultsSeventy-two ERCP procedures were performed on 45 patients referred for postcholecystectomy complications. The most common mode of presentation was ascending cholangitis [16 (35.6%)], followed by persistent biliary fistula [12 (26.7%)]. The overall median duration of symptoms after cholecystectomy was 20 weeks, with a range of 1-162 weeks. The most common postcholecystectomy complication observed was retained stone [16 (35.6%)]. Other postcholecystectomy complications included bile leakage, bile stricture, bile leakage with stricture, and persistent bile leakage from the T-tube in 12 (26.7%), 11 (24.4%), 4 (8.9%), and 2 (4.4%) patients, respectively. Ampullary cannulation during ERCP was successful in all patients (45, 100%). Patients with complete biliary stricture (10/12) required hepaticojejunostomy.ConclusionEndoscopic management of postcholecystectomy complications was found to be safe and reduce the number of needless surgeries to which such patients are exposed. We recommended prompt referral of such patients for ERCP.

MiRNA biomarkers to predict risk of primary non-function of fatty allografts and drug induced acute liver failures.

Primary non-function (PNF) of an allograft defines an irreversible graft failure and although rare, constitutes a life-threatening condition that requires high-urgency re-transplantation. Equally, drug induced acute liver failures (ALF) are seldom but the rapid loss of hepatic function may require orthotropic liver transplantation (OLT). Recently, we reported the development of a rodent PNF-disease model of fatty allografts and showed that a dysfunctional Cori and Krebs cycle and inhibition of lactate transporters constitute a mechanism of PNF. Based on findings from the rat PNF-disease model, we selected 15 miRNA-biomarker candidates for clinical validation and performed RT-qPCRs in well-documented PNF cases following OLT of fatty allografts. To assess specificity and selectivity, we compared their regulation in pre- and intraoperative liver biopsies and pre- and post-operative blood samples of patients undergoing elective hepatobiliary surgery. Additionally, we assessed their regulation in druginduced ALF. We confirmed clinical relevance for 11 PNF-associated miRNAs and found expression of miRNA-27b-3p, miRNA-122-3p, miRNA-125a-5p, miRNA-125b-5p and miRNA-192-5p to correlate with the hepatic steatosis grades. Furthermore, we demonstrate selectivity and specificity for the biomarker candidates with opposite regulation of let-7b-5p, miRNA-122-5p, miRNA-125b-5p and miRNA-194-5p in blood samples of patients following successful OLTs and/or liver resection. Moreover, by considering findings from 21 independent ALF-studies, we observed nine PNF-associated miRNAs regulated in common. We report miRNAs highly regulated in PNF and ALF, and their common regulation in different diseases broadens the perspective as biomarker candidates. Our study warrants independent confirmation in randomized clinical trials.

Exploring the Potential of Robotic Single-Port Surgery for Gallbladder Cancer: Initial Insights and Future Prospects.

Robotic surgery has demonstrated outcomes comparable or superior to open and laparoscopic surgeries for extended cholecystectomy.1-8 Despite its advantages, the minimally invasive robotic single-port (SP) system remains underutilized in complex hepatobiliary pancreatic surgery due to instrument limitations and retraction issues.9,10 This study evaluated the feasibility, safety, and effectiveness of the da Vinci SP system in gallbladder cancer surgery. The study was approved by the Ethics Committee of OOO University Hospital (IRB no. DAUH IRB-24-081) and conducted in accordance with the principles of the Declaration of Helsinki. The requirement for informed consent was waived due to the study's retrospective design. A 62-year-old woman with a diagnosis of gallbladder cancer was referred for surgery. Preoperative computed tomography (CT) scans showed no evidence of metastasis (T2N0). Therefore, a robotic SP extended cholecystectomy was planned. Figure 1 shows a 30-mm SP port and a 1-mm assistant port inserted for the procedure. Due to the absence of an energy device for the liver wedge resection, Maryland bipolar forceps were used, mimicking the Kelly clamp crushing technique. A monopolar cautery hook was used for lymph node resection of stations 7, 8, 12, and 13 (Fig. 2). Fig. 1 Port placement for robotic extended cholecystectomy using the da Vinci Xi system Fig. 2 Demonstration of full lymph node dissection RESULTS: The total duration of the operation was 226 min, with an estimated blood loss of 200 ml. The CT scan on day 5 showed no abnormalities, and the patient was discharged routinely on day 7 (Fig. 3). The pathologic examination confirmed adenocarcinoma (T2a) with clear resection, and all six lymph nodes tested negative for malignancy. Fig. 3 The wound 2 weeks after surgery CONCLUSIONS: This study underscores the adequacy of robotic surgeries and emphasizes the potential of the da Vinci SP system in hepatobiliary surgery. Despite current challenges related to instrument limitations, the authors are confident that the SP system will evolve into a crucial asset for hepatobiliary surgical practices in the foreseeable future.

Experience-based transition to robotic surgery in an experienced program in minimally invasive hepatobiliary surgery.

The adoption of robotic techniques in liver surgery introduces significant challenges for their safe integration within hepatobiliary surgery units. This study is designed to investigate the complexities associated with establishing a robotic surgery program. Data on robotic hepatobiliary surgeries were prospectively collected from October 2021 to October 2023. Historical cohorts from the institutional experiences for comparison were hand-assisted (HALS) and purely laparoscopic procedures (PLS). Inverse probability of treatment weighting and propensity score matching were employed to compare outcomes between PLS and robotic resections. The learning curve for robotic surgeries was evaluated by the cumulative sum method. In this study, 454 patients were enrolled (113 robotic surgeries, 157 HALS, and 184 PLS). The posterosuperior segments resections were significantly higher in the robotic group (47.8%) compared to PLS (31.5%) and HALS (35.7%). There were no conversions in the robotic group, in PLS 2.7% and HALS 3.8%. The degree of difficulty according to the median of the IWATE score and IMM score was significantly higher in the robot group (p < 0.001 and p = 0.008, respectively). No significant differences in short-term outcomes were observed between robotic procedures and PLS in a matched subset of patients. Operative efficiency and blood loss improved significantly after the 75th robotic surgery patient, with high-difficulty cases (IWATE ≥ 10) incorporated from the beginning. This study suggests that robotic liver surgery in units with prior experience in minimally invasive liver surgery offers benefits, such as a lower conversion rate and a higher rate of successful difficult resections.

Real-time ultrasound AR 3D visualization toward better topological structure perception for hepatobiliary surgery.

Ultrasound serves as a crucial intraoperative imaging tool for hepatobiliary surgeons, enabling the identification of complex anatomical structures like blood vessels, bile ducts, and lesions. However, the reliance on manual mental reconstruction of 3D topologies from 2D ultrasound images presents significant challenges, leading to a pressing need for tools to assist surgeons with real-time identification of 3D topological anatomy. We propose a real-time ultrasound AR 3D visualization method for intraoperative 2D ultrasound imaging. Our system leverages backward alpha blending to integrate multi-planar ultrasound data effectively. To ensure continuity between 2D ultrasound planes, we employ spatial smoothing techniques to interpolate the widely spaced ultrasound planes. A dynamic 3D transfer function is also developed to enhance spatial representation through color differentiation. Comparative experiments involving our AR visualization of 3D ultrasound, alongside AR visualization of 2D ultrasound and 2D visualization of 3D ultrasound, demonstrated that the proposed method significantly reduced operational time(110.25 ± 27.83s compared to 292 ± 146.63s and 365.25 ± 131.62s), improved depth perception and comprehension of complex topologies, contributing to reduced pressure and increased personal satisfaction among users. Quantitative experimental results and feedback from both novice and experienced physicians highlight our system's exceptional ability to enhance the understanding of complex topological anatomy. This improvement is crucial for accurate ultrasound diagnosis and informed surgical decision-making, underscoring the system's clinical applicability.

Impact of psychological resilience and social support on psycho-social adjustment in postoperative patients with primary hepatocellular carcinoma: mediating effects of fear of progression.

Postoperative patients with primary hepatocellular carcinoma (HCC) confront not only physiological challenges but also psychological and social adaptation issues. It is imperative to enhance psycho-social adjustment (PSA) levels and further improve the quality of life among this population. However, research on PSA levels in postoperative HCC patients is lacking, and investigations into its associations with psychological resilience, social support, and fear of progression (FoP) remain unexplored currently. This study aims to: (1) investigate the current status of PSA and analyze its influencing factors among postoperative HCC patients; (2) explore the interrelationships among psychological resilience, social support, FoP and PSA based on the Chronic Illness Adaptation Model employing a structural equation model. Convenience sampling methods were employed to recruit participants from the Department of Hepatobiliary Surgery at a tertiary hospital in Xi'an, Shaanxi, China, and a total of 399 patients completed the surveys. The survey instruments included a general information questionnaire, Connor-Davidson Resilience Scale (CD-RISC), Social Support Rating Scale (SSRS), Fear of Progression Questionnaire-Short Form (FoP-Q-SF), and Psychosocial Adjustment to Illness Scale Self-report (PAIS-SR). Data entry was conducted using Epidata 3.1 with dual verification, followed by statistical analyses performed using SPSS 27.0 and Amos 28.0. The structural equation model revealed two paths. In Path 1 (psychological resilience → FoP → PSA), the direct effect was -0.383 (95% CI [-0.589, -0.112]), with an indirect effect of -0.075 (95% CI [-0.170, -0.018]). In Path 2 (social support → FoP → PSA), the direct effect was -0.297 (95% CI [-0.587, -0.063]), with an indirect effect of -0.069 (95% CI [-0.156, -0.019]). Postoperative patients with primary HCC exhibit lower levels of PSA. Higher levels of psychological resilience and social support correspond to elevated PSA levels. Conversely, advanced age, greater financial burden, and increased FoP are associated with lower PSA levels. FoP serves as a partial mediator between psychological resilience and PSA, as well as between social support and PSA. Future research would benefit from longitudinal designs to elucidate the developmental trajectories and causal links among these variables.

The preoperative recurrence score: Predicting early recurrence in peri-hilar cholangiocarcinoma

IntroductionDespite advances in surgical techniques, the rate of early recurrence in perihilar cholangiocarcinoma (PCC) remains high. We sought to develop the Preoperative Recurrence Score (PRS), a model to estimate the risk of early recurrence after resection based on preoperative radiological characteristics. Materials and methodsData of patients who underwent surgery for PCC were retrospectively collected, and preoperative imaging was reviewed to assess tumor characteristics. A model to assess the risk of early recurrence based on preoperative radiologic characteristics was internally developed and externally validated on two cohorts of patients from two European major hepatobiliary surgery referral centers. ResultsA total of 215 patients among three different patient cohorts were included in the study. Tumor size ≥18 mm (HR 2.70, 95 % CI 1.48–4.92, p = 0.001), macroscopic portal vein involvement (HR 2.28, 95%CI 1.19–4.34, p = 0.013), hepatic arteries involvement (HR 2.44, 95%CI 1.26–4.71, p = 0.008), and presence of suspicious lymph nodes (HR 1.98, 95%CI 1.02–3.83, p = 0.043) were significantly associated with recurrence-free survival (RFS). The model showed excellent discrimination both on the internal (AUC 0.83) and external validation cohorts (external 1: AUC 0.84; external 2: AUC 0.70). High PRS was associated with worse RFS among all three cohorts, with a 1-year recurrence probability of 80.1 %, 100.0 %, and 54.2 % in the internal and external validation cohorts 1 and 2, respectively. ConclusionsThe PRS is a simple tool that can accurately assess the risk of early recurrence in patients with PCC. Up-front surgery should be carefully evaluated in patients with high PRS, as it could result in a futile resection.

Indocyanine Green and Hepatobiliary Surgery: An Overview of the Current Literature.

Indocyanine green (ICG) is an inert polypeptide that almost totally binds to high molecular weight plasma proteins; it is cleared by the hepatocytes and directly excreted into the bile with a half-life of about 3-5 minutes. Specific systems are required to see fluorescent images. The use of this dye has been reported in different surgical specialties, and the applications in hepatobiliary surgery are widening. Being firstly used to evaluate the preoperative liver function, intra- and postoperative dynamic checking of hepatic activity has been reported and integrated within perioperative protocols allowing a tailored treatment allocation. Intravenous injection (IV) or injection into the gallbladder can ease difficult cholecystectomy. Biliary leakage detection could be enhanced by IV ICG injection. Although with some contrasting results, the use of ICG for both delineating the limits of the resection and tumor-enhanced visualization was demonstrated to improve short- and long-term outcomes. Although the lack of strong evidence still precludes the introduction of this tool in clinical practice, it harbors great potential in liver surgery.

Efficacy of early postoperative hypocaloric supplementary parenteral nutrition in patients undergoing hepatobiliary surgery

Efficacy of early postoperative hypocaloric supplementary parenteral nutrition in patients undergoing hepatobiliary surgery

Clinical implications of aberrant anatomy of the common hepatic duct in liver surgery: a systematic review and meta-analysis.

Knowledge of anatomical variants that affect the hepatic duct (HD) are of particular clinical relevance during hepatobiliary surgical procedures. More specifically, the aberrant anatomy of the common HD is the most common anatomical variation affecting the biliary tree. Below, we describe different classifications of anatomical variants that affect this canal. According to Huang's classification, variations are determined depending on the insertion of the right posterior hepatic duct (RPHD). Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases were investigated until January 2024. The methodological quality was assessed with an anatomical studies assurance tool (AQUA). Pooled prevalence was estimated using a random effects model. For the subgroup analysis, Student's T-test was used. The prevalence rate of aberrant hepatic duct (AHD) was 15% (confidence interval [CI] of 7-22%). The first subgroup had cadavers and images. For the cadavers, the prevalence was 15.83% (CI: 11.22-18.3%), while the images had a prevalence of 22.06% (CI: 18.12-25.33%). This subgroup analysis showed no statistically significant difference between these groups (p = 0.127). The second subgroup comprised the continents where the included studies were from. In this subgroup, no statistically significant differences were found (p = 0.613). Finally, regarding the right or left laterality of the HD variant, there were no statistically significant differences (p = 0.089). A AHD corresponds to a finding that can occur in a significant percentage of our society, which could be an accidental discovery during surgeries or present asymptomatically throughout life and be a cadaveric discovery later. We believe it is important for surgeons to have prior knowledge of the possible variants of HD to prevent possible complications during and after surgery.

Application of three-dimensional visualization technology in early surgical repair of bile duct injury during laparoscopic cholecystectomy

ObjectiveThis study aimed to explore the application value of three-dimensional (3D) visualization technology in the early surgical repair of bile duct injury during laparoscopic cholecystectomy (LC).MethodsA retrospective analysis was conducted on the clinical data of 15 patients who underwent early surgical repair of bile duct injury during LC with the assistance of 3D visualization technology at the Hepatobiliary Surgery Department of Ningxia Hui Autonomous Region People’s Hospital from January 2019 to December 2022. Postoperative efficacy and long-term follow-up outcomes were summarized.ResultsBefore the repair surgery, 15 cases of bile duct injury during LC were evaluated using 3D visualization technology according to the Strasberg-Bismuth classification: 2 cases of type C, 4 of type E1, 3 of type E2, 3 of type E3, and 3 of type E4. Intraoperative findings were consistent with the 3D visualization reconstruction results, and all patients successfully underwent hepaticojejunostomy using Roux-en-Y anastomosis guided by the 3D visualization navigation. The time interval between LC and bile duct repair surgery ranged from 5 to 28 (14.2 ± 9.7) days. The surgical time was between 120 and 190 (156.40 ± 23.92) min, and estimated blood loss ranged from 80 to 250 (119.66 ± 47.60) mL. The length of hospital stay ranged from 12 to 25 days (median: 16 days). One patient experienced mild bile leakage after the operation, which healed with conservative treatment. All patients were followed up for 12–56 months (median: 34 months) without any loss to follow-up. During the follow-up period, no complications, such as anastomotic stricture or stone formation, were observed.ConclusionThe application of 3D visualization technology for preoperative evaluation and intraoperative navigation can accurately and effectively facilitate early surgical repair of bile duct injury during LC and has clinical value for promotion and application.

Forecasting intraoperative hypotension during hepatobiliary surgery.

Prediction and avoidance of intraoperative hypotension (IOH) can lead to less postoperative morbidity. Machine learning (ML) is increasingly being applied to predict IOH. We hypothesize that incorporating demographic and physiological features in an ML model will improve the performance of IOH prediction. In addition, we added a "dial" feature to alter prediction performance. An ML prediction model was built based on a multivariate random forest (RF) trained algorithm using 13 physiologic time series and patient demographic data (age, sex, and BMI) for adult patients undergoing hepatobiliary surgery. A novel implementation was developed with an adjustable, multi-model voting (MMV) approach to improve performance in the challenging context of a dynamic, sliding window for which the propensity of data is normal (negative for IOH). The study cohort included 85% of subjects exhibiting at least one IOH event. Males constituted 70% of the cohort, median age was 55.8years, and median BMI was 27.7. The multivariate model yielded average AUC = 0.97 in the static context of a single prediction made up to 8min before a possible IOH event, and it outperformed a univariate model based on MAP-only (average AUC = 0.83). The MMV model demonstrated AUC = 0.96, PPV = 0.89, and NPV = 0.98 within the challenging context of a dynamic sliding window across 40min prior to a possible IOH event. We present a novel ML model to predict IOH with a distinctive "dial" on sensitivity and specificity to predict first IOH episode during liver resection surgeries.

EP361 - Left Sided Gall Bladder: A Surgical Surprise

Abstract Laparoscopic cholecystectomy is a minimally invasive surgical procedure used for the removal of a diseased gallbladder. Since the early 1990s, this technique has largely replaced the open technique for cholecystectomies. We present a unique incident where a left-sided gallbladder was incidentally discovered during a laparoscopic cholecystectomy, posing a technical challenge for the surgeon. Our patient was a 34-year-old female who visited our hospital with complaints of right upper abdominal pain and postprandial nausea lasting for three months. Ultrasound examination revealed two gallstones measuring 16mm and 13mm in the neck of the gallbladder. During the routine laparoscopic cholecystectomy, the surgeon encountered a left-sided gallbladder. To ensure a safe and effective dissection, an additional port was required during the surgical procedure. The prevalence of this rare congenital anomaly, known as a left-sided gallbladder, ranges from 0.1% to 0.7%. It is characterized by the gallbladder being located on the left side of the ligamentum teres and falciform ligament, with the cystic artery passing in front of the common bile duct from right to left. This anatomical variation is often associated with abnormalities in the biliary tree and the porto-venous system. Failing to recognize these variations can lead to serious complications, particularly in hepatobiliary surgery. Discovering a left-sided gallbladder during surgery is an infrequent finding that can increase the complexity and morbidity rate of the procedure.

Predictors and risk factors of bile duct injury after transcatheter arterial chemoembolization for hepatocellular carcinoma

PurposeBile duct injury is a serious complication after transcatheter arterial chemoembolization (TACE). If it is not detected early and treated actively, it will not only affect the subsequent tumor-related treatment of hepatocellular carcinoma (HCC) patients, but also may lead to serious consequences such as infection, liver failure and even death. To analyze the risk factors of bile duct injury after TACE in patients with HCC and explore the predictive indicators of bile duct injury after TACE, which is helpful for doctors to detect and intervene early and avoid the occurrence of serious complications.MethodWe retrospectively analyzed the clinical data of 847 patients with primary hepatocellular carcinoma who underwent TACE for the first time in our interventional department. Patients were divided into two groups according to whether bile duct injury occurred after TACE: (1) bile duct injury group, N = 55; (2) no bile duct injury group, N = 792. The basic data, intraoperative conditions and the outcome of bile duct injury were analyzed. The chi-square test was used for comparison of enumeration data. The Mann-Whitney U test was used for comparison of measurement data. Risk factor analysis was performed using binary logistic regression analysis.ResultsBasic data and intraoperative conditions were compared between the bile duct injury group and the group without bile duct injury: preoperative alkaline phosphatase (ALP) (103.24 ± 32.77U/L vs. 89.17 ± 37.35U/L, P = 0.003); history of hepatobiliary surgery (36.4% vs. 20.8%, P = 0.011); intraoperative lipiodol volume (P = 0.007); combined use of gelatin sponge particles (65.5% vs. 35.0%, P < 0.001); hypovascularity (58.2% vs. 24.5%, P < 0.001); and embolization site (P < 0.001). Comparison of postoperative liver function between bile duct injury group and non-bile duct injury group: postoperative total bilirubin (43.34 ± 25.18umol/L vs. 21.94 ± 9.82umol/L, P < 0.001); postoperative γ-glutamyltransferase(GGT) (188.09 ± 55.62U/L vs. 84.04 ± 36.47U/L, P < 0.001); postoperative ALP(251.51 ± 61.51U/L vs. 99.92 ± 45.98U/L, P < 0.001).ConclusionThe dosage of lipiodol in TACE, supplementation of gelatin sponge particles, embolization site, and hypovascularity of the tumor are risk factors for biliary duct injury after TACE. After TACE, GGT and ALP increased ≥ 2 times compared with preoperative indicators as predictors of bile duct injury. Bile duct injury occurring after TACE can achieve good outcomes with aggressive management.

Predicting risk factors for acute pain after hepatobiliary and pancreatic surgery: an observational case control study

BackgroundInadequate postoperative analgesia is associated with increased risks of various postoperative complications, longer hospital stay, decreased quality of life and higher costs.ObjectivesThis study aimed to investigate the risk factors for...

Study protocol of the FRENCH24-ANIS study: postoperative anti-infective strategy following pancreaticoduodenectomy in patients with preoperative biliary stents—an intergroup FRENCH-ACHBT-SFAR prospective randomized controlled trial

BackgroundDespite advances in surgical techniques and care, pancreatoduodenectomy (PD) continues to have high morbidity and mortality rates. Complications such as sepsis, hemorrhage, pulmonary issues, shock, and pancreatic fistula are common postoperative challenges. A key concern in PD outcomes is the high incidence of infectious complications, especially surgical site infections (SSI) and postoperative pancreatic fistula (POPF). Bacteriobilia, or bile contamination with microorganisms, significantly contributes to these infections, increasing the risk of early postoperative complications. The occurrence of SSI in patients who undergo hepatobiliary and pancreatic (HPB) surgeries such as PD is notably higher than that in patients who undergo other surgeries, with rates ranging from 20 to 55%. Recent research by D'Angelica et al. revealed that, compared to cefoxitin, piperacillin/tazobactam considerably lowers the rate of postoperative SSI. However, these findings do not indicate whether extending the duration of antibiotic treatment is beneficial for patients at high risk of bacterial biliary contamination. In scenarios with a high risk of SSI, the specific agents, doses and length of antibiotic therapy remain unexplored. The advantage of prolonged antibiotic prophylaxis following PD has not been established through prospective studies in PD patients following biliary drainage.MethodsThis is an intergroup FRENCH-ACHBT-SFAR multicenter, open-labelled randomized, controlled, superiority trial comparing 2 broad-spectrum antibiotic (piperacillin/tazobactam) treatment modalities to demonstrate the superiority of 5-day postoperative antibiotic therapy to antibiotic prophylaxis against the occurrence of surgical site infections (SSI) following pancreaticoduodenectomy in patients with preoperative biliary stents. The primary endpoint of this study is the overall SSI rate, defined according to the ACS NSQIP, as a composite of superficial SSI, deep incisional SSI, and organ/space SSI.In addition, we will analyze overall morbidity, antibiotic resistance profiles, the pathogenicity of bacteriological and fungal cocontamination, the impact of complications after bile drainage and neoadjuvant treatment on the bacteriological and fungal profile of biliculture and cost-effectiveness.ConclusionThis FRENCH24-ANIS study aims to evaluate 5-day post-operative antibiotic therapy combined with antibiotic prophylaxis on the occurrence of surgical site infections (SSI) following pancreaticoduodenectomy in patients with preoperative biliary stents.Trial registrationClinicaTrials.gov number, NCT06123169 (Registration Date 08–11–2023); EudraCT number 2021–006991-18; EUCT Number: 2024–515181-14–00.

Application of ERAS Guided Health Education Nursing Pathway Model in Patients Undergoing Laparoscopic Hepatobiliary Surgery

Application of ERAS Guided Health Education Nursing Pathway Model in Patients Undergoing Laparoscopic Hepatobiliary Surgery

Dr. Wu Mengchao (1922-2021), founder and pioneer of Chinese hepatobiliary surgery.

Wu Mengchao had been engaged in basic and clinical research in hepatobiliary surgery since the 1950s and is recognised as the founder and pioneer of hepatobiliary surgery in China. In his career of over 60 years, Wu performed over 16,000 operations and made numerous breakthroughs in hepatobiliary surgery, liver cancer signal transduction, immunotherapy and molecular pathology research. Wu's series of achievements have driven the innovative development of basic theoretical research on the liver in China, establishing it as a long-term international leader in the field of hepatobiliary surgery. This biography elucidates Wu's outstanding contributions to the establishment and development of Chinese hepatobiliary surgery.

Shoeshine maneuver for cystic duct dissection: a simple technique to make Calot-triangle dissection smooth.

Laparoscopic cholecystectomy, introduced in 1985 by Prof. Dr. Erich Mühe, has become the gold standard for treating chronic symptomatic calculous cholecystopathy and acute cholecystitis, with an estimated 750,000 procedures performed annually in the United States of America. The risk of iatrogenic bile duct injury persists, ranging from 0.2 to 1.3%. Risk factors include male gender, obesity, acute cholecystitis, previous hepatobiliary surgery, and anatomical variations in Calot's triangle. Strategies to mitigate bile duct injury include the Critical View of Safety and fundus-first dissection, along with intraoperative cholangiography and alternative approaches like subtotal cholecystectomy. This paper introduces the shoeshine technique, a maneuver designed to achieve atraumatic exposure of anatomical structures, local hemostatic control, and ease of infundibulum mobilization. This technique involves the use of a blunt dissection tool and gauze to create traction and enhance visibility in Calot's triangle, particularly beneficial in cases of severe inflammation. Steps include using the critical view of safety and Rouviere's sulcus line for orientation, followed by careful dissection and traction with gauze to maintain stability and reduce the risk of instrument slippage. The technique, routinely used by the authors in over 2000 cases, has shown to enhance patient safety and reduce bile duct injury risks. The shoeshine technique represents a simple and easy way to apply maneuver that can help surgeon during laparoscopic cholecystectomies exposing the hepatocystic area and promote blunt dissection.