Laparoscopic Cholecystojejunostomy Research Articles

Review of anatomy in managing complications of chronic pancreatitis-case report

The main problem of chronic pancreatitis is managing the chronic pain. When pharmacological means fail, ablative procedures like coeliac plexus ablation or bilateral splanchnicectomy becomes necessary. These procedures are designed based on anatomy. Pancreatic duct and common bile duct obstruction are known complications of chronic pancreatitis and methods of treatment are essentially based on interpretation of images. We present a case history of a patient with chronic pancreatitis who underwent bilateral thoracoscopic splanchnicectomy and later laparoscopic cholecysto-jejunostomy for common bile duct obstruction. The importance of anatomy in diagnosis and treatment are highlighted.

Single hole laparoscopic cholecystojejunostomy in the treatment of low malignant biliary obstruction

Single hole laparoscopic cholecystojejunostomy in the treatment of low malignant biliary obstruction

Laparoscopic choledochojejunostomy and gastrojejunostomy in a porcine model.

Surgical extirpation remains the only known curative treatment for cancer of the pancreas. Because of locally advanced or metastatic tumor, up to 80% of patients are unresectable at the time of initial diagnosis [13]. Other investigators previously have suggested that laparoscopy before laparotomy aids in the diagnosis of unresectable pancreatic cancer in a fair number of patients even after negative computed tomography scans [3, 17]. Many surgeons are reluctant to incorporate laparoscopy into the workup of patients with cancer of the pancreas because of the frequent need for surgical bypass in the management of either biliary tract obstruction or gastric outlet obstruction [9, 13]. Previous studies have demonstrated the feasibility of laparoscopic cholecystojejunostomy combined with gastrojejunostomy in a porcine model, as well as the individual accomplishment of laparoscopic choledochojejunostomy. The purpose of this study was to document the feasibility of performing laparoscopic choledochojejunostomy with gastrojejunostomy. Under general anesthesia, seven pigs underwent laparoscopic choledochojejunostomy and gastrojejunostomy using an intracorporeal hand-sutured technique. The mean operating time ranged from 150 to 450 min. All the animals recovered completely from the operation and had patent anastomoses at the time of necropsy. One pig died of gastric bleeding on postoperative day 13, and two animals had intraabdominal fluid collections discovered at the time of necropsy. These results suggest that synchronous laparoscopic bypass of biliary and gastric outlet obstruction is feasible, and can be performed in a manner similar to that used in open operations. We believe this lends support to the argument promoting laparoscopy in the evaluation of pancreatic cancer.

Robotic-assisted laparoscopic cholecystojejunostomy

Surgical laparoscopic robotic systems have been developed to transfer time-consuming, repetitive tasks from human to robot, thus increasing safety and improving surgical outcome. Laparoscopic cholecystojejunostomy for unresectable pancreatic cancer has become widely accepted. The main manipulation of this operation is suturing, which could possibly be done with robotic assistance. The aim of this study was to assess the feasibility and the technical aspects of robotic-assisted laparoscopic cholecystojejunostomy. Sixteen pigs were divided into two groups of eight. Robotic-assisted laparoscopic cholecystojejunostomy (Roux-Y anastomosis) was performed in one group of animals (Group RLC). The second group was used as control and underwent a laparoscopic cholecystojejunostomy using the ordinary laparoscopic instruments, except with robotic camera control (Group LC). Laparotomy and fluoroscopic examination were performed postoperatively. Animals in both groups tolerated the operations well. There was no significant difference in set-up time between groups. The operative time and the time for completing the two anastomoses were significantly longer in the RLC group. There was no leakage after anastomoses in any animal, as confirmed by laparotomy and fluoroscopy. Robotic-assisted laparoscopic cholecystojejunostomy is technically feasible. Stable images and comfortable manipulation can be obtained using this technique. One or two surgeons can perform this operation, assisted by the robotic system. The main disadvantages are longer operative time and the use of expensive devices. With improvements in robotic instruments and techniques, the operative time will be decreased and the technology could become widely accepted.

Laparoscopic palliation of unresectable pancreatic cancers: preliminary results.

To assess the feasibility of laparoscopic gastroenteric and cholecystenteric bypass procedures for palliation of inoperable cancer of the pancreas. Prospective study. Teaching hospital, Italy. 6 patients (4 men and 2 women, range 53-72 years, median 64) who presented between July 1995 and April 1997 with inoperable pancreatic cancer. Laparoscopic gastroenterostomy for duodenal obstruction. Four patients had already had endoscopic biliary decompression. 2 patients also had laparoscopic cholecystojejunostomy for biliary obstruction at the time of the laparoscopic gastroenterostomy. Morbidity and mortality. The procedure was completed laparoscopically in all patients. There was no perioperative mortality and morbidity was low (1 bleeding from the drain and 1 paralytic ileus). The median postoperative stay was 4.5 days (range 4-6). Laparoscopic gastroenterostomy, together with cholecystojejunostomy in selected patients with inoperable pancreatic cancer, offers a less invasive alternative to open surgery with a short hospital stay and rapid return to normal activity.

Laparoscopic gastrojejunostomy in the palliation of pancreatic cancer: reflections on the preliminary results.

The aim of this study was to assess the feasibility of laparoscopic gastroenteric and cholecystenteric bypass procedures for palliation of inoperable cancer of the pancreas. Between July 1994 and January 1996, five patients underwent laparoscopic gastroenterostomy for duodenal obstruction due to pancreatic cancer. There were four men and one woman, ranging in age from 53 to 72 years (median 63). Four patients already had endoscopic biliary decompression. One patient underwent laparoscopic cholecystojejunostomy for biliary obstruction at the time of the laparoscopic gastroenterostomy. The procedure was completed laparoscopically in all patients. There was no perioperative mortality, and the morbidity was low. The median post-operative stay was 4 days (range, 4-6). Laparoscopic gastroenterostomy associated with cholecystojejunostomy in selected cases offers a less invasive alternative than open surgery, with a shorter hospital stay and more rapid return to normal activity.

Cystic duct (CD) patency in malignant biliary obstruction (MBO): Consideration for laparoscopic cholecystojejunostomy (CCJ)

Cystic duct (CD) patency in malignant biliary obstruction (MBO): Consideration for laparoscopic cholecystojejunostomy (CCJ)

Palliation for pancreatic cancer Feasibility of laparoscopic cholecystojejunostomy and gastrojejunostomy in a porcine model

Although laparoscopy reveals undetected metastases in many patients with pancreatic cancer, most surgeons have chosen to proceed directly with laparotomy in an attempt at resection or for palliation of biliary and gastric outlet obstruction. In an effort to overcome this limitation, this study attempted to determine the feasibility of laparoscopic cholecystojejunostomy and gastrojejunostomy. Under general anesthesia, seven pigs underwent laparoscopic cholecystojejunostomy and gastrojejunostomy using either a hand-sutured or the stapled/sutured technique. Mean operating time was less with the stapled/sutured vs hand-sutured technique (150 +/- 21 vs 230 +/- 13 min, P < 0.05). All animals recovered completely and there was no change in their weight or liver function tests as a result of the procedure. At sacrifice, all anastomoses were patent, although some were significantly narrowed in these unobstructed animals. These results suggest that simultaneous laparoscopic palliation of biliary and gastric outlet obstruction is feasible. We believe these results warrant further study in the clinical setting.

Palliation for pancreatic cancer

Background: Although laparoscopy reveals undetected metastases in many patients with pancreatic cancer, most surgeons have chosen to proceed directly with laparotomy in an attempt at resection or for palliation of biliary and gastric outlet obstruction. In an effort to overcome this limitation, this study attempted to determine the feasibility of laparoscopic cholecystojejunostomy and gastrojejunostomy.

Cystic Duct Patency in Malignant Obstructive Jaundice An ERCP-Based Study Relevant to the Role of Laparoscopic Cholecystojejunostomy

This endoscopic retrograde cholangiopancreatography-(ERCP)based study estimates the potential role of laparoscopic cholecystojejunostomy for palliation of patients with malignant obstructive jaundice. Traditional treatment of malignant obstructive jaundice has used a standard bilioenteric anastomosis. Laparoscopic biliary bypass via a gallbladder conduit currently is an established technique; it provides a low initial morbidity alternative to open procedures, similar to endoscopic stenting. No study has specifically addressed anatomic factors relevant to cholecystojejunostomy, such as prior cholecystectomy, stricture location in reference to the hepatocystic junction, and cystic duct patency in patients with malignant obstructive jaundice. Retrograde cholangiograms were reviewed from consecutive patients with malignant obstructive jaundice and a control group without biliary disease who underwent ERCP during a 2-year period. Patients with either prior biliary surgery or hilar tumors were excluded. The presence of gallbladder or cystic duct filling was assessed. In patients with patent cystic ducts, the distance from obstruction to the cystic duct takeoff was classified as either greater or less than 1 cm. Nearly half the patients with malignant obstructive jaundice were ineligible for cholecystojejunostomies because of prior biliary surgery (29%) or hilar tumors (17%). Half (50 of 101) of the remaining potential candidates had patent hepatocystic junctions. Patients with ampullary carcinoma and patent hepatocystic junctions (5 of 9) were all ideal candidates for cholecystojejunostomies, having biliary obstruction more than 1 cm from the cystic duct takeoff. Two thirds of the remaining eligible patients (28 of 45) had obstructions less than 1 cm from patent hepatocystic junctions. Palliation of malignant obstructive jaundice by laparoscopic cholecystojejunostomy should only be attempted after direct cholangiography demonstrates a patent hepatocystic junction that is well separated from the malignant stricture. The majority of patients with malignant obstructive jaundice are ineligible for cholecystojejunostomies because of prior cholecystectomies, hilar obstructions, or tumor involvement of the hepatocystic junction. Nonoperative treatments will continue to be indicated for the majority of patients with malignant obstructive jaundice.