Perioperative Cholangiography Research Articles

A Comparative Study between Operative Ultrasonography and Perioperative Cholangiography in Screening of The Common Bile Duct for Stones During Laparoscopic Cholecystectomy

A Comparative Study between Operative Ultrasonography and Perioperative Cholangiography in Screening of The Common Bile Duct for Stones During Laparoscopic Cholecystectomy

Fibrin Sealant for Prevention of Bile Leakage After Laparoscopic Common Bile Duct Incision: Outcome of a Randomized Controlled Trial.

Background: There are several methods used to extract common bile duct (CBD) stones encountered during cholecystectomy. Intraoperative cholangiotomy, cholangioscopy, and laparoscopic CBD exploration (LCBDE) are techniques that allow removal of stones from the CBD during the index procedure. However, bile leakage following CBD exploration is a common problem. The aim of this study was to assess whether fibrin sealant applied to the duct incision is safe. Methods: Patients planned for laparoscopic gallstone surgery at the Department of Surgery, Enköping Hospital, were included in the study. In cases where perioperative cholangiography showed CBD stones, LCBDE was performed through a longitudinal incision in the CBD. Randomization between closure of the incision with polyglactin sutures or with fibrin sealant was performed. After all the stones had been removed and the incision closed according to the allocation, an abdominal drain was placed close to the incision. A T tube was placed in the CBD or a straight tube into cystic duct for eventual postoperative cholangiogram. The patient and the surgeon assessing the postoperative course were blinded to the randomized allocation. Results: Altogether 51 patients were included from December 2012 to July 2016. Mean operative time was 188 minutes in the fibrin sealant group and 214 minutes in the suture group (P = .159). There was no significant difference between groups in bile flow in the abdominal drainage tube or in the CBD drain during the three first postoperative days. The time to removal of the abdominal drain did not differ significantly between groups. Conclusion: Although the present study lacks the statistical power to prove a benefit from fibrin sealant, it indicates that closure of the incision may be an option to reduce the risk for leakage. Further studies are required to confirm this. The study was retrospectively registered on clinicaltrials.gov September 5, 2015 (NCT02545153).

Bile Duct Injury During Cholecystectomy: Necessity to Learn How to Do and Interpret Intraoperative Cholangiography.

Introduction: Biliary duct injury (BDI) is a serious complication during cholecystectomy. Perioperative cholangiography (POC) has recently been generating interest in order to prevent BDI. However, the current literature (including randomized controlled trials) cannot conclude whether POC is protective or not against the risk of BDI. The aim of our study was to investigate whether POC could demonstrate earlier BDI and which criteria are required to make that diagnosis.Methods: We performed a retrospective study between 2005 and 2018 in our French tertiary referral center, which included all patients who had presented following BDI during cholecystectomy.Results: Twenty-two patients were included. Nine patients had POC, whereas 13 did not. When executed, POC was interpreted as normal for three patients and abnormal for six. In this latter group, only two cases had a BDI diagnosed intraoperatively. In other cases, the interpretation was not adequate.Conclusion: BDIs are rare but may reduce patients' quality of life. Our study highlights the surgeon's responsibility to learn how to perform and interpret POC in order to diagnose and manage BDIs and potentially avoid catastrophic consequences.

Metabolic Syndrome in the Development of Gallstone Disease in Children

Backrounds: Several studies carried out in the adult population have concluded to a correlation between metabolic syndrome and the development of gallstones which has not really been demonstrated in children. Objective: To investigate the association between metabolic syndrome and the development of gallstone disease in children. Methods Retrospective review of patients aged less than 14 years treated for gallstones from January 2014 to 2019 at the department of pediatric surgery of Hedi Chaker Hospital, Sfax, TUNISIA. Results Thirteen cases were conllected reparted in eight girls and five boys. The mean age at operation was 11,1 years (range: 3-14 years). Females were older than males at the time of surgery (12,3 vs 9,2 years). Symptomatic chlolelithiasis was the indication for cholecystectomy in 11 cases. The clinical presentation was marked by the presence of hepatic colic in all patients, presence of vomiting in 54% of patients and epigastralgia in 15% of patients. The mean weight was 38,5 Kg with five patients whose BMI was >97percentile. The gallstones were idiopathic in 61%, due to hemolytic anemia in 31% and due to hypercholesterolemia in 7,6% of cases. Complications were acute cholecystitis in one patient and pancreatitis in one case. All patients underwent single site laparoscopic surgery. One patient had perioperative cholangiography. The mean time of hospitalization was 2 days. Patients were asymptomatic. Conclusion: As reported in adult population we found that obesity is correlated with the development of gallstones disease in pediatric population. Further studies are necessary to confirm our findings.

Congenital solitary intrahepatic biliary cyst in infant: A rare case report

Abstract Solitary liver cysts (SLCs) are usually asymptomatic, uncommon and nonparasitic cysts of congenital origin, most frequently discovered during imaging studies. It may develop in the form of simple cyst and biliary cyst. The majority of the cysts that are discovered incidentally remain small. The etiology of SLC is unknown. Perioperative cholangiography is helpful to confirm the connection between cyst and biliary tree. In several clinical situations, including resection of malignant or benign biliary lesions, reconstruction of the biliary system using the Roux-en-Y jejunum limb should be performed as the standard procedure.

Laparoscopy-assisted transjejunal ERCP in a patient with roux-en-Y gastric bypass

In the case of Roux-en-Y gastric bypass with a long afferent limb, the need to carry out an ERCP still represents a technical challenge. In this article we describe the case of a 50-year-old male admitted to the ER for abdominal pain in the right upper quadrant, in the context of prior Roux-en-Y gastric bypass (4 years ago), with uncomplicated gallbladder stones discovered 3 months ago. The patient presented recurrent abdominal pain for 3 months but in the last few days the pain became continuous. The blood test revealed elevation of hepatic enzymes and bilirubin levels. The US findings were uncomplicated gallbladder lithiasis with no signs of lithiasic migration in the common bile duct, despite strong clinical suspicion and positive MRI 3 weeks before. We decided therefore to perform a laparoscopic cholecystectomy with perioperative cholangiography and a laparoscopy-assisted transjejunal ERCP through a jejunostomy 80 cm distal to the ligament of Treitz, allowed us to successfully carry out sphincterotomy and extraction of a 10mm lithiasis from the common bile duct.

The Discovery of a Choledochal Cyst During a Single-Port Cholecystectomy With Intra-Operative Cholangiogram

Choledochal cyst is a rare congenital malformation, which is most often discovered in pediatric patients. Perioperative cholangiography is routinely performed in our institution during standard or single-port cholecystectomies. We report the case of a 25 year-old woman with a choledochal cyst identified during a single-port cholecystectomy with cholangiogram. The case illustrates the feasibility and usefulness of single-port intra-operative cholangiogram. doi: http://dx.doi.org/10.4021/jmc1011e

The Discovery of a Choledochal Cyst During a Single-Port Cholecystectomy With Intra-Operative Cholangiogram

Choledochal cyst is a rare congenital malformation, which is most often discovered in pediatric patients. Perioperative cholangiography is routinely performed in our institution during standard or single-port cholecystectomies. We report the case of a 25 year-old woman with a choledochal cyst identified during a single-port cholecystectomy with cholangiogram. The case illustrates the feasibility and usefulness of single-port intra-operative cholangiogram. J Med Cases. 2013;4(2):114-115 doi: https://doi.org/10.4021/jmc1011e

Is perioperative cholangiography necessary in children undergoing elective laparoscopic cholecystectomy?, G. Mattioli, A. Pini-Prato, M. Castagnetti, in: Eur J Pediatr Surg, 17/3. (2007), 179

The necessity of pre- or intraoperative imaging of the biliary tree to rule out a possible anatomical anomaly or the presence of common bile duct (CBD) stones in patients undergoing laparoscopic cholecystectomy (LC) is still debated. The authors assessed prospectively the risk of developing symptoms of bile duct injury or CBD stones after LC in children not receiving perioperative cholangiography. Perioperative cholangiography of the CBD was not performed unless there was a suspicion of CBD stones based on clinical examination, serum amylase levels, or liver ultrasound.

Is Perioperative Cholangiography Necessary in Children Undergoing Elective Laparoscopic Cholecystectomy?

The necessity of carrying out pre- or intra-operative imaging of the biliary tree to rule out a possible anatomical abnormality or the presence of common bile duct (CBD) stones in patients undergoing laparoscopic cholecystectomy (LC) is debated. We prospectively assessed the risk of developing symptoms related to bile duct injury or CBD stones after LC in children not receiving peri-operative cholangiography. All patients <or= 14 years undergoing elective LC at our institution from January 2003 to June 2005 were included in this study. Peri-operative cholangiography of the CBD was not performed unless there was a suspicion of CBD stones based on clinical examination, liver biochemistry, serum amylase levels or liver ultrasound scan. Patients were prospectively followed up, looking for possible symptoms or clinical, biochemical and radiological signs related to bile duct injury or CBD stones. Twenty-six patients fulfilled the inclusion criteria. The median age at elective LC was 9.8 (4.1 - 14.3) years. Surgery was uneventful in all patients. All patients were discharged on postoperative day 1. None developed early symptoms of stone migration. USS performed 1 month after surgery did not show dilatation of the biliary system or stones in the CBD in any patient and no patient developed symptoms related to CBD stones after a median postoperative follow-up of 25 (6 - 37) months. Patients scheduled for elective LC presenting with unremarkable clinical examination, normal liver biochemistry and serum amylase levels, and without dilatation of the biliary tree on ultrasound scan do not need pre- or intra-operative cholangiography.

Management of common bile duct stones in a single operation combining laparoscopic cholecystectomy and perioperative endoscopic sphincterotomy.

Laparoscopic cholecystectomy (LC) has become the reference treatment for biliary lithiasis, but the management strategy for common bile duct stones (CBDS) remains a subject of controversy in the absence of an established consensus. While conventional surgery remains the reference treatment for CBDS, minimally invasive techniques are becoming more and more popular. These methods consist of the extraction of the common bile duct stones either exclusively by laparoscopy or by sequential treatment with endoscopic sphincterotomy (ES) followed by LC. The aim of this study was to evaluate the treatment of CBDS in a one-stage operation by laparoscopic cholecystectomy (LC) and perioperative endoscopic sphincterotomy. Between January 1994 and March 1998, 44 patients, 20 male and 24 female, (sex ratio 1.2) with a median age of 57 years (range 28-84 years) were treated for suspected or confirmed CBDS. The CBDS were uncomplicated in 39 cases (88%) and associated with a complication in 5 cases (12%), namely, cholangitis (2 cases) or acute pancreatitis (3 cases). The perioperative ES was performed immediately after the LC during the same operative time, with perioperative cholangiography being systematically performed (1 failure). In 6 cases, a transcystic drain was left in place (to ensure complete evacuation of the CBDS postoperatively) when there were more than three stones and/or when they were larger than 6 mm. The patient was positioned in the left lateral position in order to perform the ES. Mean operative time for LC was 60 min, range 40-90 min. The general anesthesia was prolonged by 40 min in order to perform an ES (range 30-60 min). The perioperative ES was unsuccessful in one case (2%), due to the impossibility of catheterizing the papilla, the preoperative MR cholangiogram being normal. Immediate clearance of the CBD was achieved in 95% of the cases (42 p). In 2 cases, residual stone was found in the sixth day after cholangiography and was spontaneously evacuated as shown by 21st-day control. There was no mortality or postoperative complications. The duration of the postoperative hospitalization was 4.6 days (range 3-6). We believe that LC combined with perioperative ES is a quick, reliable, and safe technique for the treatment of CBDS during a single operative procedure, although this approach is limited by the proximity and availability of an endoscopic team.

An analysis of perioperative cholangiography in one thousand laparoscopic cholecystectomies

Background . We undertook this retrospective study to ascertain the proper role of perioperative cholangiography in the management of 1002 patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis. Methods . Nine hundred forty-one patients were categorized as being at high or low risk for choledo-cholithiasis according to the presence or absence of jaundice, pancreatitis, elevated bilirubin, alkaline phosphatase, serum glutamic-oxaloacetic transaminase, or radiographic evidence of common bile duct stones (CBDSs). Results . Intraoperative cholangiography (IOCG) and preoperative endoscopic retrograde cholangiopancreatography (ERCP) were equivalent in the detection of CBDSs, and laparoscopic common bile duct exploration (CBDE) was successful in 12 of the 21 patients (57%) in whom it was attempted. The ducts of the other 52 patients with CBDSs were successfully cleared by preoperative or postoperative ERCP. Conclusions . Laparoscopic IOCG is successful in detecting CBDS in high-risk patients and half of these ducts can be cleared laparoscopically. The incidence of CBDS in low-risk patients is 1.7%, a risk that does not warrant routine cholangiography. These data suggest ERCP should be reserved for those at-risk individuals in whom IOCG or laparoscopic duct clearance has been unsuccessful.

The Mexican experience with laparoscopic cholecystectomy and common bile duct exploration. A multicentric trial.

We present here the initial data collected since the first laparoscopic cholecystectomy (LC) was performed in our country (June 1990). Twenty-one centers were surveyed (2,399 patients). The most frequent indication for LC was chronic gallstone disease (76.2%). The female population predominated (69.4%). Seven centers always perform the laparoscopic approach. Antibiotic prophylaxis is the rule, and most centers use nasogastric tube and urinary catheterization. Perioperative cholangiography is done selectively. The instrument of choice to dissect the gallbladder is the electrosurgical hook-knife. General anesthesia is preferred (97%). The complication rate was 8.87%. Injury to the bile duct and bowel perforation occurred in 0.25% and common duct stone retention occurred in 0.29% of patients. Mortality rate reached 0.12%. It is our hope that this study will help in defining the situation of LC in developing countries and that it also can serve as a first step in the organization of minimally invasive surgery groups in Mexico.

A CASE OF CLONORCHIASIS INCIDENTALLY FOUND FOLLOWING CHOLECYSTECTOMY

A 58-year-old man was admitted to the hospital because of diarrhea and epigastric pain. Complete blood count disclosed an increase of WBC to 13400/mm3. Cholelithiasis was diagnosed by drip-infusion cholangiography, abdominal echography and abdominal CT. Choledochotomy was performed, because perioperative cholangiography following cholecystectomy revealed irregularity of its wall. Then, 28 blackish-brown, flat and small stone-like substances measuring 4×10 mm emerged from the duct. Choledochoduodenostomy was performed by side to side anastomosis. The gallbladder contained one stone measuring 0.7×1×1 cm and six small stone-like substances measuring 4×10 mm. Postoperatively, these small stone-like substances were identified as clonorchis sinensis by microscopic findings.Its ova were detected by stool examination (MGL method). An anthelmintic (Biltricide, 41.4 mg/kg/day) was administered from the 17th postoperative day. The patient recovered well and was discharged on the 42nd day after operation.On postoperative investigation of his dietary habit in detail, it was found that he had a habit of eating sliced meat of a carp (washed in cold water) a few times/year. Eating slices of raw fish is a very common and frequently-practiced habit of the Japanese. Therefore, close examination is necessary with likelihood of clonorchiasis in mind, when patients are suspected to have bile duct diseases.

Hepatic trauma: experience with 135 consecutive liver injuries (1982?1989) and arguments for conservative surgery

Most hepatic traumas are easily cured, but the series of 135 consecutive hepatic wounds reported in the present paper is unusual in that the patients were specifically recruited from among patients subjected to neurosurgical or spinal operations, 25% of whom sustained severe hepatic injuries (classes IV and V) as a result of the surgery. The postoperative mortality was analyzed according to such potentially predictive factors as severity of the hepatic wound, the concomitant extraabdominal lesions, the initial shock, and the kind of surgical treatment. The statistical comparison of the factors affecting the results was analyzed by the Chi-square test. The postoperative mortality rate was 24.4% (33 deaths). This mortality rate is evidently related to the severity of the hepatic lesions and to the frequent associated lesions. The 14 deaths from benign and moderate hepatic injuries were due to concomitant lesions. Among the 19 deaths from severe lesions, 12 were directly related to the severity of the hepatic injury and 7 to associated wounds. Complications directly related to the hepatic trauma occurred in 39 cases with 16 deaths. In general, conservative surgical treatment can be performed with quite low mortality. Among the patients who require hepatic resection one of two dies of hemorrhage or coagulopathy. Among conservative procedures, perihepatic packing has proved to be efficient and safe. If perioperative cholangiography has excluded any leak from a major bilde duct, septic complications are rare. Therefore, the surgical treatment of hepatic trauma should be as conservative as possible, because this can stop hemorrhage and decrease the risk of coagulopathy.(ABSTRACT TRUNCATED AT 250 WORDS)