Postoperative Biliary Fistula Research Articles

Comparative analysis of Roux-en-Y cystojejunostomy versus conservative surgical strategies for giant hepatic hydatid cysts: A retrospective study

BackgroundThis retrospective study addressed the challenge of postoperative biliary fistula, a common complication observed after surgical management of giant hepatic hydatid cysts. The primary objective was to compare the efficacy and safety of conservative surgical techniques versus prophylactic Roux-en-Y cystojejunostomy (R-en-Y CJ) in addressing residual cavity. MethodsRetrospective analysis was conducted on patients who underwent surgical intervention for giant hepatic hydatid cysts with cysto-biliary communication from July 2021 to Jan 2024. Preoperative laboratory tests, imaging studies, surgical procedures, and postoperative outcomes were reviewed from medical records. Results32 patients who underwent surgery for giant hepatic hydatid cysts were included. There were 19 (59.38%) female patients, with a mean age of cohort was 39.13 years. The patients were divided into two groups with respect to the treatment modality: Group A (n = 14), treated with conservative surgical techniques and R-en-Y CJ, and Group B (n = 18), treated with conservative surgical methods. The overall cavity-related complications occurred in 9/18 (50%) in Group B, whereas 2/14 patients (14.29%) in Group A during the follow-up period (p < 0.05). ConclusionR-en-Y CJ is an effective and safe surgical procedure for tackling residual cavities in giant hepatic hydatid cysts with cysto-biliary communication.

The establishment and validation of a clinical prediction model for postoperative biliary fistula after pancreaticoduodenectomy.

At present, pancreaticoduodenectomy (PD) is a classic surgical treatment for benign and malignant tumors around ampulla. The operation is complicated and postoperative complications are frequent. Biliary fistula is the most common anastomotic fistula after pancreatic fistula. Our objective is to analyze the risk factors for biliary fistula after PD and to construct a nomogram to predict biliary fistula after PD. The clinical data of a total of 196 patients who underwent PD from March 2014 to March 2024 in Yueyang Hospital Affiliated to Hunan Normal University and The Third Xiangya Hospital of Central South University were retrospectively analyzed. The number of included patients was divided in the ratio of 7:3 using the random split method, with 130 patients in the training set and 66 patients in the validation set. Predictors were screened and a nomogram prediction model was constructed by one-way logistic regression analysis, Lasso regression analysis and multifactorial logistic regression analysis. The discriminative ability, consistency and clinical effectiveness of the models were assessed by area under the curve (AUC) of the working characteristics of the subjects, calibration curve and decision curve analysis (DCA). The results of multifactorial logistic regression analysis showed that diabetes, low albumin, postoperative gastroparesis, abdominal bleeding, abdominal infection, and postoperative pancreatic fistula were the independent risk factors for biliary fistula after PD (P<0.05). The AUC of the column-line graph prediction model constructed from the above factors was 0.807 [95% confidence interval (CI): 0.652-0.962] in the training set and 0.782 (95% CI: 0.517-1.000) in the validation set, suggesting that the diagnostic efficacy of the model was better, and the calibration curves plotted in the training and validation sets were closer to the standard curves, suggesting that the model consistency was better. The plotted DCA curves also indicated a significant positive net gain. The nomogram prediction model constructed by diabetes, albumin, postoperative gastroparesis, abdominal bleeding, abdominal infection, and postoperative pancreatic fistula can well identify high-risk patients with postoperative biliary fistula (POBF) in PD, which has a good clinical application value.

Predictive risk factors for resection surface-related complications after laparoscopic simultaneous resection of primary colorectal tumor and synchronous liver metastases: a single-center retrospective study.

Laparoscopic simultaneous resection (LSR) of primary colorectal tumors and synchronous colorectal liver metastases (sCRLM) has been recently performed. This study aimed to evaluate the postoperative outcomes after LSR and determine the risk factors for resection surface-related complications (RSRC), such as postoperative biliary fistula and liver-transection surface abscess. Between 2009 and 2022, consecutive patients with sCRLM who underwent LSR were included. We retrospectively analyzed clinicopathological data, including intraoperative factors and postoperative outcomes. The difficulty level of all liver resections was classified according to the IWATE difficulty scoring system (DSS). We then performed univariate and multivariate analyses to identify the risk factors for RSRC. Of the 112 patients, 94 (83.9%) underwent partial hepatectomy and colorectal surgery. The median DSS score was 5 points (1-11), with 12 (10.7%) patients scoring ≥ 7 points. Postoperative complications were observed in 41 (36.6%) patients, of whom 16 (14.3%) experienced severe complications classified as Clavien-Dindo grade IIIa or higher. There was no postoperative mortality. The most common complication was RSRC (19 patients, 17.0%). Multivariate analysis identified American Society of Anesthesiologists (ASA) classification ≥ 3 [odds ratio (OR) 10.3, 95% confidence interval (CI) 1.37-77.8; P = 0.023], DSS score ≥ 7 points (OR 5.08, 95% CI 1.17-20.0; P = 0.030), and right-sided colectomy (OR 4.67, 95% CI 1.46-15.0; P = 0.009) as independent risk factors for RSRC. Postoperative hospital stays were significantly longer for patients with RSRC than for those without RSRC (22 days vs. 11days; P < 0.001). Short-term outcomes of LSR for patients with sCRLM were acceptable in an experienced center. RSRC was the most common complication, and high-difficulty hepatectomy, right-sided colectomy, and ASA classification ≥ 3 were independent risk factors for RSRC.

Application of "modified double pocket suture" pancreatoenterostomy in laparoscopic pancreatoduodenectomy

Objective: The purpose of this study was to explore the value of the "improved double purse-string suture method" for pancreatojejunostomy in laparoscopic pancreaticoduodene-ctomy. Methods: The clinical data of 273 patients who underwent laparoscopic pancreaticoduode-nectomy in the Department of Hepatobiliary and Pancreatic Surgery of the First Hospital of Jilin University from January 2021 to May 2022 were retrospectively analyzed. According to the method of pancreaticoenteric anastomosis, the patients were divided into two groups: the "improved double purse-string suture method" group and the "Hong's one-stitch method" group. Results: The "improved double purse-string suture method" for pancreaticoenteric anastomosis was performed in a total of 189 patients, including 107 males and 82 females, with a mean age of (59.6±10.2) years. The "Hong's one-stitch method" group" was performed in a group of 84 patients, including 52 males and 32 females, with a mean age of (60.8±9.3) years.The results showed that the "improved double purse-string suture method" group had a lower incidence of postoperative pancreatic fistula (6.88% vs 8.33% for grade B fistula, and 1.58% vs 2.38% for grade C fistula) and a shorter anastomosis time [(25.25±4.73) min vs (25.76±6.71) min] than the "Hong's one-stitch method" group. There was no statistically significant difference between the two groups in terms of postoperative biliary fistula, abdominal bleeding, delayed gastric emptying, and other complications (P>0.05). Conclusion: The "improved double purse-string suture method" for pancreatojejunostomy is safe and feasible in laparoscopic pancreaticoduodenectomy.

Biliary fistula and late recurrence of liver hydatid cyst: Role of cysto-biliary communication: A prospective multicenter study.

Hydatid cyst disease (HCD) is common in certain locations. Surgery is associated with postoperative biliary fistula (POBF) and recurrence. The primary aim of this study was to identify whether occult cysto-biliary communication (CBC) can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and alkaline phosphatase (ALP) levels in predicting POBF and recurrent HCD. To identify whether occult CBC can predict recurrent HCD. The secondary aim was to assess the role of cystic fluid bilirubin and ALP levels in predicting POBF and recurrent HCD. From September 2010 to September 2016, a prospective multicenter study was undertaken involving 244 patients with solitary primary superficial stage cystic echinococcosis 2 and cystic echinococcosis 3b HCD who underwent laparoscopic partial cystectomy with omentoplasty. Univariable logistic regression analysis assessed independent factors determining biliary complications and recurrence. There was a highly statistically significant association (P ≤ 0.001) between cystic fluid biochemical indices and the development of biliary complications (of 16 patients with POBF, 15 patients had high cyst fluid bilirubin and ALP levels), where patients with high bilirubin-ALP levels were 3405 times more likely to have biliary complications. There was a highly statistically significant association (P ≤ 0.001) between biliary complications, biochemical indices, and the occurrence of recurrent HCD (of 30 patients with recurrent HCD, 15 patients had high cyst fluid bilirubin and ALP; all 16 patients who had POBF later developed recurrent HCD), where patients who developed biliary complications and high bilirubin-ALP were 244.6 and 214 times more likely to have recurrent hydatid cysts, respectively. Occult CBC can predict recurrent HCD. Elevated cyst fluid bilirubin and ALP levels predicted POBF and recurrent HCD.

Classification of left-side hepatolithiasis for laparoscopic middle hepatic vein-guided anatomical hemihepatectomy combined with transhepatic duct lithotomy.

Laparoscopic middle hepatic vein-guided anatomical hemihepatectomy combined with transhepatic duct lithotomy (MATL) is an approach that can substantially improve stone clearance rates while reducing the rate of postoperative biliary fistula formation, residual stone rates, and rates of recurrence. In this study, we classified left-side hepatolithiasis cases into four subtypes based upon the diseased stone-containing bile duct, the middle hepatic vein, and the right hepatic duct. We then investigated the risk associated with different subtypes and evaluated the safety and efficacy of the MATL procedure. In total, 372 patients who underwent left hemihepatectomy for left intrahepatic bile duct stones were enrolled. Based on the distribution of the stones, the cases could be divided into four types. The risk of surgical treatment was compared for the four types and the safety, short-term efficacy, and long-term efficacy of the MATL procedure in the four types of left intrahepatic bile duct stones were studied. Type II was found to be the most likely to cause intraoperative bleeding while type III was likely to cause biliary tract damage and type IV was associated with the highest stone recurrence rate. The MATL procedure did not increase the risk of surgery and was found to reduce the rate of bile leakage, residual stones, and stone recurrence. Left-side hepatolithiasis-associated risk classification is feasible and may represent a viable means of improving the safety and feasibility of the MATL procedure.

Fluorescent Laparoscopic Central Hepatectomy for Liver Cancer Using Indocyanine Green Negative Staining.

Laparoscopic hepatectomy is an important treatment method for liver cancer. In the past, the resection boundary was usually determined by intraoperative ultrasound, important vascular structures, and surgeon experience. With the development of anatomical hepatectomy, visual surgery technology has gradually been applied to this type of surgery, particularly indocyanine green (ICG)-guided anatomical hepatectomy. As ICG can be specifically ingested by hepatocytes and used for fluorescence tracing, negative staining techniques have been applied according to different tumor positions. Under ICG fluorescent guidance, the surface boundary and deep resection plane can be more accurately displayed during liver resection. Thus, the tumor-bearing liver segment can be anatomically removed, which helps to avoid damage to important vessels and reduce ischemia or congestion of the remaining liver tissue. Finally, the incidence of postoperative biliary fistula and liver dysfunction is reduced; therefore, a better prognosis is obtained after the resection of liver cancer. Centrally located liver cancer is usually defined as a tumor located at segments 4, 5, or 8 that requires resection of the middle section of the liver. These are among the most difficult hepatectomies to perform because of the large surgical wounds and multiple vessel transections. Based on the specific tumor location, we formulated the required resection ranges by designing personalized fluorescent staining strategies. By completing anatomical resection based on the portal territory, this work aims to achieve the best therapeutic effect.

Endoscopic Retrograde Cholangiopancreatography on Pediatric Patients: Experience of a Portuguese Adult Gastroenterology Department

Introduction: Experience with endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric population is limited. Few medical centers have experts specifically trained in pediatric therapeutic endoscopy. As a result, patients are generally referred to adult endoscopists with high experience in the procedure. The aim of this study was to characterize the experience of an adult endoscopy unit with ERCP on pediatric patients, with a special focus on very young patients. Methods: We retrospectively analyzed indications, technical success rate, final clinical diagnosis, and complications of ERCPs in children <18 years at our tertiary referral hospital center between January 1994 and June 2022. Results: Sixty-five ERCPs were performed on 57 children with a median age of 13 years (range 1–17 years). Eleven ERCPs were performed on 9 patients up to 5 years old. Indications for ERCP were as follows: biliary obstruction (n = 40), mainly due to choledocholithiasis, lithiasic acute pancreatitis (n = 19), recurrent pancreatitis (n = 3), stent extraction (n = 2), and post-operative biliary fistula (n = 1). The cannulation success rate was 95.1%. Therapeutic interventions were performed in 79% of ERCP. All patients were followed up as inpatients. Complications were recorded in two procedures (3.1%), and no procedure-related mortality occurred. Conclusion: In our experience, ERCP in children can be safely performed with high success rates by advanced adult-trained expert endoscopists at a high-volume center.

Outcome of combined pancreatic and biliary fistulas after pancreatoduodenectomy

BackgroundPostoperative pancreatic fistula (POPF) as well as postoperative biliary fistula (POBF) are considered the main source of postoperative morbidity and mortality after pancreatoduodenectomy (PD). However, little is known about the incidence and complications of combined POPF/POBF compared to isolated POPF or POBF. MethodsThis single-center study investigated retrospectively the incidence and postoperative outcome of combined POPF/POBF compared to isolated fistulas following PD in a tertiary German pancreatic center between 2009 and 2018. ResultsA total of 678 patients underwent PD for benign and malignant periampullary lesions. Combined fistulas occurred in 6%, isolated POPF in 16%, and isolated POBF in 2%. Pancreatic ductal adenocarcinoma and chronic pancreatitis had a protective effect on the occurrence of combined fistulas, whereas serous cystadenoma and pancreatic metastasis were risk factors. Morbidity (Grade C fistula, post-pancreatectomy hemorrhage, revisional surgery) and mortality was significantly higher in patients with combined fistulas than in those with isolated fistula. Moreover, the duration of ICU stay was longer. ConclusionsA combined POPF/POBF is associated with a significant increase of morbidity and mortality compared to isolated fistulas after PD. Early surgical revision in these patients may improve the postoperative survival rate.

The risk factors of biliary fistula after radical resection of perihilar cholangiocarcinoma in elderly patients and its influence on prognosis: a retrospective cohort study.

Nowadays, the incidence of perihilar cholangiocarcinoma (PHCC) is increasing yearly, and biliary fistula is a common complication. However, there are few reports on the factors affecting the occurrence of biliary fistula. This study aimed to analyze the risk factors for the occurrence of biliary fistula after radical surgery for PHCC in elderly patients to provide a reference basis for improving the prognosis. From April 2016 to April 2021, we randomly included 250 elderly patients with pathologically diagnosed PHCC. Based on our established inclusion and exclusion criteria, we included 211 patients finally Bile drainage for 3 consecutive days after abdominal drainage or single bile drainage ≥100 mL/d was used as the diagnostic criteria for biliary fistula. Multiple logistic regression was used to analyze the independent risk factors for biliary fistula after radical surgery for PHCC. Besides, the Prognostic Score (PS), the Karnofsky performance score (KPS), and the quality of life (QOL) score were used to assess the patients' postoperative recovery, and survival curves were drawn to reflect their 1-year survival rate, using overall survival. The statistical results showed a 36.5% incidence of biliary fistula. Our study showed that preoperative cholangitis, number of biliary anastomoses, etc. were independent risk factors for grade B and grade C biliary fistula. Besides, the presence of intraoperative hemorrhage (OR =0.223, P=0.006) and γ-glutamyl transpeptidase (γ-GT) on the first postoperative day (OR =1.011, P=0.013) were still independent risk factors for grade B biliary fistula, while C-reactive protein (CRP) (OR =1.026, P=0.011) and total bilirubin (TBil) (OR =0.003, P=1.066) on the first postoperative day and bile duct diameter (OR =0.299, P=0.020) were independent risk factors for grade C biliary fistula. Analysis of variance (ANOVA) showed statistically significant differences (P<0.05) between the three groups in terms of PS (P=0.000), KPS (P=0.001), and QOL scores (P=0.000). The incidence of postoperative biliary fistula remains high in elderly patients treated with radical surgery for PHCC and seriously affects their prognosis. Therefore, focusing on the clinical characteristics and risk factors of patients, improving surgical precision and enhancing postoperative patient care to reduce the likelihood of postoperative biliary fistula, thereby prolonging patient life.

Curative effect and technical key points of laparoscopic surgery for choledochal cysts in children.

The purpose of this study was to investigate the curative effect of and experience with laparoscopic surgery for congenital choledochal cysts in children. This is a retrospective analysis of 33 children diagnosed with congenital choledochal cyst in the pediatric surgery department of the Affiliated Hospital of Southwest Medical University between January 2019 and December 2021. The cohort included 8 males and 25 females aged 0.25-13.7 years (median age, 3.2 years), including 21 cases of type I and 12 cases of type IV choledochal cyst (Todani classification). Laparoscopic choledochal cyst resection and hepaticojejunostomy with Roux-en-Y anastomosis were performed in all the patients. Laparoscopy without transit opening was successfully performed in the 33 cases. The duration of the procedure was 235-460 min (mean ± SD, 316 ± 61 min), and intraoperative blood loss volume was 15-40 ml (23 ± 7.6 ml). Postoperative hospital stay was 7-14 days (9 ± 1.8 days). Postoperative biliary fistula and pancreatitis occurred in two cases each, and all four patients were successfully treated with conservative treatment. No anastomotic stenosis, delayed bleeding, cholangitis, intestinal obstruction, or other complications occurred. All the children were followed up for 2-36 months (median period, 17.2 months). The clinical symptoms disappeared, and no obvious hepatic dysfunction was found on abdominal color ultrasound and liver function examination. Laparoscopic surgery for congenital choledochal cyst in children is safe and effective, as it is a minimally invasive surgery that is associated with a low degree of trauma and bleeding, rapid postoperative recovery, and satisfactory aesthetic appearance.

Definition and outcomes of postoperative biliary fistula after bile duct injury repair surgery

Background: Bile duct injury remains constant since the introduction of laparoscopic cholecystectomy. In many instances, the placement of a stent is the treatment of choice. Otherwise, a bilioenteric anastomosis is required. Postoperative biliary fistula is a recognized complication of the procedure. The evolution of the leak is variable, it is quite common in the very early postoperative period, and in most cases no more procedures will be necessary. In some instances, on the contrary the leak persists, often requiring the placement of intrahepatic drains to control the fistula. Perpetuation of the leak is an adverse situation for the final result of the anastomosis, and until now there is no definition that adequately refers the volume of output or number of days needed to become a clinically relevant fistula. The aim of this study is to analyze the frequency, management, and outcome in patients with postoperative biliary fistula according to our definition in a high-volume bile duct repair center.

HEPATECTOMIA PARCIAL EMPREGANDO GRAMPEADOR LINEAR CORTANTE: HÁ VANTAGENS?

ABSTRACT BACKGROUND: Morbidity of liver resections is related to intraoperative bleeding and postoperative biliary fistulas. The Endo-GIA stapler (EG) in liver resections is well established, but its cost is high, limiting its use. The linear cutting stapler (LCS) is a lower cost device. AIMS: To report open liver resections, using LCS for transection of the liver parenchyma and en bloc stapling of vessels and bile ducts. METHODS: Ten patients were included in the study. Four patients with severe abdominal pain had benign liver tumors (three adenomas and one focal nodular hyperplasia). Among the remaining six patients, four underwent liver resection for the treatment of colorectal liver metastases, three of which had undergone preoperative chemotherapy. The other two cases were one patient with metastasis from a testicular teratoma and the other with metastasis from a gastrointestinal neuroectodermal tumor. RESULTS: The average length of stay was five days (range 4–7 days). Of the seven patients who underwent resections of segments II/III, two presented postoperative complications: one developed a seroma and the other a collection of abdominal fluid who underwent percutaneous drainage, antibiotic therapy, and blood transfusion. Furthermore, the three patients who underwent major resections had postoperative complications: two developed anemia and received blood transfusions and one had biloma and underwent percutaneous drainage and antibiotic therapy. CONCLUSIONS: The use of the linear stapler in hepatectomies was efficient and at lower costs, making it suitable for use whenever EG is not available. The size of the LCS stapler shaft is more suitable for en bloc transection of the left lateral segment of the liver, which is thinner than the right one. Further studies are needed to evaluate the safety of LCS for large liver resections and resections of tumors located in the right hepatic lobe.

Influencing factors of biliary fistula after radical resection of hilar cholangiocarcinoma: a prospect cohort

BackgroundBiliary fistula is a common but serious complication after radical resection of hilar cholangiocarcinoma. We aimed to evaluate the influencing factors of biliary fistula after radical resection, to provide insights to the clinical treatment of hilar cholangiocarcinoma.MethodsPatients undergoing radical resection of hilar cholangiocarcinoma from January 1, 2015 to March 31, 2022 were selected. Patients’ personnel characteristics and laboratory test results of patients with and without biliary fistula were collected and compared. Logistic regression analyses were conducted to evaluate the associated risk factors of biliary fistula.Results160 patients undergoing radical resection of hilar cholangiocarcinoma were included, the incidence of postoperative biliary fistulas was 20.63%. There were significant differences in the age, preoperative cholangitis and number of biliary anastomosis between biliary fistula and no biliary fistula patients (all p < 0.05). There were significant differences in the gamma glutamyl transpeptidase (GGT) on the first day after surgery, Klebsiella pneumoniae between biliary fistula and no biliary fistula patients (all p < 0.05). Logistic regression analysis indicated that age ≥ 65 years (OR 2.035, 95%CI 1.131–3.007), preoperative cholangitis (OR 1.584, 95% CI 1.081–2.361), number of biliary anastomosis ≥ 2(OR 2.866, 95%CI 1.942–3.624), GGT on the first day after surgery ≥ 120 U/L (OR 1.823, 95%CI: 1.274–2.906), preoperative bile culture for Klebsiella pneumoniae (OR 3.181, 95%CI: 2.426–3.992) were the risk factors of postoperative biliary fistulas (all p < 0.05).ConclusionsThere are many independent risk factors for postoperative biliary fistula in patients undergoing radical resection of hilar cholangiocarcinoma. Clinical medical workers should take early interventions and treatment measures for these high-risk patients to reduce the occurrence of postoperative biliary fistula.

Value of indocyanine green fluorescence tracer in laparoscopic cholecystectomy for acute cholecystitis

Objective: To explore the value of low-dose indocyanine green (ICG) fluorescence imaging in laparoscopic cholecystectomy (LC) for acute cholecystitis. Methods: Clinical data of 198 patients with acute cholecystitis and had received LC in Changzhou No.2 People's Hospital from January 2020 to September 2021 were collected. In the fluorescence group (n=97), peripheral intravenous injection of ICG was performed 15 minutes before LC, while conventional white light was applied in the control group (n=101). The efficiency of bile duct discrimination, operation time, intraoperative bleeding and postoperative complications were compared between the two groups. Results: Of the 198 patients, 86 were males and 112 females. The differences were not statisticly significant in age [52 (44, 63) vs 56 (46, 68) years, P>0.05], history of chronic inflammation [34(35.1%) vs 31(30.7%) cases, P>0.05] and other clinical baseline data between the two groups. Compared with the control group, the fluorescence group had higher efficiency of bile duct identification [18 (16,19) vs 38 (28,55) min,P<0.001], shorter operation time [45 (40,60) vs 80 (65,100) min,P<0.001], less intraoperative bleeding [10 (5,15) vs 60 (20,100) ml,P<0.001], and less postoperative liver function damage [alanine aminotransferase 35.0 (23.4,51.0) vs 98.3 (67.0,134.8)U/L,P<0.001]. In the control group, there was one case of biliary duct injury during operation, one case of postoperative biliary fistula, and one case of postoperative hemorrhage. No similar adverse event was found in fluorescence group. Conclusions: ICG fluorescence imaging can improve the efficiency of LC for patients with acute cholecystitis. It is easy to operate and has a good clinical application value.

БИЛИАРНАЯ ФИСТУЛА ПОСЛЕ ПАНКРЕАТОДУОДЕНАЛЬНОЙ РЕЗЕКЦИИ

Literature searches were carried out on the Pubmed information platform and in the elibrary and Cyberleninka libraries by Keywords. Inclusion criteria are the following: availability of the full-text version of the original article, full compliance with the topic, publication period no more than 5 years. From 144 publications received, those completely duplicated and not meeting the inclusion criteria, were excluded. A total of 36 articles are included in the review. The epidemiology of biliary fistula after pancreatoduodenal resection, modern views on pathogenesis, classification, preventive measures and therapeutic and diagnostic tactics during its development are considered. In the postoperative period of pancreatoduodenal resection, biliary fistula is formed with a frequency of 1-24%. Non-modifiable risk factors include male gender, thin common bile duct, benign biliopancreatoduodenal pathology, and cancer with previous neoadjuvant therapy. Modifiable risk factors include obesity, hypoalbuminemia, obstructive jaundice, duration of hepaticojejunostomy, and prior endoscopic biliary drainage. Nowadays, effective and safe procedures are available in modern interventional radiology for the diagnosis and treatment of postoperative biliary fistula, which can be used as an alternative to endoscopic manipulations and revision interventions when the latter are associated with high risks of complications. Timely detection and treatment ensures the prevention of severe biliary fistula and repeated interventions and favorable prognosis, as well as saving medical and financial resources.

Laparoscopic modified subtotal cholecystectomy is a safe method in the management of mirizzi syndrome type I

Background: Efforts to reveal the cystic duct and the cystic artery during standard cholecystectomy in Mirizzi Syndrome (MS) without preoperative or intraoperative diagnosis increase the risk of biliary and vascular injury due to intense fibrosis in the Calot’s triangle. We aim to evaluate the postoperative results of a group of MS type I patients who were diagnosed by video scope intraoperatively and underwent laparoscopic modified subtotal cholecystectomy (LMSC) in the same session since safe dissection of Calot’s triangle could not be performed. Methods: Ten out of 1680 patients who underwent conventional laparoscopic cholecystectomy for acute or chronic cholecystitis between 2017 and 2019 were diagnosed with MS type I intraoperatively. These 10 patients underwent LMSC and their demographic characteristics, preoperative clinical histories, radiological images, intraoperative and postoperative findings were evaluated retrospectively. Intraoperative MS type determination and LMSC technique are explained. Results: The diagnoses of MS type I in all our cases were made laparoscopically with the help of a videoscope during the operation where safe dissection of the Calot’s triangle could not be performed in either elective or emergency cholecystectomy. LMSC was performed without leaving any cavity behind, and there was no need for any intervention at the operation site (suture, staple closure) since the cystic duct orifice was already obstructed due to fibrosis as visually verified by the camera. There were no intraoperative bile duct injuries or postoperative biliary fistula. None of our patients developed postcholecystectomy syndrome (range 1-38 months) Conclusion: The LMSC is a safe procedure in the diagnosis and surgery of MS type I where safe dissection of Calot’s triangle could not be performed

Predictive Ability of Prognostic Markers in Cystic Echinococcosis with Bile Leakage

Objective: The most important post-surgical complication of cystic echinococcosis (CE) is cystobiliary communication and bile leakage in terms of mortality and morbidity. Therefore, we aimed to predict bile leakage using prognostic markers before the operation. Materials and Methods: All patients hospitalized with the diagnosis of CE in the Hepatobiliary Surgery Service of Atatürk University Research Hospital between 2011 and 2021 were retrospectively analyzed. Patients who were operated for CE and developed postoperative leakage were included in the study. Prognostic markers were calculated using preoperative laboratory tests. And these values were analyzed according to the recovery time of the patient. Results: The mean recovery time of postoperative biliary fistula was 13.97 ± 7.33 days. No mortality was observed in the patients. The mean prognostic nutritional index (PNI), the neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) values were 48.68 ± 8.46, 3.09 ± 2.61, and 149.34 ± 86.17, respectively. PLR significantly affected the recovery times. An increase in PLR meant a prolonged recovery period. PNI and NLR had no significant effect on the recovery times of biliary fistula. Conclusion: In patients with a high PLR value, caution should be exercised in terms of postoperative biliary fistula. PLR can be used as a marker if the cyst is to be intervened in the preoperative period.

Biliary Leakage Following Pancreatoduodenectomy: Experience from a High-Volume Center.

Purpose: Hepaticojejunostomy leak and bile fistula after pancreaticoduodenectomy (PD) are less frequent than pancreatic leaks. Patients with biliary fistula (BF) have an increased risk of serious complications and an extended hospital stay. This study has investigated the occurrence and outcome of BF.Methods: All patients who underwent a PD from January 1st, 2015 to December 31st, 2019 were included. The significance of multiple risk factors was examined. Univariate analysis was used to identify predictive variables for postoperative BF.Results: Of the 552 patients who underwent PD, 38 patients (6.7%) developed a BF. Patients with nonmalignant diagnoses and malignancies without bile duct obstruction had a greater risk of developing BF. BF did not increase the mortality, though most patients had complications, including surgical site infections, intraabdominal abscesses, and an extended hospital stay.Conclusion: BF after PD leads to an increased risk of subsequent complications and an extended hospital stay but does not increase mortality. Patients with nonmalignant diagnoses and malignancies without bile duct obstruction have an increased risk of BF.

The Application of Preoperative Three-Dimensional Reconstruction Visualization Digital Technology in the Surgical Treatment of Hepatic Echinococcosis in Tibet.

Objective: The present study aims to explore the application value of three-dimensional (3D) reconstruction technology in the preoperative evaluation of patients with complicated hepatic echinococcosis in Tibet.Methods: A total of 200 patients with complicated hepatic echinococcosis, admitted to our hospital between May 2019 and December 2020, who underwent radical hepatectomy, were enrolled in the present study. The patients were randomly divided into a preoperative computer tomography group and a preoperative 3D reconstruction group. According to the imaging results, a surgical plan was formulated. A comparison was made between the two groups of the coincidence rate of the surgical plan and intraoperative and postoperative complications.Results: The patients with hepatic echinococcosis who underwent 3D visualization reconstruction before surgery had a high compliance rate with the surgical plans and the operating time, the number of cases with blood flow blockage, the blood flow blockage time, intraoperative hemorrhage, and postoperative biliary fistulas were significantly lower.Conclusion: The application of preoperative 3D visualization reconstruction in patients with complicated hepatic echinococcosis in Tibet could effectively improve surgical safety.