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Bioscience Trends Jul 2020Our purpose was to explore the status of laparoscopic radical resection of hilar cholangiocarcinoma (LRRHcca) in Mainland China. Studies published before February 2020... (Review)
Review
Our purpose was to explore the status of laparoscopic radical resection of hilar cholangiocarcinoma (LRRHcca) in Mainland China. Studies published before February 2020 were retrieved from CNKI database, Pubmed database and Wanfang database. Search terms included "hilar cholangiocarcinoma", "Klatskin tumor", "laparoscopy", "radical operation". Relevant articles regarding LRRHcca in Mainland China were also retrieved. 13 articles were included in this study, with a total of 189 cases. The operation time was 354 min (weighed average, WA), and the mean intraoperative blood loss was 324 mL (WA). The rate of negative margin (R0 rate) was 95.2%, and the number of lymph nodes received was 9.5 (WA). 2.6% of cases were converted to laparotomy. The incidence of postoperative complications was 21.2%, with 3.2% for those classified as Clavien-Dindo ≥ 3, 12.2% for bile leakage, 1.6% for postoperative abdominal hemorrhage, 1.6% for liver insufficiency, and 1.1% for abdominal infection. In-hospital mortality was 0.5%, with mean postoperative hospital stay of 15 days (WA), and the rate of reoperation was 1.1%. The mean postoperative follow-up time was 16 months (WA), and 1-year overall survival rate was 84.5%. In conclusions, laparoscopic radical hilar cholangiocarcinoma is safe and feasible in experienced hands after careful selection of HCCA cases.
Topics: Anastomosis, Surgical; Anastomotic Leak; Bile Duct Neoplasms; Blood Loss, Surgical; China; Feasibility Studies; Follow-Up Studies; Hepatic Duct, Common; Hospital Mortality; Humans; Incidence; Klatskin Tumor; Laparoscopy; Length of Stay; Margins of Excision; Postoperative Hemorrhage; Survival Rate
PubMed: 32389939
DOI: 10.5582/bst.2020.03010 -
Endoscopy Dec 2022
Topics: Humans; Cystic Duct; Cholangiopancreatography, Endoscopic Retrograde; Cholelithiasis; Cholecystectomy, Laparoscopic
PubMed: 35863338
DOI: 10.1055/a-1882-5491 -
Cureus Jun 2023Thyroglossal duct cysts are one of the most common cervical congenital anomalies. They occur along the thyroid migration tract, which extends from the base of the tongue...
Thyroglossal duct cysts are one of the most common cervical congenital anomalies. They occur along the thyroid migration tract, which extends from the base of the tongue through the midline of the neck to the level of the cricoid cartilage. Thyroglossal duct cysts present as a midline neck mass and are closely associated with the hyoid bone. Here, we describe a case where two cystic structures were found just inferior to the thyroid gland and inferior to the hyoid bone, suggesting a double thyroglossal duct cyst. It is important to diagnose and surgically manage thyroglossal duct cysts as they are associated with complications, such as infection and malignancy.
PubMed: 37485128
DOI: 10.7759/cureus.40660 -
Frontiers in Surgery 2022Biliary duct management is of great significance after laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE) in the treatment...
OBJECTIVE
Biliary duct management is of great significance after laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE) in the treatment of cholecystolithiasis accompanied with common bile duct (CBD) stones. This study is to evaluate the safety and effectiveness of primary closure with C-tube drainage through cystic duct after LC + LCBDE.
METHODS
Through a retrospective study, 290 patients who underwent LC + LCBDE in our hospital from January 2019 to April 2022 were enrolled and divided into 2 groups. 143 patients underwent primary closure with C-tube drainage through cystic duct (C-tube group) and the other 147 patients underwent traditional T-tube drainage (T-tube group). Personal information, perioperative examinations, surgical results, and follow-up results were collected and analyzed.
RESULTS
There were no significant differences in the average age, gender, the mean of CBD diameters and the rate of comorbidities (acute cholecystitis, obstructive jaundice, acute pancreatitis and acute cholangitis) between the two groups ( > 0.05). Hospital stay, postoperative hospital stay were significantly shorter in the C-tube group than T-tube group ( < 0.05). In addition, the average time of placing and removal the drainage tubes was significantly less than those of the T-tube group ( < 0.05). This study also showed significant differences in the incidence of postoperative abdominal infection and soft tissue infection in the two groups ( < 0.05). There were no significant differences in the incidence of postoperative complications including cholangitis, bile duct stenosis, mortality in two groups. There were also no significant differences between the two groups of the recurrence of CBD stones, reoperation and readmition in 30 days during the median follow-up of 6 months.
CONCLUSIONS
Compared with T tube drainage, patients with C-tube drainage after LC + LCBDE with primary closure of cystic duct recovered faster and had fewer complications. C-tube drainage is a safe and feasible treatment option for patients with cholecystolithiasis and choledocholithiasis.
PubMed: 36386513
DOI: 10.3389/fsurg.2022.972490 -
Parasite (Paris, France) 2021Hilar biliary duct stricture may occur in hepatic cystic echinococcosis (CE) patients after endocystectomy. This study aimed to explore diagnosis and treatment...
AIM
Hilar biliary duct stricture may occur in hepatic cystic echinococcosis (CE) patients after endocystectomy. This study aimed to explore diagnosis and treatment modalities.
METHODS
Clinical data of 26 hepatic CE patients undergoing endocystectomy who developed postoperative hilar biliary duct stricture were retrospectively analyzed and were classified into three types: type A, type B, and type C. Postoperative complications and survival time were successfully followed up.
RESULTS
Imaging showed biliary duct stenosis, atrophy of ipsilateral hepatic lobe, reactive hyperplasia, hepatic hilum calcification, and dilation or discontinuity of intrahepatic biliary duct. All patients received partial hepatectomy to resect residual cyst cavity and atrophic liver tissue, and anastomosis of hepatic duct with jejunum or common bile duct exploration was applied to handle hilar biliary duct stricture. Twenty-five patients were successfully followed up. Among type A patients, one patient died of organ failure, and upper gastrointestinal bleeding and liver abscess occurred in one patient. Moreover, calculus of intrahepatic duct was found in one type B and type C patient.
CONCLUSION
Long-term biliary fistula, infection of residual cavity or obstructive jaundice in hepatic CE patients after endocystectomy are possible indicators of hilar bile duct stricture. Individualized and comprehensive treatment measures, especially effective treatment of residual cavity and biliary fistula, are optimal to avoid serious hilar bile duct stricture.
Topics: Biliary Tract Surgical Procedures; Constriction, Pathologic; Echinococcosis; Humans; Liver; Retrospective Studies
PubMed: 34142953
DOI: 10.1051/parasite/2021051 -
Journal of Gastrointestinal Surgery :... Mar 2021Bilio-enteric diversion is the current surgical standard in patients after deceased donor liver transplantation (DDLT) with a biliary anastomotic stricture failing...
BACKGROUND
Bilio-enteric diversion is the current surgical standard in patients after deceased donor liver transplantation (DDLT) with a biliary anastomotic stricture failing interventional treatment and requiring surgical repair. In contrast to this routine, the aim of this study was to show the feasibility and safety of a duct-to-duct biliary reconstruction.
PATIENTS
Between 2012 and 2019, we performed a total of 308 DDLT in 292 adult patients. The overall biliary complication rate was 20.5%. Patients with non-anastomotic or combined strictures were excluded from this analysis. Out of 273 patients after a primary duct-to-duct reconstruction, 20 (7.3%) developed late isolated AS. Seven of these patients failed interventional biliary treatment and required a surgical repair.
RESULTS
Duct-to-duct reconstruction was feasible and successful in all patients. Liver function tests fully normalized and no patient required any form of biliary intervention after surgery. One patient with intraoperative cholangiosepsis was ICU bound for 5 days, and another patient with a subhepatic abscess required percutaneous drainage. There was no perioperative death. The median length of hospital stay was 8 (5-17) days. The median time of follow-up after relaparotomy was 1593 (434-2495) days.
CONCLUSION
Duct-to-duct reconstruction is a feasible and safe option in selected patients requiring surgical repair for isolated AS after DDLT. This approach preserves the biliary anatomy and avoids the potential side effects of a bilio-enteric diversion.
Topics: Adult; Anastomosis, Surgical; Bile Ducts; Biliary Tract Surgical Procedures; Constriction, Pathologic; Humans; Liver Transplantation; Living Donors; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 32728823
DOI: 10.1007/s11605-020-04735-y -
World Journal of Gastroenterology Apr 2021Bile duct epithelial tumours showing papillary neoplasm in the bile duct lumen are present in the intrahepatic and extrahepatic bile ducts. Clinicopathological images of... (Review)
Review
Bile duct epithelial tumours showing papillary neoplasm in the bile duct lumen are present in the intrahepatic and extrahepatic bile ducts. Clinicopathological images of these tumours are distinctive and diverse, including histological images with a low to high grade dysplasia, infiltrating and noninfiltrating characteristics, excessive mucus production, and similarity to intraductal papillary mucinous neoplasm (IPMN) of the pancreas. The World Health Organization Classification of Tumours of the Digestive System in 2010 named these features, intraductal papillary neoplasm of the bile duct (IPNB), as precancerous lesion of biliary carcinoma. IPNB is currently classified into type 1 that is similar to IPMN, and type 2 that is not similar to IPMN. Many of IPNB spreads superficially, and diagnosis with cholangioscopy is considered mandatory to identify accurate localization and progression. Prognosis of IPNB is said to be better than normal bile duct cancer.
Topics: Bile Duct Neoplasms; Bile Ducts, Extrahepatic; Bile Ducts, Intrahepatic; Cholangiocarcinoma; Humans; Pancreatic Neoplasms
PubMed: 33958844
DOI: 10.3748/wjg.v27.i15.1569 -
Plastic and Reconstructive Surgery.... Oct 2021Thoracic duct occlusion can lead to devastating complications, resulting in recalcitrant chylothoraces, ascites, generalized lymphedema, metabolic derangement, and...
Thoracic duct occlusion can lead to devastating complications, resulting in recalcitrant chylothoraces, ascites, generalized lymphedema, metabolic derangement, and death. Lymphatic extravasation has traditionally been managed conservatively and, in recent years, using minimally invasive techniques, such as thoracic duct ligation and embolization. However, these measures are often limited in application and therapeutic success, resulting in chronically difficult conditions with few modalities available for definitive management. Advances in microsurgery have allowed for surgical treatment and resolution of peripherally-based lymphatic pathology, though microsurgical intervention to address central lymphatic abnormalities is scarcely described. This report is the first series detailing experiences utilizing microsurgical thoracic duct lymphovenous bypass in a refractory adult population with thoracic duct occlusion. Four patients successfully underwent the procedure, with three achieving complete resolution of symptoms. The fourth patient enjoyed partial resolution, though ubiquitous lymphatic deformities have conferred recurrent residual lower-extremity peripheral edema requiring future intervention. Postoperatively, patent anastomoses were confirmed under magnetic resonance lymphangiography. This series demonstrates the feasibility of microsurgical thoracic duct lymphovenous bypass as a promising technique in treating patients suffering from thoracic duct occlusion. This intervention is effective for recalcitrant chylothorax, chylous ascites, and generalized lymphedema, particularly when traditional and interventional radiological techniques are unsuccessful.
PubMed: 34815915
DOI: 10.1097/GOX.0000000000003875 -
Journal of Minimally Invasive Surgery Dec 2023Left-sided gallbladder is a rare finding that is mostly discovered incidentally during surgery and is often associated with anatomic anomalies. We herein report a case...
Left-sided gallbladder is a rare finding that is mostly discovered incidentally during surgery and is often associated with anatomic anomalies. We herein report a case in which laparoscopic cholecystectomy and common bile duct exploration were achieved for an 89-year-old female patient with left-sided gallbladder. Surgery was carried out using our usual trocar position. Calot triangle was covered by the body of the gallbladder and could not be detected. We dissected the gallbladder from the fundus towards the neck. The cystic duct joined the common bile duct from the right side, and common bile duct exploration was performed routinely without perioperative comorbidities. Although the preoperative diagnosis rate is low and the risk of intraoperative bile duct injuries in patients with left-sided gallbladder is high, laparoscopic cholecystectomy and common bile duct exploration can be safely performed by understanding the location and bifurcation of the cystic duct.
PubMed: 38098356
DOI: 10.7602/jmis.2023.26.4.218 -
European Journal of Pediatric Surgery... Jan 2020Congenital choledochal malformations (CCMs) are characterized by intra- and/or extrahepatic bile duct dilatation. Five basic types (1-5) are recognized in Todani's...
Congenital choledochal malformations (CCMs) are characterized by intra- and/or extrahepatic bile duct dilatation. Five basic types (1-5) are recognized in Todani's classification and its modifications, of which types 1 and 4 typically have an associated anomalous pancreatobiliary junction and common channel (CC). We describe two cases with previously undescribed features. 1 Antenatal detection of a cyst at porta hepatis was made in an otherwise normal girl of Iranian parentage. She was confirmed to be a CCM (20 mm diameter), postnatally, with no evidence of obstruction. Surgical exploration was performed at 12 weeks. She had an isolated cystic dilatation of the right-hepatic duct only. The left-hepatic duct and common bile duct (CBD) were normal without a CC. Histology of the resected specimen showed stratified squamous epithelium. A preterm (31 weeks of gestation) boy of Nigerian parentage was presented. His mother was HIV + ve and he was treated with nucleoside reverse transcriptase inhibitors following birth. He had persistent cholestatic jaundice and a dilated (10 mm) bile duct from birth. Although the jaundice resolved, the dilatation persisted and increased, coming to surgery aged 2.5 years. This showed cystic dilatation confined to the common hepatic duct, and otherwise normal distal common bile duct and no CC. Both underwent resection with the Roux-en-Y hepaticojejunostomy reconstruction to the transected right-hepatic duct alone in case 1, leaving the preserved left duct and CBD in continuity, and to the transected common hepatic duct in case 2. Neither choledochal anomaly fitted into the usual choledochal classification and case 1 appears unique in the literature.
PubMed: 33194534
DOI: 10.1055/s-0039-1693998