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Frontiers in Surgery 2023Subtotal cholecystectomy is a type of surgical bail-out procedure indicated when facing difficult laparoscopic cholecystectomy due to not reaching the critical view of... (Review)
Review
INTRODUCTION
Subtotal cholecystectomy is a type of surgical bail-out procedure indicated when facing difficult laparoscopic cholecystectomy due to not reaching the critical view of safety, inadequate identification of the anatomical structures involved and/or risk of injury.
MATERIALS AND METHODS
A comprehensive search on PubMed were performed using the following Mesh terms: Subtotal cholecystectomy and Partial cholecystectomy. The PubMed databases were used to search for English-language reports related to Subtotal cholecystectomy between January 1, 1987, the date of the first published laparoscopic cholecystectomy, through January 2023. 41 studies were included.
RESULTS
Subtotal cholecystectomy's incidence oscillates between 4.00% and 9.38%. Strasberg et al., divided subtotal cholecystectomies in "fenestrating" and "reconstituting" types based on if the remaining portion of the gallbladder was left open or closed. Subtotal cholecystectomy can sometimes be a challenging procedure and is associated to a high rate of complications such as biliary fistula, retained gallstones, subhepatic or subphrenic collections, among others.
CONSLUSION
Subtotal cholecystectomy is a safe alternative when facing difficult cholecystectomy in which the critical view of safety is not reached in order to avoid complications. A classification system should be implemented in surgical descriptions to compare the different surgical techniques employed. In order to avoid bile leakage and cholecystitis of the remnant gallbladder, the surgical technique must be performed skillfully. There is still a current lack of information on alternative techniques such as omental plugging or falciform patch in order to judge their utility. There needs to be further research on long-term complications such as malignancy of the remnant gallbladder.
PubMed: 37151864
DOI: 10.3389/fsurg.2023.1142579 -
Revista Espanola de Enfermedades... Jan 2022Hydatidosis is a zoonosis caused by Echinococcus in the larval stage. Humans are accidental intermediary hosts where cystic lesions develop, primarily in the liver and... (Review)
Review
Hydatidosis is a zoonosis caused by Echinococcus in the larval stage. Humans are accidental intermediary hosts where cystic lesions develop, primarily in the liver and the lungs. It is usually asymptomatic, hence it often represents an incidental finding. Symptoms result from cyst expansion and/or host inflammatory reaction. Hepatomegaly is the most common sign. Hydatidosis induces no specific changes in lab tests but immunodiagnostics are available that may complement its study, with antibody detection being the modality of choice. While ultrasound is the main diagnostic technique, tomography offers more accurate information regarding both characteristics and anatomical relations. A number of therapy options are presently available. Treatment with albendazole, whether combined or not with praziquantel, is useful for smaller, uncomplicated cysts (< 5 cm). Only 30 % of cysts disappear with medical treatment alone. Surgery is indicated for bigger liver cysts (> 10 cm), and cysts at risk of rupture and/or complicated cysts. The laparoscopic approach is scarcely widespread. The radical technique (total cystopericystectomy) is preferable because of its lower risk for postoperative abdominal infection, biliary fistula, and overall morbidity. Conservative techniques are appropriate in endemic areas where surgery is performed by nonspecialist surgeons. PAIR (puncture-aspiration-injection-reaspiration) is an innovative technique representing an alternative to surgery. It is indicated for inoperable cases and/or patients who reject surgery, for recurrence after surgery, and for lack of response to medical treatment. Active surveillance without treatment may be indicated for quiescent or inactive, uncomplicated liver cysts.
Topics: Albendazole; Cysts; Echinococcosis; Echinococcosis, Hepatic; Humans; Liver Diseases
PubMed: 34034501
DOI: 10.17235/reed.2021.7896/2021 -
Revista Espanola de Enfermedades... May 2019Spontaneous external biliary fistula or cholecystocutaneous fistula is defined as the rupture of the gallbladder through all layers of the abdominal wall, with...
Spontaneous external biliary fistula or cholecystocutaneous fistula is defined as the rupture of the gallbladder through all layers of the abdominal wall, with development of a fistulous tract to the skin without prior biliary surgery or trauma. We report the case of an octogenarian woman with debilitating comorbidities and consequently immunosuppression who presented with spontaneous external biliary fistula and a history of ERCP three months before, a procedure that was carried out with no apparent immediate complications.
Topics: Aged, 80 and over; Biliary Fistula; Cutaneous Fistula; Female; Gallbladder Diseases; Humans
PubMed: 30912668
DOI: 10.17235/reed.2019.5882/2018 -
JAMA Surgery Mar 2018Zollinger-Ellison syndrome (ZES) is a life-threatening disease caused by a malignant tumor that secretes gastrin (gastrinoma). Gastrinomas typically occur in the...
IMPORTANCE
Zollinger-Ellison syndrome (ZES) is a life-threatening disease caused by a malignant tumor that secretes gastrin (gastrinoma). Gastrinomas typically occur in the pancreas or the duodenum.
OBJECTIVE
To describe the incidence and prognosis of very unusual gastrinomas originating in the hepatobiliary tract.
DESIGN, SETTING, AND PARTICIPANTS
This study included 223 consecutive patients at the National Institutes of Health and Stanford University Hospital who were enrolled in a prospective protocol to treat ZES using proton pump inhibitors to control acid hypersecretion and surgical resection to ameliorate the tumoral process. Data were collected from June 1982 to August 2017.
MAIN OUTCOMES AND MEASURES
Incidence, location, surgical results, and cure rate and overall survival among patients with gastrinomas that originate in the liver or bile ducts. Cure was defined as serum gastrin levels within the reference range, negative results of a secretin test, and no tumor found on imaging.
RESULTS
Of the 223 patients who underwent surgery to remove gastrinomas, 7 (3.1%) had liver or biliary tract primary tumors, including 5 men and 2 women (mean age at diagnosis, 43 years; range 27-54 years). The mean serum gastrin level was 817 pg/mL (range, 289-2700 pg/mL). Each patient had positive results of a secretin test. None had evidence of multiple endocrine neoplasia 1. Four patients had primary tumors in the liver (1 in segment II, 2 in segment IV, and 1 in segment V); 3, in the bile duct (1 in the right hepatic duct, 1 in the left hepatic duct, and 1 in the common hepatic duct). Surgical resection required 1 right hepatic lobectomy, 1 left lateral segmentectomy, 2 left hepatic lobectomies, 1 central hepatectomy, and 2 bile duct resections. Four patients had nodal metastases, and no patient had distant metastases. No operative deaths occurred, but 3 patients had complications, including bile duct stricture, portal vein stricture, and biliary fistula. Each patient was disease free in the immediate postoperative period, and 3 had recurrences in the liver and portal lymph nodes (at 3, 11, and 15 years). Three patients (43%) remained free of disease at follow-up ranging from 24 months to 26 years.
CONCLUSIONS AND RELEVANCE
Primary gastrinomas of the hepatobiliary tract are uncommon (3%), but the hepatobiliary system is the second most frequent extraduodenopancreatic primary location (after the lymph nodes). These tumors can occur outside the gastrinoma triangle and must be specifically considered. Furthermore, their discovery changes the operative approach because aggressive liver or bile duct resection is indicated, with high rates of long-term cure and survival and acceptable rates of complications. In addition, their discovery dictates that lymph nodes in the porta hepatis should be routinely excised because nearly 50% of patients will have lymph node metastases.
Topics: Adult; Bile Duct Neoplasms; Disease-Free Survival; Female; Gastrinoma; Gastrins; Hepatectomy; Humans; Liver Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Omeprazole; Prognosis; Prospective Studies; Proton Pump Inhibitors; Secretin; Survival Rate; Zollinger-Ellison Syndrome
PubMed: 29365025
DOI: 10.1001/jamasurg.2017.5083 -
Seminars in Interventional Radiology Oct 2021The safety of radioembolization with yttrium-90 ( Y) is well documented and major complications are rare. Previous studies have demonstrated that biliary complications... (Review)
Review
The safety of radioembolization with yttrium-90 ( Y) is well documented and major complications are rare. Previous studies have demonstrated that biliary complications following Y, including bile duct injury and hepatic abscess formation, occur at an increased rate in patients who have had prior biliary surgery and interventions. This article reviews a case of a patient who developed recurrent cholangitis and sepsis as well as a biliary-caval fistula following radioembolization. Additionally, we review current data regarding biliary complications following radioembolization in patients with prior biliary intervention.
PubMed: 34629719
DOI: 10.1055/s-0041-1735605 -
Journal of Acute Medicine Sep 2021Gallstone ileus is an infrequent cause of mechanical small bowel obstruction. The mortality rate of gallstone ileus remains relatively high, since gallstone ileus...
Gallstone ileus is an infrequent cause of mechanical small bowel obstruction. The mortality rate of gallstone ileus remains relatively high, since gallstone ileus usually presents on elderly patients with multiple underlying diseases. Typically, the way of gallstone migration to small bowel is through biliary-enteric flstula, which is a rare complication of chronic cholecystitis. Patients present with diffuse abdominal pain and vomiting when the gallstone lodges in distal small bowel. The goals of surgical intervention include release of the bowel obstruction and closure of biliary-enteric flstula.
PubMed: 34595095
DOI: 10.6705/j.jacme.202109_11(3).0005 -
Kardiochirurgia I Torakochirurgia... Dec 2021Bilio-bronchial fistulization is a rare complication of neglected liver hydatid cysts ruptured in the thorax by anatomical contiguity. Because of the bronchopulmonary... (Review)
Review
Bilio-bronchial fistulization is a rare complication of neglected liver hydatid cysts ruptured in the thorax by anatomical contiguity. Because of the bronchopulmonary and hepato-biliary lesions that it can cause and in the context of severe infection, the morbi-mortality remains high in these fragile patients. The diagnosis is based on clinical arguments: biliptysis mainly with a hepato-thoracic syndrome, imaging data showing the fistulous path, and especially bronchial and biliary endoscopy. The pretherapeutic stage aims at correcting the hydrolytic, anemic and nutritional defects, but above all at controlling the hepatobronchial infection after removal of the biliary obstruction (endoscopic sphincterotomy) and by broad-spectrum antibiotic therapy as well as active respiratory physiotherapy. This preparatory step may be sufficient, otherwise surgical sanction is necessary in operable patients to establish the hepato-phreno-thoracic disconnection. The choice of the thoracic or abdominal approach depends on the initial and progressive lesion assessment and on the surgical strategy envisaged.
PubMed: 35079267
DOI: 10.5114/kitp.2021.112192 -
Transplantation Proceedings 2021Biliary complications in liver transplantation (LT) can cause significant morbidity or even lead to a potential graft loss and patient mortality. Oftentimes biliary...
BACKGROUND
Biliary complications in liver transplantation (LT) can cause significant morbidity or even lead to a potential graft loss and patient mortality. Oftentimes biliary internal stents (ISs) are used at the time of LT to lower the risk for or prevent these biliary complications; however, their efficacy and outcomes remain controversial.
METHODS
A retrospective cohort study was conducted on all of the adult patients who underwent a deceased-donor LT (DDLT) with an end-to-end choledococholedocostomy. An IS was placed across the biliary anastomosis, passing through the ampulla. We compared the demographic profiles and various outcomes between the 2 groups (no-IS group vs IS group) and examined risk factors associated with anastomotic biliary complications.
RESULTS
The study comprised 350 patients in the no-IS group and 132 patients in the IS group. Anastomotic biliary fistula (ABF) occurred in 5 (1.4%) and 1 (0.8%) patients in the no-IS group and the IS group, respectively (P = .55). Anastomotic biliary stricture (ABS) occurred in 53 (15.1%) and 18 (13.6%) patients, respectively (P = .68). No significant difference was found in the overall biliary complications between the 2 groups (P = .33). In multivariate logistic regression analysis, acute rejection was the only risk factor for ABS (P = .02). One biliary complication-induced mortality occurred in the no-IS group in which the patient died of an ABF-induced hepatic artery pseudoaneurysm rupture.
CONCLUSION
The use of biliary ISs in DDLT did not reduce the overall risk for biliary complications, but more research is needed to draw definite conclusions.
Topics: Adult; Anastomosis, Surgical; Biliary Tract Surgical Procedures; Cohort Studies; Female; Humans; Liver Transplantation; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors; Stents; Treatment Outcome
PubMed: 32684369
DOI: 10.1016/j.transproceed.2020.06.019 -
Annals of the Royal College of Surgeons... Mar 2017INTRODUCTION Biliary-enteric anastomoses are performed for a range of indications and may result in early and late complications. The aim of this study was to assess the...
INTRODUCTION Biliary-enteric anastomoses are performed for a range of indications and may result in early and late complications. The aim of this study was to assess the risk factors and management of anastomotic leak and stricture following biliary-enteric anastomosis. METHODS A retrospective analysis of the medical records of patients who underwent biliary-enteric anastomoses in a tertiary referral centre between 2000 and 2010 was performed. RESULTS Four hundred and sixty-two biliary-enteric anastomoses were performed. Of these, 347 (75%) were performed for malignant disease. Roux-en-Y hepaticojejunostomy or choledocho-jejunostomy were performed in 440 (95%) patients. Perioperative 30-day mortality was 6.5% (n=30). Seventeen patients had early bile leaks (3.7%) and 17 had late strictures (3.7%) at a median of 12 months. On univariable logistic regression analysis, younger age was a significant risk factor for biliary anastomotic leak. However, on multivariable analysis only biliary reconstruction following biliary injury (odds ratio [OR]=6.84; p=0.002) and anastomosis above the biliary confluence (OR=4.62; p=0.03) were significant. Younger age and biliary reconstruction following injury appeared to be significant risk factors for biliary strictures but multivariable analysis showed that only younger age was significant. CONCLUSIONS Biliary-enteric anastomoses have a low incidence of early and late complications. Biliary reconstruction following injury and a high anastomosis (above the confluence) are significant risk factors for anastomotic leak. Younger patients are significantly more likely to develop an anastomotic stricture over the longer term.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Ampulla of Vater; Anastomosis, Surgical; Anastomotic Leak; Bile Duct Diseases; Bile Duct Neoplasms; Bile Ducts; Biliary Tract Surgical Procedures; Carcinoma, Pancreatic Ductal; Cholangiocarcinoma; Choledochostomy; Common Bile Duct; Common Bile Duct Neoplasms; Constriction, Pathologic; Databases, Factual; Female; Hepatic Duct, Common; Humans; Jejunostomy; Logistic Models; Male; Middle Aged; Mortality; Multivariate Analysis; Odds Ratio; Pancreatic Neoplasms; Pancreatitis, Chronic; Postoperative Complications; Retrospective Studies; Tertiary Care Centers; Young Adult
PubMed: 27659373
DOI: 10.1308/rcsann.2016.0293