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Endoscopy Dec 2023
Topics: Humans; Choledocholithiasis; Cystic Duct; Laparoscopy; Cholecystectomy; Common Bile Duct; Cholecystectomy, Laparoscopic; Retrospective Studies; Cholangiopancreatography, Endoscopic Retrograde
PubMed: 37084780
DOI: 10.1055/a-2067-4587 -
BMC Pediatrics Nov 2022Duplication of the common bile duct (CBD) is extremely rare among the anatomical variations in the biliary tract system, which presents a septum within the CBD or an...
BACKGROUND
Duplication of the common bile duct (CBD) is extremely rare among the anatomical variations in the biliary tract system, which presents a septum within the CBD or an accessory CBD. In our study, we report a rare case of duplication of the common bile duct combined congenital biliary dilatation.we present a rare case of a septum in the dilated biliary tract.
CASE PRESENTATION
We reported a 5-year-old Asian girl who had history of repeated abdominal pain for 4 days and aggravated for 1 day. Magnetic resonance cholangiopancreatography (MRCP) examination revealed duplicated common bile duct (DCBD) malformation with congenital biliary dilatation and distal cholelithiasis. The patient underwent choledochal cyst resection and biliary tract reconstruction and abdominal cavity irrigation and drainage under general anesthesia. A septum was found within the common bile duct during the operation. The septum divided the extrahepatic bile duct into two parts connected to the left and right hepatic ducts respectively and the gallbladder is attached to the repeated right bile duct which was not previously reported in the literature.
CONCLUSIONS
We complement and adjust the classification of common bile duct duplication by reviewing the literature.
Topics: Female; Humans; Child, Preschool; Choledochal Cyst; Common Bile Duct; Biliary Tract; Biliary Tract Surgical Procedures; Bile Ducts, Extrahepatic
PubMed: 36348383
DOI: 10.1186/s12887-022-03708-1 -
HPB Surgery : a World Journal of... Sep 1988We describe the histological and histochemical changes of the common bile-duct mucosa in specimens obtained by means of peroral cholangioscopy, 1-12 years after...
We describe the histological and histochemical changes of the common bile-duct mucosa in specimens obtained by means of peroral cholangioscopy, 1-12 years after choledochoduodenal anastomosis. Our findings--hyperplasia of the superficial epithelium, metaplastic goblet cells containing predominantly acid sialomucins, and pyloric-like gland formation containing neutral mucins--express a morphological and functional differentiation of the common bile-duct mucosa that probably facilitates its survival in a different environment. We consider that these adaptive changes may explain the uneventful long-term postoperative period of choledochoduodenostomized patients.
Topics: Choledochostomy; Common Bile Duct; Epithelium; Humans; Mucins; Mucous Membrane; Sialomucins; Staining and Labeling
PubMed: 2484792
DOI: 10.1155/1988/85102 -
Annals of the Royal College of Surgeons... Jan 1980Sixty-one patients undergoing simple cholecystectomy and 12 undergoing cholecystectomy and exploration of the common bile duct were studied. The volumes produced from...
Sixty-one patients undergoing simple cholecystectomy and 12 undergoing cholecystectomy and exploration of the common bile duct were studied. The volumes produced from the abdominal drains were measured and the postoperative course observed and compared in all cases. The mean total drainage after simple cholecystectomy was 135 ml in 5 days and after cholecystectomy and exploration of the common bile duct 94 ml in 5 days. With such low volumes drained the majority of patients undergoing simple elective cholecystectomy do not need to be drained. In the small number of patients studied our results would also appear to indicate that a policy of non-drainage may be safe after cholecystectomy with exploration of the common bile duct or after cholecystectomy combined with other operative procedures--for example, vagotomy and pyloroplasty. If the surgeon decides to use a drain it would seem that the RediVac system is as efficient as other systems commonly used and is associated with less pain and fewer complications.
Topics: Adult; Aged; Child; Cholecystectomy; Cholecystitis; Chronic Disease; Common Bile Duct; Drainage; Female; Humans; Male; Middle Aged; Postoperative Complications
PubMed: 7362191
DOI: No ID Found -
European Review For Medical and... Aug 2017The aim of this project was to study the imaging characteristics of multi-detector CT (MDCT) in different types of malignant tumor in the common bile duct ampulla.
OBJECTIVE
The aim of this project was to study the imaging characteristics of multi-detector CT (MDCT) in different types of malignant tumor in the common bile duct ampulla.
PATIENTS AND METHODS
We examined 30 cases of pancreatic head cancer, 35 of terminal cholangiocarcinoma, 26 of ampullary carcinoma, and 40 of benign lesions, all confirmed by pathology. We used 64-slice spiral CT plain scan and multi-phase enhanced scan with multi-planar reconstruction (MPR) and curved planar reconstruction (CPR) post-processing to obtain three-dimensional images. From these images, we analyzed intrahepatic and extrahepatic bile ducts, gallbladder and common bile duct dilation, and morphology and enhancement pattern of lesions and surrounding tissue.
RESULTS
The dilatation rate of intrahepatic, extrahepatic bile duct and gallbladder in terminal cholangiocarcinoma was the highest. The double duct sign was most evident in pancreatic head cancer. Ampullary carcinoma fell in between, and the benign lesions had no intrahepatic or extrahepatic bile duct and pancreatic duct dilation. Pancreatic cancer had a larger diameter, a higher internal rate of necrosis, and the surrounding tissues had a higher vulnerability to invasion. Terminal cholangiocarcinoma had a smaller diameter and a thicker wall. Benign lesions showed isodensity and hyperdensity shadow in the lumen, but no other significant changes were observed. Pancreatic head carcinoma had lower enhancement degree than normal pancreatic tissue, no enhancement in the internal necrotic area, and the borderline was unclear. Thickened ductal wall of the terminal cholangiocarcinoma showed equal density, enhancement and commonly delayed enhancement. The enhancement degree was higher than in the cancer of the pancreatic head and slightly lower than in ampullary cancer. Ampullary cancer had a regular margin and a significant enhancement, with enhancement degree higher than in pancreatic cancer and lower than in common bile duct cancer. Arterial and venous phases showed enhancement, but benign lesions did not show enhancement.
CONCLUSIONS
MDCT imaging and post-processing techniques have significant application in the diagnosis of benign and malignant lesions, as well as a malignant tumor of the common bile duct ampulla.
Topics: Aged; Ampulla of Vater; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Cholangiocarcinoma; Common Bile Duct; Female; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Pancreatic Neoplasms; Retrospective Studies; Tomography, Spiral Computed
PubMed: 28925490
DOI: No ID Found -
JSLS : Journal of the Society of... 2014One-stage laparoscopic management for common bile duct stones in patients with gallbladder stones has gained wide acceptance. We developed a novel technique using a...
BACKGROUND AND OBJECTIVES
One-stage laparoscopic management for common bile duct stones in patients with gallbladder stones has gained wide acceptance. We developed a novel technique using a transcystic approach for common bile duct exploration as an alternative to the existing procedures.
METHODS
From April 2010 to June 2012, 9 consecutive patients diagnosed with cholelithiasis and common bile duct stones were enrolled in this study. The main inclusion criteria included no upper abdominal surgical history and the presence of a stone measuring <5 mm. After the gallbladder was dissected free from the liver connections in a retrograde fashion, the fundus of the gallbladder was extracted via the port incision in the right epigastrium. The choledochoscope was inserted into the gallbladder through the small opening in the fundus of the gallbladder extracorporeally and was advanced toward the common bile duct via the cystic duct under the guidance of both laparoscopic imaging and endoscopic imaging. After stones were retrieved under direct choledochoscopic vision, a drainage tube was placed in the subhepatic space.
RESULTS
Of 9 patients, 7 had successful transcystic common bile duct stone clearance. A narrow cystic duct and the unfavorable anatomy of the junction of the cystic duct and common bile duct resulted in losing access to the common bile duct. No bile leakage, hemobilia, or pancreatitis occurred. Wound infection occurred in 2 patients. Transient epigastric colic pain occurred in 2 patients and was relieved by use of anisodamine. A transient increase in the amylase level was observed in 3 patients. Short-term follow-up did not show any recurrence of common bile duct stones.
CONCLUSION
Our novel transcystic approach to laparoscopic common bile duct exploration is feasible and efficient.
Topics: Adult; Aged; Biliary Tract Surgical Procedures; Common Bile Duct; Cystic Duct; Female; Gallstones; Humans; Laparoscopy; Male; Middle Aged
PubMed: 25516702
DOI: 10.4293/JSLS.2014.00184 -
JSLS : Journal of the Society of... 2010To compare the effectiveness of laparoscopic common bile duct exploration in patients with failed endoscopic retrograde cholangiopancreatography (ERCP). (Comparative Study)
Comparative Study
OBJECTIVES
To compare the effectiveness of laparoscopic common bile duct exploration in patients with failed endoscopic retrograde cholangiopancreatography (ERCP).
METHODS
This is a descriptive, comparative study. Patients with an indication of common bile duct exploration between February 2005 and October 2008 were included. We studied 2 groups: Group A: patients with failed ERCP who underwent LCBDE plus LC. Group B: patients with common bile duct stones managed with the 1-step approach (LCBDE + LC) with no prior ERCP.
RESULTS
Twenty-five patients were included. Group A: 9 patients, group B: 16 patients. Success rate, operative time, and hospital stay were as follows: group A 66% vs group B 87.5%; group A 187 minutes vs 106 minutes; group A 4.5 days vs 2.3 days; respectively.
CONCLUSION
Patients with failed ERCP should be considered as high-complex cases in which the laparoscopic procedure success rate decreases, and the conversion rate increases considerably.
Topics: Adult; Aged; Cholangiopancreatography, Endoscopic Retrograde; Cholecystectomy, Laparoscopic; Cholecystolithiasis; Choledocholithiasis; Common Bile Duct; Female; Humans; Laparoscopy; Male; Middle Aged; Treatment Outcome
PubMed: 20932377
DOI: 10.4293/108680810X12785289144395 -
World Journal of Gastroenterology May 2015To investigate whether children with congenital common bile duct dilatation (CBDD) differ from children with obstructive CBDD in cholangiographic characteristics. (Comparative Study)
Comparative Study
AIM
To investigate whether children with congenital common bile duct dilatation (CBDD) differ from children with obstructive CBDD in cholangiographic characteristics.
METHODS
In this retrospective cohort study, the baseline data and the results of imaging analyses were reviewed among children who had endoscopic retrograde cholangiopancreatography (ERCP) due to CBDD. ERCP was performed on all pediatric patients by experienced pediatric endoscopists. The maximal transverse diameter of the common bile duct (CBD) was measured on ERCP. To assess whether age-adjusted CBDD could be used for differential diagnosis, a CBDD severity index (SI) was calculated by dividing the measured CBD diameter by the age-corrected maximal diameter of a normal CBD.
RESULTS
A retrospective medical chart review revealed that 85 consecutive children under 16 years of age with hepatobiliary disease and CBDD were referred to Seoul Asan Medical Center. Fifty-five (64.7%) children had congenital CBDD and 30 (35.3%) had obstructive CBDD. The two groups did not differ significantly in terms of clinical characteristics except for sex. The congenital and obstructive CBDD groups did not differ significantly in terms of mean CBD diameter (19.3 ± 9.6 mm vs 12.2 ± 4.1 mm, P > 0.05). However, congenital CBDD cases had a significantly higher mean SI than obstructive CBDD cases (3.62 ± 1.64 vs 1.98 ± 0.71, P = 0.01). In multivariate analysis, an SI value ≥ 2.32 and comorbidity with anomalous union of pancreaticobiliary duct (APBDU) in ERCP independently predicted congenital CBDD.
CONCLUSION
Measuring the CBD may aid the differential diagnosis of both CBDD and APBDU in children.
Topics: Adolescent; Age Factors; Child; Child, Preschool; Cholangiopancreatography, Endoscopic Retrograde; Choledochal Cyst; Choledocholithiasis; Cholestasis; Common Bile Duct; Diagnosis, Differential; Dilatation, Pathologic; Female; Humans; Male; Predictive Value of Tests; Republic of Korea; Retrospective Studies
PubMed: 26034357
DOI: 10.3748/wjg.v21.i20.6229 -
Annals of Surgery Feb 2023This study aims to examine the indications, techniques, and outcomes of choledochoscopy during laparoscopic bile duct exploration and evaluate the results of the wiper...
OBJECTIVE
This study aims to examine the indications, techniques, and outcomes of choledochoscopy during laparoscopic bile duct exploration and evaluate the results of the wiper blade maneuver (WBM) for transcystic intrahepatic choledochoscopy.
SUMMARY OF BACKGROUND DATA
Choledochoscopy has traditionally been integral to bile duct explorations. However, laparoscopic era studies have reported wide variations in choledochoscopy availability and use, particularly with the increasing role of transcystic exploration.
METHODS
The indications, techniques, and operative and postoperative data on choledochoscopy collected prospectively during transcystic and choledo- chotomy explorations were analyzed. The success rates of the WBM were evaluated for the 3 mm and 5 mm choledochoscopes.
RESULTS
Of 935 choledochoscopies, 4 were performed during laparoscopic cholecystectomies and 931 during 1320 bile duct explorations (70.5%); 486 transcystic choledochoscopies (52%) and 445 through choledochotomies (48%). Transcystic choledochoscopy was utilized more often than blind exploration (55.7%% vs 44.3%) in patients with emergency admissions, jaundice, dilated bile ducts on preoperative imaging, wide cystic ducts, and large, numerous or impacted bile duct stones. Intrahepatic choledochoscopy was successful in 70% using the 3 mm scope and 81% with the 5 mm scope. Choledochoscopy was necessary in all 124 explorations for impacted stones. Twenty retained stones (2.1%) were encountered but no choledochoscopy related complications.
CONCLUSIONS
Choledochoscopy should always be performed during a chol- edochotomy, particularly with multiple and intrahepatic stones, reducing the incidence of retained stones. Transcystic choledochoscopy was utilized in over 50% of explorations, increasing their rate of success. When attempted, the transcystic WBM achieves intrahepatic access in 70%-80%. It should be part of the training curriculum.
Topics: Humans; Gallstones; Laparoscopy; Common Bile Duct; Cholecystectomy, Laparoscopic; Catheterization
PubMed: 33856382
DOI: 10.1097/SLA.0000000000004912 -
World Journal of Gastroenterology Dec 2016To evaluate the feasibility of repairing a common bile duct defect with a decellularized ureteral graft in a porcine model.
AIM
To evaluate the feasibility of repairing a common bile duct defect with a decellularized ureteral graft in a porcine model.
METHODS
Eighteen pigs were randomly divided into three groups. An approximately 1 cm segment of the common bile duct was excised from all the pigs. The defect was repaired using a 2 cm long decellularized ureteral graft over a T-tube (T-tube group, = 6) or a silicone stent (stent group, = 6). Six pigs underwent bile duct reconstruction with a graft alone (stentless group). The surviving animals were euthanized at 3 mo. Specimens of the common bile ducts were obtained for histological analysis.
RESULTS
The animals in the T-tube and stent groups survived until sacrifice. The blood test results were normal in both groups. The histology results showed a biliary epithelial layer covering the neo-bile duct. In contrast, all the animals in the stentless group died due to biliary peritonitis and cholangitis within two months post-surgery. Neither biliary epithelial cells nor accessory glands were observed at the graft sites in the stentless group.
CONCLUSION
Repair of a common bile duct defect with a decellularized ureteral graft appears to be feasible. A T-tube or intraluminal stent was necessary to reduce postoperative complications.
Topics: Allografts; Animals; Biliary Tract Surgical Procedures; Cholecystectomy; Common Bile Duct; Disease Models, Animal; Feasibility Studies; Female; Humans; Iatrogenic Disease; Male; Postoperative Complications; Random Allocation; Plastic Surgery Procedures; Stents; Sus scrofa; Transplantation, Homologous; Ureter
PubMed: 28082809
DOI: 10.3748/wjg.v22.i48.10575