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Transplantation Direct Mar 2023Biliary complications are a common cause of morbidity after liver transplantation and associated with bile duct injury. To reduce injury, a bile duct flush is performed...
UNLABELLED
Biliary complications are a common cause of morbidity after liver transplantation and associated with bile duct injury. To reduce injury, a bile duct flush is performed with high-viscosity preservation solution. It has been suggested that an earlier additional bile duct flush with low-viscosity preservation solution may reduce bile duct injury and biliary complications. This study aimed to investigate whether an earlier additional bile duct flush would reduce bile duct injury or biliary complications.
METHODS
A randomized trial was conducted using 64 liver grafts from brain dead donors. The control group received a bile duct flush with University of Wisconsin (UW) solution after donor hepatectomy. The intervention group received a bile duct flush using low-viscosity Marshall solution immediately after the onset of cold ischemia and a bile duct flush with University of Wisconsin solution after donor hepatectomy. The primary outcomes were the degree of histological bile duct injury, assessed using the bile duct injury score, and biliary complications within 24 mo of transplant.
RESULTS
Bile duct injury scores were not different between the 2 groups. Similar rates of biliary complications occurred in the intervention group (31% [n = 9]) and controls (23% [n = 8]) ( = 0.573). No difference between groups was observed for anastomotic strictures (24% versus 20%, = 0.766) or nonanastomotic strictures (7% versus 6%, = 1.00).
CONCLUSIONS
This is the first randomized trial to investigate an additional bile duct flush using low-viscosity preservation solution during organ procurement. The findings from this study suggest that performing an earlier additional bile duct flush with Marshall solution does not prevent biliary complications and bile duct injury.
PubMed: 36875942
DOI: 10.1097/TXD.0000000000001443 -
Anatomy Research International 2012Purpose. Thorough understanding of biliary anatomy is required when performing surgical interventions in the hepatobiliary system. This study describes the anatomical...
Purpose. Thorough understanding of biliary anatomy is required when performing surgical interventions in the hepatobiliary system. This study describes the anatomical variations of right bile ducts in terms of branching and drainage patterns, and determines their frequency. Methods. We studied 73 samples of cadaveric material, focusing on the relationship of the right anterior and posterior segmental branches, the way they form the right hepatic duct, and the main variations of their drainage pattern. Results. The anatomy of the right hepatic duct was typical in 65.75% of samples. Ectopic drainage of the right anterior duct into the common hepatic duct was found in 15.07% and triple confluence in 9.59%. Ectopic drainage of the right posterior duct into the common hepatic duct was discovered in 2.74% and ectopic drainage of the right posterior duct into the left hepatic duct in 4.11%. Ectopic drainage of the right anterior duct into the left hepatic ductal system and ectopic drainage of the right posterior duct into the cystic duct was found in 1.37%. Conclusion. The branching pattern of the right hepatic duct was atypical in 34.25% of cases. Thus, knowledge of the anatomical variations of the extrahepatic bile ducts is important in many surgical cases.
PubMed: 23056946
DOI: 10.1155/2012/838179 -
Singapore Medical Journal Dec 2022
Topics: Humans; Adenoma, Bile Duct; Liver Neoplasms; Bile Duct Neoplasms; Bile Ducts, Intrahepatic
PubMed: 34544211
DOI: 10.11622/smedj.2021101 -
World Journal of Gastroenterology Jul 2007Bile duct cancers are frequently diagnosed as advanced diseases. Over half of patients with advanced bile duct cancer present with unresectable malignancies and their... (Review)
Review
Bile duct cancers are frequently diagnosed as advanced diseases. Over half of patients with advanced bile duct cancer present with unresectable malignancies and their prognosis has been very poor even after curative resections. Although there has been a need to diagnose bile duct cancer at its early stage, it has been a difficult goal to achieve due to our lack of knowledge regarding this disease entity. Early bile duct cancer may be defined as a carcinoma whose invasion is confined within the fibromuscular layer of the extrahepatic bile duct or intrahepatic large bile duct without distant metastasis irrespective of lymph node involvement. Approximately 3%-10% of resected bile duct cancers have been reported to be early cancers in the literature. The clinicopathological features of patients with early bile duct cancer differ from those of patients with advanced bile duct cancer, with more frequent asymptomatic presentation, characteristic histopathological findings, and excellent prognosis. This manuscript is organized to emphasize the need for convening an international consensus to develop the concept of early bile duct cancer.
Topics: Bile Duct Neoplasms; Bile Ducts; Humans; Prevalence; Prognosis
PubMed: 17659686
DOI: 10.3748/wjg.v13.i25.3409 -
Radiology Case Reports Sep 2023Chyle leak is a rare and serious condition caused by damaged lymphatic vessels. It can occur after retroperitoneal surgery involving extensive lymphadenectomy for kidney...
Chyle leak is a rare and serious condition caused by damaged lymphatic vessels. It can occur after retroperitoneal surgery involving extensive lymphadenectomy for kidney cancer. Besides lymphatic channel damage, the obstruction of the thoracic duct worsens the leakage. Managing patients with thoracic duct obstruction and postsurgical chyle leakage is challenging due to limited data on how to handle this condition. In this case report, a 28-year-old female patient underwent left nephrectomy for left kidney cancer. Three days after the surgery, milky fluid drained from the left renal fossa. Conservative treatment failed, and further examination through magnetic resonance lymphangiography revealed the absence of the thoracic duct and contrast extravasation at the left renal fossa. Lymphangiography confirmed distal thoracic duct obstruction. The patient's condition was successfully managed by using thoracic duct stenting. This report contributes to the understanding that thoracic duct obstruction can lead to lymphatic collateral circulation within the abdomen, thereby increasing the risk of postoperative chylous leak.
PubMed: 37448602
DOI: 10.1016/j.radcr.2023.06.048 -
Arquivos Brasileiros de Oftalmologia 2024
Topics: Humans; Lacrimal Duct Obstruction; Nasolacrimal Duct; Endoscopy; Dacryocystorhinostomy
PubMed: 38808911
DOI: 10.5935/0004-2749.2024-0087 -
HPB : the Official Journal of the... May 2021Bile duct injury is a serious surgical complication of laparoscopic cholecystectomy. The aim of this study was to identify distinct visual gaze patterns associated with...
BACKGROUND
Bile duct injury is a serious surgical complication of laparoscopic cholecystectomy. The aim of this study was to identify distinct visual gaze patterns associated with the prompt detection of bile duct injury risk during laparoscopic cholecystectomy.
METHODS
Twenty-nine participants viewed a laparoscopic cholecystectomy that led to a serious bile duct injury ('BDI video') and an uneventful procedure ('control video') and reported when an error was perceived that could result in bile duct injury. Outcome parameters include fixation sequences on anatomical structures and eye tracking metrics. Surgeons were stratified into two groups based on performance and compared.
RESULTS
The 'early detector' group displayed reduced common bile duct dwell time in the first half of the BDI video, as well as increased cystic duct dwell time and Calot's triangle glances count during Calot's triangle dissection in the control video. Machine learning based classification of fixation sequences demonstrated clear separability between early and late detector groups.
CONCLUSION
There are discernible differences in gaze patterns associated with early recognition of impending bile duct injury. The results could be transitioned into real time and used as an intraoperative early warning system and in an educational setting to improve surgical safety and performance.
Topics: Bile Duct Diseases; Bile Ducts; Cholecystectomy, Laparoscopic; Common Bile Duct; Cystic Duct; Humans; Surgeons
PubMed: 32988756
DOI: 10.1016/j.hpb.2020.09.007 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Jul 2020To investigate the feasibility of endoscopic nasolacrimal decompression for chronic dacryocystitis. 22 patients with chronic dacryocystitis hospitalized at Longgang ENT...
To investigate the feasibility of endoscopic nasolacrimal decompression for chronic dacryocystitis. 22 patients with chronic dacryocystitis hospitalized at Longgang ENT hospital were participated in this study. An injection of 30% iohexol was administered to conduct lacrimal sac angiography. The injection was stopped when the agent reflux from the lacrimal duct, and a computed tomography(CT) scan of the lacrimal duct was performed immediately. Sinuses Trachea Isoftware was used to reconstruct a three-dimensional(3D) view of the lacrimal passage and its surrounding structures. The software was used to simulate the "cutting" of the lacrimal sac and nasolacrimal duct; the lacrimal sac and nasal lacrimal duct were removed after 1/2-3/4 circumferences to decompress the passage and expose the membranous nasolacrimal duct. CT scans were performed on ten adult frozen cadaveric heads, and the nasolacrimal duct decompression operation was simulated. Then, the bone of the nasolacrimal duct was removed, membranous nasolacrimal duct was exposed, and the capsular nasolacrimal duct was dilated. ①The lacrimal angiography study revealed that lacrimal duct obstruction occurred in the nasolacrimal duct segment, accounting for 72.7%(16/22) of the study cases. ② The anatomical examination showed that the outer sidewall of the nasolacrimal duct was composed of the tear groove of the maxilla, and the inner wall was composed of the descending process of the lacrimal bone. ③ In cadaveric heads, decompression of the osseous nasolacrimal duct was performed, exposing the membranous nasolacrimal duct. ④ A balloon catheter could dilate the membranous nasolacrimal duct and allow the lacrimal passage to be flushed. Endoscopic nasolacrimal decompression preserves the integrity of the lacrimal duct, allows drainage of the lacrimal duct, and avoids obstruction of the lacrimal duct by preventing lacrimal granulation.
Topics: Adult; Dacryocystitis; Dacryocystorhinostomy; Endoscopy; Humans; Lacrimal Apparatus; Lacrimal Duct Obstruction; Nasolacrimal Duct
PubMed: 32791645
DOI: 10.13201/j.issn.2096-7993.2020.07.018 -
International Journal of Surgery Case... 2018Double cancers of the biliary tract system are rare. Most of these cancers are synchronous double cancers of the gall bladder and bile duct, associated with...
BACKGROUND
Double cancers of the biliary tract system are rare. Most of these cancers are synchronous double cancers of the gall bladder and bile duct, associated with pancreaticobiliary maljunction (PBM). Synchronous double cancers of the extrahepatic bile duct without PBM are especially rare, and only 4 cases have been reported.
CASE PRESENTATION
A 78-year-old woman was admitted to our hospital for examination of hyperbilirubinemia and liver dysfunction. Contrast-enhanced abdominal computed tomography, Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography revealed 2 stenotic regions in the common bile duct: at its junction with the cystic duct and in the distal bile duct. No findings suggested PBM, such as a markedly long common channel. The diagnosis based on endoscopic brush cytology from both stricture portions was adenocarcinoma. The patient had a pylorus-preserving pancreaticoduodenectomy with regional lymph node resection. Macroscopically, there were 2 stenotic regions at the cystic duct junction and in the distal bile duct. Microscopically, the tumor at the junction of the cystic duct was a well-to-moderately differentiated adenocarcinoma. On the other hand, the tumor of the distal bile duct was a poorly differentiated adenocarcinoma. There was no evidence of communication between these 2 cancers.
CONCLUSION
Double cancers of the extrahepatic bile duct without PBM are very rare. Therefore, an accurate diagnosis prior to surgery is necessary. Furthermore, this rare condition seems to be associated with a poor prognosis.
PubMed: 29727803
DOI: 10.1016/j.ijscr.2018.04.020 -
Annals of Surgery May 1977Thirty patients were identified as having primary common duct stones. Criteria for diagnosis included at least a two year symptom free interval following...
Thirty patients were identified as having primary common duct stones. Criteria for diagnosis included at least a two year symptom free interval following cholecystectomy; soft, light brown stones or sludge present in the common duct; and the absence of a long cystic duct remnant or a biliary stricture from the previous surgery. The average age of the 30 patients was 66 years. The interval between cholecystectomy and the diagnosis of primary common duct stones averaged 12 years. Acute cholangitis was a frequent mode of presentation. At the time of surgery the bile duct was often dilated out of proportion to the serum bilirubin. In only one of the 30 patients was ampullary stenosis present. Twenty-six of the 30 patients had only stone extraction and insertion of a T tube for treatment of their primary common duct stones. Twenty-two of the 26 were followed for an average of four years and nine months with no evidence of recurrent stones in 82% (18/22). Four developed recurrent primary common duct stones one, five, five, and 7 years later. It is concluded that most patients with primary common duct stones do well after stone extraction alone.
Topics: Aged; Cholangiography; Cholangitis; Cholecystectomy; Common Bile Duct; Female; Gallstones; Humans; Male; Middle Aged; Recurrence; Time Factors
PubMed: 857748
DOI: 10.1097/00000658-197705000-00013