scholarly journals Risk identification and technical modifications reduce the incidence of post-cholecystectomy bile leakage: analysis of 5675 laparoscopic cholecystectomies

2021 ◽  
Author(s):  
Ahmad H. M. Nassar ◽  
Hwei Jene Ng
Keyword(s):  
Cystic Duct ◽  
Bile Leakage ◽  
Risk Identification ◽  
Blunt Dissection ◽  
Median Hospital Stay ◽  
Technical Modifications ◽  
Potential Risks ◽  
The Many ◽  
Median Hospital ◽  
Bile Leaks

Abstract Purpose The main sources of post-cholecystectomy bile leakage (PCBL) not involving major duct injuries are the cystic duct and subvesical/hepatocystic ducts. Of the many studies on the diagnosis and management of PCBL, few addressed measures to avoid this serious complication. The aim of this study was to examine the causes and mechanisms leading to PCBL and to evaluate the effects of specific preventative strategies. Methods A prospectively maintained database of 5675 consecutive laparoscopic cholecystectomies was analysed. Risk factors for post-cholecystectomy bile leakage were identified and documented and technical modifications and strategies were adopted to prevent this complication. The incidence, causes and management of patients who suffered bile leaks were studied and their preoperative characteristics, operative data and postoperative outcomes were compared with patients where potential risks were identified and PCBL avoided and with the rest of the series. Results Twenty-five patients (0.4%) had PCBL (7 expected and less than half requiring reintervention): 11 from cystic ducts (0.2%), 3 from subvesical ducts (0.05%) and 11 from unconfirmed sources (0.2%). The incidence of cystic duct leakage was significantly lower with ties (0.15%) than with clips (0.7%). Fifty-two percent had difficulty grades IV or V, 36% had empyema or acute cholecystitis and 16% had contracted gallbladders. Twelve patients required 17 reinterventions before PCBL resolved; 7 percutaneous drainage, 6 ERCP and 4 relaparoscopy. The median hospital stay was 17 days with no mortality. Hepatocystic ducts were encountered in 72 patients (1.3%) and were secured with loops (54.2%), ties (25%) or sutures (20.8%) with no PCBL. Eighteen sectoral ducts were identified and secured. Conclusion Ligation of the cystic duct reduces the incidence of PCBL resulting from dislodged endoclips. Careful blunt dissection in the proper anatomical planes avoiding direct or thermal injury to subvesical and sectoral ducts and a policy of actively searching for hepatocystic ducts during gallbladder separation to identify and secure them can reduce bile leakage from such ducts.

scholarly journals An Algorithm for the Management of Bile Leak Following Laparoscopic Cholecystectomy

2007 ◽  
Vol 89 (1) ◽  
pp. 51-56 ◽  
Author(s):  
F Ahmad ◽  
RN Saunders ◽  
GM Lloyd ◽  
DM Lloyd ◽  
GSM Robertson
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Bile Leak ◽  
Median Hospital Stay ◽  
Management Protocol ◽  
The Impact ◽  
Median Hospital ◽  
Bile Leaks

INTRODUCTION The management of bile leaks following laparoscopic cholecystectomy has evolved with increased experience of ERCP and laparoscopy. The purpose of this study was to determine the impact of a minimally invasive management protocol. PATIENTS AND METHODS Twenty-four patients with a bile leak following laparoscopic cholecystectomy were recorded consecutively between 1993 and 2003. Between 1993–1998, 10 patients were managed on a case-by-case basis. Between 1998–2003, 14 patients were managed according to a minimally invasive protocol utilising ERC/biliary stenting and re-laparoscopy if indicated. RESULTS Bile leaks presented as bile in a drain left in situ post laparoscopic cholecystectomy (8/10 versus 10/14) or biliary peritonitis (2/10 versus 4/14). Prior to 1998, neither ERC nor laparoscopy were utilised routinely. During this period, 4/10 patients recovered with conservative management and 6/10 (60%) underwent laparotomy. There was one postoperative death and median hospital stay post laparoscopic cholecystectomy was 10 days (range, 5–30 days). In the protocol era, ERC ± stenting was performed in 11/14 (P = 0.01 versus pre-protocol) with the main indication being a persistent bile leak. Re-laparoscopy was necessary in 5/14 (P = 0.05 versus preprotocol). No laparotomies were performed (P < 0.01 versus pre-protocol) and there were no postoperative deaths. Median hospital stay was 11 days (range, 5–55 days). CONCLUSIONS The introduction of a minimally invasive protocol utilising ERC and re-laparoscopy offers an effective modern algorithm for the management of bile leaks after laparoscopic cholecystectomy.

Absence of Cystic Duct Leakage Using Locking Clips in 1017 Cases of Laparoscopic Cholecystectomy

2012 ◽  
Vol 78 (11) ◽  
pp. 1228-1231 ◽  
Author(s):  
Yoichi Matsui ◽  
Sou Yamaki ◽  
Tomohisa Yamamoto ◽  
Morihiko Isizaki ◽  
Kosuke Matsui ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cystic Duct ◽  
Outcome Measurement ◽  
Bile Leakage ◽  
University Hospital ◽  
Preventive Effect ◽  
Surgical Department ◽  
Bile Leaks

Cystic duct leakage with metal clips persists after laparoscopic cholecystectomy (LC). The aim of the study is to evaluate the preventive effect of locking clips on leaks from the cystic duct stump after LC as an alternative to metal clips. Locking clips were routinely used to close the cystic duct in LC. A total of 1101 patients who underwent LC were retrospectively assessed from a database of the surgical department at our university hospital. A main outcome measurement is bile leakage after LC. From January 2006 to April 2011, 1053 LCs were performed. Of these, the cystic duct was closed with locking clips in 1017 cases, and no bile leaks from the cystic duct were observed in any of these 1017 cases. Locking clips should be routinely used to close the cystic duct in preference to metallic clips to reduce postoperative bile leaks after LC.

Risk identification and modeling for blockchain-enabled container shipping

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Son Nguyen ◽  
Peggy Shu-Ling Chen ◽  
Yuquan Du
Keyword(s):  
Design Methodology ◽  
Directed Acyclic Graph ◽  
Risk Identification ◽  
Container Shipping ◽  
Content Type ◽  
Acyclic Graph ◽  
Operational Risks ◽  
Systems Security ◽  
Event Risk ◽  
Potential Risks

PurposeAlthough being considered for adoption by stakeholders in container shipping, application of blockchain is hindered by different factors. This paper investigates the potential operational risks of blockchain-integrated container shipping systems as one of such barriers.Design/methodology/approachLiterature review is employed as the method of risk identification. Scientific articles, special institutional reports and publications of blockchain solution providers were included in an inclusive qualitative analysis. A directed acyclic graph (DAG) was constructed and analyzed based on network topological metrics.FindingsTwenty-eight potential risks and 47 connections were identified in three groups of initiative, transitional and sequel. The DAG analysis results reflect a relatively well-connected network of identified hazardous events (HEs), suggesting the pervasiveness of information risks and various multiple-event risk scenarios. The criticality of the connected systems' security and information accuracy are also indicated.Originality/valueThis paper indicates the changes of container shipping operational risk in the process of blockchain integration by using updated data. It creates awareness of the emerging risks, provides their insights and establishes the basis for further research.

scholarly journals Recommendations for the pharmacological treatment of COPD: questions and answers

2017 ◽  
Vol 43 (4) ◽  
pp. 290-301 ◽  
Author(s):  
Frederico Leon Arrabal Fernandes ◽  
Alberto Cukier ◽  
Aquiles Assunção Camelier ◽  
Carlos Cezar Fritscher ◽  
Cláudia Henrique da Costa ◽  
...  
Keyword(s):  
Pharmacological Treatment ◽  
End Of Life Care ◽  
Behavioral Changes ◽  
Pharmacological Treatments ◽  
Risks And Benefits ◽  
Questions And Answers ◽  
Potential Risks ◽  
Two Phases ◽  
The Many ◽  
Classification And Treatment

ABSTRACT The treatment of COPD has become increasingly effective. Measures that range from behavioral changes, reduction in exposure to risk factors, education about the disease and its course, rehabilitation, oxygen therapy, management of comorbidities, and surgical and pharmacological treatments to end-of-life care allow health professionals to provide a personalized and effective therapy. The pharmacological treatment of COPD is one of the cornerstones of COPD management, and there have been many advances in this area in recent years. Given the greater availability of drugs and therapeutic combinations, it has become increasingly challenging to know the indications for, limitations of, and potential risks and benefits of each treatment modality. In order to critically evaluate recent evidence and systematize the major questions regarding the pharmacological treatment of COPD, 24 specialists from all over Brazil gathered to develop the present recommendations. A visual guide was developed for the classification and treatment of COPD, both of which were adapted to fit the situation in Brazil. Ten questions were selected on the basis of their relevance in clinical practice. They address the classification, definitions, treatment, and evidence available for each drug or drug combination. Each question was answered by two specialists, and then the answers were consolidated in two phases: review and consensus by all participants. The questions answered are practical questions and help select from among the many options the best treatment for each patient and his/her peculiarities.

Comparison of laparoscopic pyelolithotomy and retrograde intrarenal surgery in the management of large renal pelvic stone

2020 ◽  
Author(s):  
Mehmet Cagatay Cicek ◽  
Tariq Asi ◽  
Kadir Omur Gunseren ◽  
Hakan Kilicarslan
Keyword(s):  
Operation Time ◽  
Retrograde Intrarenal Surgery ◽  
Median Hospital Stay ◽  
Efficient Procedure ◽  
Laparoscopic Pyelolithotomy ◽  
Stone Free Rate ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Median Hospital ◽  
Free Rate

Abstract Background To compare the clinical outcomes of laparoscopic pyelolithotomy (LP) and retrograde intrarenal surgery (RIRS) in the management of large renal pelvic stones. Methods This study included patients who presented with a single renal pelvic stone sized ≥20 mm and who were treated primarily by laparoscopic pyelolithotomy or retrograde intrarenal surgery. The patients were grouped based on the surgical procedure they underwent. We retrospectively examined and compared the age, the longest axis and the surface area of the stone, operation time, hospitalization time, complications and stone-free rates of the two groups. Results Of the 156 patients included in the study, 44 had laparoscopic pyelolithotomy, and 112 had retrograde intrarenal surgery. Patients who received laparoscopic pyelolithotomy (13 males, 31 females) had a median age of 54 (18-79) years, while those who underwent retrograde intrarenal surgery (46 males, 66 females) had a median age of 54.5 (18-79). Patients who received laparoscopic pyelolithotomy were found to have larger median stone size (30 mm vs 24 mm, p=0.003), longer operation time (100 minutes vs 70 minutes, p=0.007), lower complication rate (2% vs 8.9%, p=0.063), longer median hospital stay (3 days vs 1 day, p<0.001) and better stone-free rate at the third month (90.9% vs 67.9%, p<0.001). Conclusion LP is a safe and efficient procedure that could be used as an alternative to retrograde intrarenal surgery in managing large renal pelvic stones.

scholarly journals On-Site Monitoring of Postoperative Bile Leakage Using Bilirubin-Inducible Fluorescent Protein

2020 ◽  
Vol 44 (12) ◽  
pp. 4245-4253
Author(s):  
Yoshiharu Kono ◽  
Takeaki Ishizawa ◽  
Norihiro Kokudo ◽  
Yugo Kuriki ◽  
Ryu J. Iwatate ◽  
...  
Keyword(s):  
Fluorescence Imaging ◽  
Fluorescent Protein ◽  
Imaging Techniques ◽  
Abdominal Cavity ◽  
Bile Leakage ◽  
Indirect Bilirubin ◽  
Site Monitoring ◽  
Real Time Identification ◽  
Time Required ◽  
Bile Leaks

Abstract Background Bile leakage is the most common postoperative complication associated with hepatobiliary and pancreatic surgery. Until now, however, a rapid, accurate diagnostic method for monitoring intraoperative and postoperative bile leakage had not been established. Method Bilirubin levels in drained abdominal fluids collected from 23 patients who had undergone hepatectomy (n = 22) or liver transplantation (n = 1) were measured using a microplate reader with excitation/emission wavelengths of 497/527 nm after applying 5 µM of UnaG to the samples. UnaG was also sprayed directly on hepatic raw surfaces in swine hepatectomy models to identify bile leaks by fluorescence imaging. Results The bilirubin levels measured by UnaG fluorescence imaging showed favorable correlations with the results of the conventional light-absorptiometric methods (indirect bilirubin: rs = 0.939, p < 0.001; direct bilirubin: rs = 0.929, p < 0.001). Approximate time required for bilirubin measurements with UnaG was 15 min, whereas it took about 40 min with the conventional method at a hospital laboratory. Following administration of UnaG on hepatic surfaces, the fluorescence imaging identified bile leaks not only on the resected specimens but also in the abdominal cavity of the swine hepatectomy models. Conclusion Fluorescence imaging techniques using UnaG may enable real-time identification of bile leaks during hepatectomy and on-site rapid diagnosis of bile leaks after surgery.

scholarly journals Omental Infarction: a Reappraisal of Conservative Management in Children

2014 ◽  
Vol 27 (4) ◽  
pp. 433 ◽  
Author(s):  
José Estevão-Costa ◽  
Ana Sofia Alvarenga ◽  
Ana Catarina Fragoso ◽  
Maria Garcia ◽  
Miguel Campos
Keyword(s):  
Conservative Management ◽  
Imaging Techniques ◽  
Operative Management ◽  
Single Institution ◽  
Laboratory Findings ◽  
Median Hospital Stay ◽  
Course Of Disease ◽  
Omental Infarction ◽  
Non Operative Management ◽  
Median Hospital

<p><strong>Introduction</strong>: Accurate recognition of omental infarction has resulted in increasing supporters of non-operative approach. In order to assess the efficacy and safety of conservative management, we surveyed the cases of omental infarction treated at a single institution.<br /><strong>Material and Methods:</strong> Primary omental infarction treated between 2004 and 2011 were reviewed. Cases recognized by imaging studies were submitted to conservative treatment that consisted of intravenous analgesics and antibiotics. Demographics, clinical presentation, laboratory findings, imaging diagnosis and outcome were analyzed.<br /><strong>Results:</strong> There were 9 cases of omental infarction. Eight patients (4 males; median age, 8.5 years) presented at initial course of disease; all had right-sided abdominal pain and a normal or lightly increased leukocyte count. Six cases, diagnosed by CT scan after US suspicion in four, were managed conservatively, recovered uneventfully, and were discharged after a median hospital stay of 3 days. Two patients were only recognized at surgery. An additional case presented with intestinal obstruction due to an internal hernia and was successfully resolved by laparoscopy.<br /><strong>Discussion:</strong> Imaging techniques were diagnostic of omental infarction in the majority of cases, enabling a conservative approach to be adopted. Non-operative management was successful with no complications in all patients presenting at the initial course of disease. One patient presented with a harmful complication that required operative treatment.<br /><strong>Conclusion:</strong> In the absence of a standard approach for omental infarction, conservative management is an effective noninvasive alternative but it claims for active surveillance.<br /><strong>Keywords:</strong> Infarction; Omentum.</p>

Risk Assessment

2017 ◽  
Author(s):  
Morton Lippmann ◽  
Richard B. Schlesinger
Keyword(s):  
Risk Assessment ◽  
Risk Identification ◽  
Environmental Chemicals ◽  
Special Interest Groups ◽  
Exposure Limits ◽  
Potential Risks ◽  
Reduce Emissions ◽  
Emission Limits ◽  
Control Technologies

This chapter describes the characterization of risk and the application of risk assessment methodologies by governments, corporations, and special interest groups so as to identify the nature and extent of known and potential risks to public health and welfare from exposure to environmental chemicals. It discusses the nature of risk, including perceived vs. real rick, risk identification and quantification, and risk communication. It reviews the different approaches that may be used in risk assessment and provides specific applications of risk analysis, including the setting of exposure limits and/or emission limits and the specification of control technologies to reduce emissions of chemicals.

scholarly journals Potential risks related to anabolic steroids use on nervous, cardiovascular and reproductive systems disorders in men

2018 ◽  
Vol 31 (3) ◽  
pp. 135-159 ◽  
Author(s):  
Agnieszka Kujawska ◽  
Joanna Androsiuk-Perkowska ◽  
Jakub Husejko ◽  
Marcin Kozuchowski ◽  
Daria Bieniek ◽  
...  
Keyword(s):  
Health Risks ◽  
Anabolic Steroids ◽  
Biochemical Mechanism ◽  
Negative Effects ◽  
Potential Health ◽  
Amateur Sport ◽  
Thrombotic Complications ◽  
Potential Risks ◽  
The Many ◽  
The Relationship

AbstractAnabolic steroids (AS) have been a subject of intensive research for the last several decades. Due to wide use of AS in pharmacological treatment and in professional and amateur sport, it is, hence, worthwhile to describe the biochemical mechanism of the effects of AS usage in humans and its potential health risks. In this work, the relationship between diet and its effect on the level of testosterone in blood is described. Testosterone affects the nervous system, however, there is need for further researches to examine the influence of AS therapy on emotional and cognitive functioning. AS therapy has known negative effects on the cardiovascular system: cardiac hypertrophy can occur, blood pressure can vastly increased, thrombotic complications can come about. These effects are observed not only in patients who are treated with AS, but also in athletes. The paper also describes the relationship between AS and reproductive system diseases. Decreased libido and erectile dysfunction are only some of the many side effects of an incorrect AS treatment.

A Laparoscopic Splenectomy Allows the Induction of Antiviral Therapy for Patients with Cirrhosis Associated with Hepatitis C Virus

2011 ◽  
Vol 77 (2) ◽  
pp. 174-179
Author(s):  
Yoshinobu Shigekawa ◽  
Kazuhisa Uchiyama ◽  
Katsunari Takifuji ◽  
Masaki Ueno ◽  
Takashi Hama ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Antiviral Therapy ◽  
Laparoscopic Splenectomy ◽  
Antiviral Treatment ◽  
Pegylated Interferon ◽  
Virologic Response ◽  
Median Hospital Stay ◽  
Postoperative Death ◽  
Median Hospital

It is difficult to treat patients with cirrhosis-associated hepatitis C with pegylated interferon (PEG-IFN) and ribavirin because of thrombocytopenia-related hypersplenism. Both safety and clinical efficacy were retrospectively analyzed for patients who underwent a laparoscopic splenectomy (LS) from January 2003 to December 2007. A total of 35 patients with cirrhosis associated with hepatitis C virus had LS for thrombocytopenia before PEG-IFN and ribavirin therapy, and all patients had thrombocytopenia, which was a contraindication for antiviral therapy. The hepatopathy was Child A in 24 patients, Child B in 10 patients, and Child C in one patient. All 35 patients increased platelet count from 48,000 ± 15,000 to 155,000 ± 55,000/μl ( P < 0.0001) after LS. The median hospital stay and blood loss were 13.0 days (range, 8 to 57 days) and 342.0 mL (range, 5 to 2350 mL). There was no postoperative death. Twenty-nine (83%) patients had PEG-IFN and ribavirin therapy after LS; 18 had complete therapy and 11 had partial therapy. Of these, nine had a sustained virologic response. A laparoscopic splenectomy for patients with cirrhosis associated with hepatitis C virus can be performed safely and allows induction of antiviral treatment.

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