Percutaneous-endoscopic rendezvous procedure for the management of bile duct injuries after cholecystectomy: short- and long-term outcomes

Abstract Background Bile duct injury (BDI) remains a daunting complication of laparoscopic cholecystectomy. In patients with complex BDI, a percutaneous-endoscopic rendezvous procedure may be required to establish bile duct continuity. The aim of this study was to assess short- and long-term outcomes of the rendezvous procedure. Methods All consecutive patients with BDI referred to our tertiary referral center between 1995 and 2016 were analyzed. A rendezvous procedure was performed when endoscopic or radiologic intervention failed, and when deemed feasible by a dedicated multidisciplinary team including hepatopancreaticobiliary surgeons, gastrointestinal endoscopists, and interventional radiologists. Classification of BDI, technical success of the rendezvous procedure, procedure-related adverse events, and outcomes were assessed. Results Among a total of 812 patients, rendezvous was performed in 47 (6 %), 31 (66 %) of whom were diagnosed with complete transection of the bile duct (Amsterdam type D/Strasberg type E injury). The primary success rate of rendezvous was 94 % (44 /47 patients). Overall morbidity was 18 % (10 /55 procedures). No life-threatening adverse events or 90-day mortality occurred. After a median follow-up of 40 months (interquartile range 23 – 54 months), rendezvous was the final successful treatment in 26 /47 patients (55 %). In 14 /47 patients (30 %), rendezvous acted as a bridge to surgery, with hepaticojejunostomy being chosen either primarily or secondarily to treat refractory or relapsing stenosis. Conclusions In experienced hands, rendezvous was a safe procedure, with a long-term success rate of 55 %. When endoscopic or transhepatic interventions fail to restore bile duct continuity in patients with BDI, rendezvous should be considered, either as definitive treatment or as a bridge to elective surgery.

Download Full-text

Open Replacement of the Thoracoabdominal Aorta: Short- and Long-term Outcomes at a Single Institution

International Journal of Angiology ◽

10.1055/s-0038-1649517 ◽

2018 ◽

Vol 27 (02) ◽

pp. 114-120

Author(s):

Davide Carino ◽

Young Erben ◽

Mohammad Zafar ◽

Mrinal Singh ◽

Adam Brownstein ◽

...

Keyword(s):

Aortic Dissection ◽

Open Surgery ◽

Elective Surgery ◽

Aortic Diseases ◽

Long Term Outcomes ◽

Thoracoabdominal Aorta ◽

Primary Endpoints ◽

Short And Long Term ◽

Optimal Approach

Background Despite much progress in the surgical and endovascular treatment of thoracoabdominal aortic diseases (TAADs), there is no consensus regarding the optimal approach to minimize operative mortality and end-organ dysfunction. We report our experience in the past 16 years treating TAAD by open surgery. Methods A retrospective review of all TAAD patients who underwent an open repair since January 2000 was performed. The primary endpoints included early morbidity and mortality, and the secondary endpoints were overall death and rate of aortic reintervention. Results There were 112 patients treated by open surgery for TAAD. Mean age was 66 ± 10 years and 61 (54%) were male. Seventy-seven (69%) patients had aneurysmal degeneration without aortic dissection and the remaining 35 (31%) had a concomitant aortic dissection. There were 12 deaths (10.7%) and they were equally distributed between the aneurysm and dissection groups (p = 0.8). The mortality for elective surgery was 3.2% (2/61). The rate of permanent paraplegia and stroke were each 2.6% (3/112). The rate of cerebrovascular accident was significantly higher in the dissection group (8.5% vs. 1.2%, p = 0.05). The survival at 1, 5, and 10 years was 80.6, 56.1, and 32.7%, respectively. Conclusion Our data confirm that open replacement of the thoracoabdominal aorta can be performed in expert centers quite safely. Different aortic pathologies (degenerative aneurysm vs. dissection) do not influence the short- and long-term outcomes. Open surgery should still be considered the standard in the management of TAAD.

Download Full-text

An audit of short- and long-term outcomes after laparoscopic removal of common bile duct stones in Finland

Surgical Endoscopy ◽

10.1007/s00464-014-3620-9 ◽

2014 ◽

Vol 28 (12) ◽

pp. 3451-3457 ◽

Cited By ~ 17

Author(s):

Anne Mattila ◽

Jussi Luhtala ◽

Johanna Mrena ◽

Hannu Kautiainen ◽

Ilmo Kellokumpu

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Common Bile Duct Stones ◽

Bile Duct Stones ◽

Long Term Outcomes ◽

Short And Long Term ◽

Laparoscopic Removal

Download Full-text

Endoscopic ultrasound-based transluminal cholecystolithotomy: the retrievable anchor assisted procedure

10.21203/rs.2.11425/v1 ◽

2019 ◽

Author(s):

Nan Ge ◽

Jinlong Hu ◽

Fei Yang ◽

Fan Yang ◽

Kai Zhang ◽

...

Keyword(s):

Adverse Events ◽

Success Rate ◽

Outcome Measures ◽

Clinical Success ◽

Safe Procedure ◽

Drainage Procedure ◽

Indwelling Time ◽

Per Oral

Abstract Background EUS guided gallbladder drainage has gradually emerging as an option among patients with cholecystitis. Stent bridged endoscope intervention in the gallbladder was further introduced. The aim of this study was to assess the effectiveness and safety of the ECE-LAMS and this newly designed retrievable puncture anchor applied in the transmural Cholecystolithotomy. Method We retrospectively reviewed consecutive patients undergoing EUS-guided transmural cholecystoscopic therapy. The main outcome measures for the EUS-GBD procedure were techniques success and adverse events, which were also compared between guided assisted group and retrievable anchor assisted group. The main outcome measures for the transmural cholecystoscopy after EUS-GBD were the stent indwelling time, clinical success and adverse events. Results A total of 24 (15 female) patients with gallstones were received the transluminal Cholecystolithotomy. Mean age is 36.08±13.69 years old. The successful rate of the anchor assisted group was high than the guidewire assisted group (92.9% Vs 70%, P=0.07). On the average of 12.25±2.77 (range 8-17) days after the initial BD drainage procedure, 20 patients received the per-oral cholecystoscopy via the fistula. Fistula broken was found in 2 patients in which the per-oral cholecystoscopy was applied on the ninth day after the EUS-GBD. During the follow-up period (mean 314.2± 213.7 days) no GB stones recurrence or other long term complications reported. Conclusion In conclusion, we have demonstrated that EUS-assisted per-oral cholecystoscopy technique with ECE-LMAS is an efficient and safe procedure. For the EUS-GBD procedure, retrievable anchor could significantly increase the success rate compared with the guidewire.

Download Full-text