Multiple Biliary Stents: A Therapeutic Option for Persistent Biliary Leak Following Laparoscopic Cholecystectomy

2006 ◽  
Vol 40 (5) ◽  
pp. 452-453
Author(s):  
Pranitha Naini ◽  
Ethan H. Dubin ◽  
Sudhir K. Dutta
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Therapeutic Option ◽  
Biliary Stents ◽  
Biliary Leak

scholarly journals Difficult iatrogenic bile duct injuries following different types of upper abdominal surgery: report of three cases and review of literature

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jerzy Lubikowski ◽  
Bernard Piotuch ◽  
Anna Stadnik ◽  
Marta Przedniczek ◽  
Piotr Remiszewski ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Abdominal Surgery ◽  
Delayed Diagnosis ◽  
Biliary Leak ◽  
Bile Duct Injuries ◽  
Upper Abdominal Surgery ◽  
Different Types ◽  
Upper Abdominal ◽  
Type Of Injury

Abstract Background Iatrogenic bile duct injuries (BDIs) are mostly associated with laparoscopic cholecystectomy but may also occur following gastroduodenal surgery or liver resection. Delayed diagnosis of type of injury with an ongoing biliary leak as well as the management in a non-specialized general surgical units are still the main factors affecting the outcome. Case presentation Herein we present three types of BDIs (Bismuth type I, IV and V) following three different types of upper abdominal surgery, ie. Billroth II gastric resection, laparoscopic cholecystectomy and left hepatectomy. All of them were complex injuries with complete bile duct transections necessitating surgical treatment. All were also very difficult to treat mainly because of a delayed diagnosis of type of injury, associated biliary leak and as a consequence severe inflammatory changes within the liver hilum. The treatment was carried out in our specialist hepatobiliary unit and first focused on infection and inflammation control with adequate biliary drainage. This was followed by a delayed surgical repair with the technique which had to be tailored to the type of injury in each case. Conclusion We emphasize that staged and individualized treatment strategy is often necessary in case of a delayed diagnosis of complex BDIs presenting with a biliary leak, inflammatory intraabdominal changes and infection. Referral of such patients to expert hepatobiliary centres is crucial for the outcome.

scholarly journals Cholelithiasis: causative factors, clinical manifestations and management

2019 ◽  
Vol 6 (6) ◽  
pp. 2133
Author(s):  
Renu Pimpale ◽  
Pradeep Katakwar ◽  
Murtaza Akhtar
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Management ◽  
Open Cholecystectomy ◽  
Clinical Manifestations ◽  
Gastrointestinal Disorder ◽  
Xanthogranulomatous Cholecystitis ◽  
Biliary Leak ◽  
Common Complaint ◽  
Causative Factors ◽  
Operative Complications

Background: Cholelithiasis is a common gastrointestinal disorder with an overall prevalence of 2-29%. This study aims to evaluate the evolution of demographic and etiological factors, the clinical manifestations of Cholelithiasis, the surgical management with its post-operative complications and the histopathological findings of the post-cholecystectomy specimen of gallbladder, in central India.Methods: Patients symptomatic or asymptomatic diagnosed ultrasonically as cholelithiasis were included in the study and patients with primary choledocholithiasis were excluded.Results: A total of 92 patients were enrolled, of which 62 (68.89%) were female, with mean age of 45.03yrs ± 13.59. Fifty four patients (58.69%) were having BMI >25. Pain was most common complaint seen in all patients. Jaundice was observed in 13 patients (14.13%) who had associated CBD calculus. Sickling was positive in 8.69% of patients. Lap cholecystectomy was done in 71 (77.17%) patients with a conversion rate of 6.57%. Nineteen (20.65%) were open cholecystectomy with or without CBD exploration and 2 underwent Lap cholecystostomy. Post operatively, surgical site infection was seen in 3 patients (4.22%) of laparoscopic cholecystectomy, 5 patients (26.31%) of open cholecystectomy and biliary leak was seen in 3 patients (15.78%) of open cholecystectomy. Histopathology of gallbladder was chronic cholecystitis in 70 patients (77.77%), malignancy was detected in 5 patients (5.55%) and Xanthogranulomatous cholecystitis in 2 patients (2.22%).Conclusions: Cholelithiasis is commonly seen in females in 4th and 5th decade mainly presenting with abdominal pain and dyspepsia. Laparoscopic cholecystectomy offers best surgical management with lesser complications.

Aspects of diagnosis and treatment of oligosymptomatic choledocholithiasis in patients with acute calculous cholecystitis

2020 ◽  
Vol 26 (2-3) ◽  
pp. 49-54
Author(s):  
V.I. Kolomiytsev ◽  
◽  
O.M. Terletskiy ◽  
O.V. Lukavetskiy ◽  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Factor Model ◽  
Therapeutic Option ◽  
Diagnostic Algorithm ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Biliary Duct ◽  
Transabdominal Ultrasound ◽  
Endoscopic Retrograde ◽  
Acute Calculous Cholecystitis ◽  
Calculous Cholecystitis

Aim. Developing optimal approaches in the diagnostic algorithm and treatment of patients with acute calculous cholecystitis complicated by oligosymptomatic choledocholithiasis. Material and Methods. The results of treatment of 215 patients with acute calculous cholecystitis complicated by oligosymptomatic choledocholithiasis were analyzed, 166 of which-were studied retrospectively, and 49 - prospectively. Female patients predominated (74.0%); the average age was 56.0±1.06 years. Blood serum biochemistry, transabdominal ultrasound, magnetic resonance cholangiopancreatography, and blood and bile microRNA were used for the diagnosis. Results and Discussion. After verification of the diagnosis by applying several tests and developed multivariate models based on determining the blood and bile microRNA, and the model consisting of 5 factors for the prediction of the presence of choledocholithiasis (alkaline phosphatase, AST, ALT, total bilirubin, the common bile duct diameter according to transabdominal ultrasound), the main therapeutic option to resolve biliary duct problems in 183 (85.1%) patients were endoscopic retrograde cholangiography (ERC) with sphincterotomy and stone extraction. In the second step, 159 (74.0%) patients underwent laparoscopic cholecystectomy. One-step interventions (laparoscopic cholecystectomy and stones removal / intraoperative therapeutic ERC) due to association with acute cholecystitis changes in the hepatoduodenal ligament were performed on 7 (3.3%) patients only. Conclusions. In patients with acute calculous cholecystitis, using a 5-factor model has a fairly high prognostic value for the prediction of choledocholithiasis, and the additional use of quantifying the expression levels of miRNA-122 and miRNA-21 significantly improves the diagnosis of asymptomatic choledocholithiasis. The optimal approach to the treatment of such patients is to perform therapeutic ERCP followed by laparoscopic cholecystectomy. Keywords: acute calculous cholecystitis, oligosymptomatic choledocholithiasis, transabdominal ultrasound, endoscopic retrograde cholangiopancreatography, laparoscopic cholecystectomy

scholarly journals Medicolegal claims following laparoscopic cholecystectomy in the UK and Ireland

2010 ◽  
Vol 92 (4) ◽  
pp. 286-291 ◽  
Author(s):  
James RH Scurr ◽  
Julian R Brigstocke ◽  
David A Shields ◽  
John H Scurr
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Vascular Injury ◽  
Expert Witness ◽  
Vascular Injuries ◽  
Biliary Leak ◽  
Delay In Diagnosis ◽  
Bile Duct Injuries ◽  
The Uk ◽  
Major Vascular Injury

INTRODUCTION The causes and outcomes of medicolegal claims following laparoscopic cholecystectomy were evaluated. SUBJECTS AND METHODS A retrospective analysis of the experience of a consultant surgeon acting as an expert witness within the UK and Ireland (1990–2007). RESULTS A total of 151 claims were referred for an opinion. Sixty-three related to bile duct injuries and four followed major vascular injury. Bowel injury resulted in 17 claims. A postoperative biliary leak not associated with a bile duct injury was responsible for 25 claims. Other reasons for claims included spilled gallstones, port-site herniae, haemorrhage and other recognised complications associated with laparoscopic cholecystectomy. Twelve of the claims are on-going, two went to trial, 79 (52%) were settled out of court and 58 (38%) were discontinued after the claimants were advised that they were unlikely to win their case. Disclosed settlement amounts are reported. CONCLUSIONS Bile duct and major vascular injuries are almost indefensible. The delay in diagnosis and (mis)management of other recognised complications following laparoscopic cholecystectomy have also led to a significant number of successful medicolegal claims.

scholarly journals The Role of Endoscopic Retrograde Cholangiopancreatography in the Management of Biliary Complication Post-Laparoscopic Cholecystectomy

2021 ◽  
Vol 9 (B) ◽  
pp. 313-317
Author(s):  
Mohamed Abdzaid Akool ◽  
Samer Makki Mohamed Al-Hakkak ◽  
Alaa Abood Al-Wadees
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Stent Placement ◽  
Biliary Injury ◽  
Stone Extraction ◽  
Biliary Leak ◽  
Endoscopic Retrograde ◽  
Plastic Stent

BACKGROUND: Laparoscopic cholecystectomy considers a golden surgery for gallbladder removal nowadays, and it carries some complications like biliary injuries, which can manage successfully by endoscopic retrograde cholangiopancreatography. AIM: To estimate the role of endoscopic management of bile duct injury (BDI) following laparoscopic cholecystectomy. PATIENT AND METHODS: A prospective study conducted at Al-Sader Medical City, Najaf City, Iraq, during the period between September 2018 and December 2020, included 44 patients complicated by the biliary injury resulting in a persistent biliary leak and/or jaundice after laparoscopic cholecystectomy and evaluated by endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: Findings revealed that 25% of cases had complete BDI, only one managed by plastic stent placement, the other 10 referred for open surgical constructions, 61% had partial injury associated with the biliary leak, all managed by sphincterotomy and plastic stent placement through ERCP, almost 7% had a partial clipping of bile duct all managed with sphincterotomy, balloon dilatation/stone extraction, and plastic stent placement, 5% had slipped clips of cystic duct stump, are managed with sphincterotomy and plastic stent placement. Moreover, only one patient, 2%, had distal common bile duct stone with bile leak, managed by sphincterotomy and stone extraction. CONCLUSIONS: Laparoscopic cholecystectomy, a gold standard therapeutic option for symptomatic cholecystolithiasis, is associated with an increased risk of biliary injury due to many factors. ERCP is a safe means of diagnosing the cause of bile leakage after laparoscopic cholecystectomy. It also offers definitive treatment in most cases by endoscopic sphincterotomy and plastic stent placement.

scholarly journals Comparative study to evaluate ultrasonic verses monopolar electrocautery dissection of gall bladder in laparoscopic cholecystectomy

2021 ◽  
Vol 8 (7) ◽  
pp. 2054
Author(s):  
Himanshi Mathur ◽  
Ashok Kumar Sharma ◽  
Dheer Singh Kalwaniya
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Operative Time ◽  
Harmonic Scalpel ◽  
Bowel Perforation ◽  
Bladder Perforation ◽  
Biliary Leak ◽  
Ultrasonic Scalpel ◽  
Time Frequency ◽  
Monopolar Electrocautery

Background: Gallstones are one of the most common routinely encountered surgical problem in the developed world. Laparoscopic cholecystectomy being the gold standard surgery for gall stones has been modified various times using different instruments in order to improve intraoperative and postoperative outcomes. The aim of the study was to see clinical outcomes of ultrasonic scalpel verses monopolar electrocautery in dissection of gall bladder in laparoscopic cholecystectomy.Methods: A prospective randomized controlled study was done with total 100 patients in which 50 patients underwent laparoscopic cholecystectomy via ultrasonic scalpel while rest 50 patients were operated using monopolar electrocautery. The study was conducted for a period of eighteen months and clinical outcomes were studied in terms of operative time, frequency of lens cleaning, gall bladder perforation, biliary leak, common bile duct injury, bowel perforation and postoperative hospital stay.Results: The two groups were comparable in terms of demographic profile considering age and sex distribution. However, there was a statistically significant reduction in operative time, frequency of lens cleaning and gall bladder perforation in group A (harmonic scalpel) as compared to group B (electrocautery).Conclusions: Harmonic scalpel is not only a safe and effective instrument but also a reliable alternative to electrocautery. Even though the study revealed no significant difference in biliary leak, common bile duct injury, bowel perforation and postoperative hospital stay but it can significantly reduce operative time and incidence of gall bladder perforation. Thus, it can improve the operative course in laparoscopic cholecystectomy.

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