scholarly journals Late postcholecystectomy Mirizzi syndrome due to a sessile gall bladder remnant calculus managed by laparoscopic completion cholecystectomy: a feasible surgical option

2019 ◽  
Vol 12 (8) ◽  
pp. e228156 ◽  
Author(s):  
Gunjan S Desai ◽  
Prasad Pande ◽  
Rajvilas Narkhede ◽  
Prasad Wagle
Keyword(s):  
Gall Bladder ◽  
Cystic Duct ◽  
Mirizzi Syndrome ◽  
Algorithmic Approach ◽  
Postcholecystectomy Syndrome ◽  
Laparoscopic Management ◽  
Subtotal Cholecystectomy ◽  
Surgical Clip ◽  
Surgical Option

Postcholecystectomy Mirizzi syndrome (PCMS) is an uncommon entity that can occur due to cystic duct stump calculus, gall bladder remnant calculus or migrated surgical clip. It can be classified into early PCMS or late PCMS. It is often misdiagnosed and the management depends on the site of impaction of stone or clip. Endoscopy can be performed for cystic duct stump calculus. However, surgery is the treatment for remnant gall bladder calculus. Role of laparoscopic management is controversial. We present here a case of a 48-year-old woman with late PCMS due to an impacted calculus in a sessile gall bladder remnant following a subtotal cholecystectomy, managed with laparoscopic completion cholecystectomy, review the literature, provide tips for safe laparoscopy for PCMS and summarise our algorithmic approach to the management of the postcholecystectomy syndrome.

scholarly journals OMENTUM PIECE FOR PREVENTION OF BILE LEAKAGE AFTER SUBTOTAL CHOLECYSTECTOMY

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Kaustubh Vasant Waikar
Keyword(s):  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Cystic Duct ◽  
Primary Closure ◽  
Bile Leak ◽  
Bile Leakage ◽  
Greater Omentum ◽  
Closure Technique ◽  
Subtotal Cholecystectomy ◽  
History Of

Introduction: Acute cholecystitis is an acute inflammatory condition of the gallbladder of which 95% of cases of acute cholecystitis are due to an obstructing calculus in the gallbladder neck or cystic duct. Acute cholecystitis and difficult gall bladder have severe inflammation and anatomical deformities i.e. empyema, Mirizzi syndrome and sometimes gangrene. In recent years, there is an increasing trend towards subtotal cholecystectomy and general acceptance is higher due to higher incidence of complications in difficult gall bladder. Although, the results of subtotal cholecystectomy are satisfactory but the post-operative bile leak is a problem of great concern. There are many techniques that have been adopted, but bile leakage compared to closing of cystic duct directly is very high in subtotal cholecystectomy.  Material and Methods:   The Omentum Plugging Technique (OPT) and Primary Closure Technique (PCT) was done to prevent bile leak in cases were total cholecystectomy could not be performed. Patients were included in the study with the diagnosis of cholelithiasis and patients who had undergone subtotal cholecystectomy for gallstone diseases with both OPT and PCT Technique. Under general anaesthesia patients were operated. Patients were first decompressed at the fundus with the suction and harmonic scalpel or l-hook was used for transection of gall bladder and wash was given and both the anterior and posterior walls were excised leaving an anterior and posterior wall intact and OPT, a piece of omentum that matches the size of the opening of the gallbladder stump is resected from the greater omentum and plugged into the gallbladder stump. Results: A total of 486 patients were operated, of which 36 patients (7.4%) underwent subtotal cholecystectomy because it was not possible to close their cystic ducts because they had difficult gallbladders, of which 18 patients in taken in OPT and 18 patients taken in PCT group. Average age in OPT group was 49.48 ± 9.59 years while in PCT group was 54.47 ± 16.21. In OPT group there were 10 (62.5%) male and 6 (37.5%) female, in PCT group 11 (68.75%) male and 5 (31.25%) female were observed. History of CBD Stone was recorded in 3 (18.75%) and 2 (12.50%) patients in OPT and PCT group respectively. No History of Abdominal Surgery was noted in both the group. Intra-operative Haemorrhage in OPT Group was 118 (16-359) ml while in PCT group was 164 (10-578) ml. Duration of Operation Time OPT Group was 156 ± 15.77 ml while in PCT group it was 105 ± 17.35 minutes. Total post-operative complications and post-operative bile leakage were seen in 2 patients in OPT group while in PCT group it was seen in 10 patients. (P= 0.0040). Post-operative intervention was done on one patient in OPT group and on 9 patients in PCT group. Mean Duration of drain was 3.5 ± 1.24 days in OPT group and 8.59 ± 2.46 days in PCT group (P< 0.0001). Post-operative hospital stay was 8.84 ± 2.14days in OPT group and 13.45 ± 2.11days (P< 0.0001). Conclusion: In a difficult gall bladder SC is required during cholecystectomy and for prevention of postoperative bile leakage OPT technique can be safe and more feasible alternative than conventional procedures. Keywords: Subtotal cholecystectomy (SC), Omentum Plugging Technique (OPT), Primary Closure Technique (PCT), gall bladder.

scholarly journals Combined Endoscopic and Laparoscopic Management of Postcholecystectomy Mirizzi Syndrome from a Remnant Cystic Duct Stone: Case Report and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Arpit Amin ◽  
Yuriy Zhurov ◽  
George Ibrahim ◽  
Anthony Maffei ◽  
Jonathan Giannone ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Mirizzi Syndrome ◽  
Endoscopic Retrograde ◽  
Laparoscopic Management ◽  
Novel Strategy ◽  
Laparoscopic Techniques ◽  
Stage 1 ◽  
Bile Duct Stent

Mirizzi syndrome has been defined in the literature as common bile duct obstruction resulting from calculi within Hartmann’s pouch or cystic duct. We present a case of a 78-year-old female, who developed postcholecystectomy Mirizzi syndrome from a remnant cystic duct stone. Diagnosis of postcholecystectomy Mirizzi syndrome was made on endoscopic retrograde cholangiography (ERCP) performed postoperatively. The patient was treated with a novel strategy by combining advanced endoscopic and laparoscopic techniques in three stages as follows: Stage 1 (initial presentation): endoscopic sphincterotomy with common bile duct stent placement; Stage 2 (6 weeks after Stage 1): laparoscopic ultrasonography to locate the remnant cystic duct calculi followed by laparoscopic retrieval of the calculi and intracorporeal closure of cystic duct stump; Stage 3 (6 weeks after Stage 2): endoscopic removal of common bile duct stent along with performance of completion endoscopic retrograde cholangiogram. In addition, we have performed an extensive review of the various endoscopic and laparoscopic management techniques described in the literature for the treatment of postcholecystectomy syndrome occurring from retained cystic duct stones.

scholarly journals Laparoscopic Management of Remnant Cystic Duct Calculi: A Retrospective Study

2009 ◽  
Vol 91 (1) ◽  
pp. 25-29 ◽  
Author(s):  
Chinnusamy Palanivelu ◽  
Muthukumaran Rangarajan ◽  
Priyadarshan Anand Jategaonkar ◽  
Madhupalayam Velusamy Madankumar ◽  
Natesan Vijay Anand
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Imaging Modality ◽  
Operating Time ◽  
Laparoscopic Management ◽  
Subtotal Cholecystectomy ◽  
Laparoscopic Excision ◽  
The Common ◽  
The Mean

INTRODUCTION Even though cholecystectomy relieves symptoms in the majority of cases, a significant percentage suffer from ‘postcholecystectomy syndrome’. Cystic duct/gall bladder remnant calculi is a causative factor. We present our experience with the laparoscopic management of cystic duct remnant calculi. PATIENTS AND METHODS We managed 15 patients with cystic duct remnant calculi from 1996 to 2007 in our institute. All these patients had earlier undergone laparoscopic subtotal cholecystectomy at our centre. They were successfully managed by laparoscopic excision of the remnant. RESULTS The mean duration between first and second surgery was 8.35 months (range, 6–10.7 months). The mean operating time was 103.5 min (range, 75–132 min). Duration of hospital stay was 4–12 days. There was a higher incidence of remnant duct calculi following laparoscopic subtotal cholecystectomy than conventional laparoscopic cholecystectomy 13/310 (4.19%) versus 2/9590 (0.02%). The morbidity was 13.33%, while there were no conversions and no mortality. CONCLUSIONS Leaving behind a cystic duct stump for too long predisposes stone formation, while dissecting too close to the common bile duct and right hepatic artery in acute inflammatory conditions is dangerous. We believe that the former is a wiser policy to follow, as cystic duct remnant calculi are easier to manage than common bile duct or vessel injury. Laparoscopic excision of the remnant is effective, especially when performed by experienced laparoscopists. ‘T’-tube is used to canulate the common bile duct in case the tissue is friable. Magnetic resonance cholangiopancreaticography is the imaging modality of choice, and is mandatory.

scholarly journals Three Episodes of Postcholecystectomy Syndrome Due to Remnant Cystic Duct with Prior Mirizzi Syndrome

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Sumedha R. Sinha ◽  
Nicholas R. Norton ◽  
Saamia Arshad ◽  
Rajesh Gulati
Keyword(s):  
Cystic Duct ◽  
Mirizzi Syndrome ◽  
Postcholecystectomy Syndrome

scholarly journals Post-Cholecystectomy Gall Bladder Remnant and Cystic Duct Stump stone: surgical pitfalls, causes of occurrence and completion cholecystectomy (open versus laparoscopic) as a safe surgical option of treatment: short and long term outcome. Randomized Controlled Clinical Trials.

2020 ◽  
Author(s):  
tamer A alnaimy ◽  
Mohammed Mahmoud mokhtar ◽  
Doaa Omar Refaat ◽  
Mohamed Lotfy ◽  
Gamal Osman ◽  
...  
Keyword(s):  
Gall Bladder ◽  
Cystic Duct ◽  
Laparoscopic Group ◽  
Open Group ◽  
Open Approach ◽  
Long Term Outcome ◽  
Short And Long Term ◽  
The Mean ◽  
Surgical Option

Abstract Introduction : cholecystectomy is the standard surgical option of symptomatic gallbladder disease. The symptoms persist after cholecystectomy in 10 - 20% of cases. Residual gall bladder/cystic duct stump stone is one of the most important cause. Aim : to compare between open and laparoscopic completion cholecystectomy for gall bladder (GB) remnant and cystic duct stump stones as regard short and long term outcome.Methods : This study was conducted on 84 cases with residual GB/cystic duct stump stone that were divided into 2 groups, the open completion cholecystectomy group and the laparoscopic completion cholecystectomy group. The diagnosis was made by ultrasound and magnetic resonance cholangio-pancreatography.Results : The mean operative time was 120±13 minutes in open group and 160±10 in laparoscopic group. Blood loss occurred in 8 cases in open group and 2 cases in laparoscopic group that necessitated blood transfusion. Biliary injuries detected intraoperative occurred in 3 cases with open approach and 2 cases with laparoscopic approach and suture immediately by vicryl 3/0. The mean hospital stay was shorter in laparoscopic group than open group. .Conclusion : laparoscopic Completion cholecystectomy is a safe surgical approach for cystic duct stump stone.Research question: is laparoscopic completion cholecystectomy is safe in managing gall bladder and cystic duct stump stones?Hypothesis: laparoscopic completion cholecystectomy is safe in managing gall bladder and cystic duct stump stones.All ethical approval was given by our local Faculty of Medicine ethical committee.Registration at clinicaltrials.gov protocol registration quality control review criteria: NCT04329143 registered in 31 March 2020.retrospective registeredThe work described has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans.

The Use of Harmonic Scalpel for Laparoscopic Clip less Cholecystectomy

JMS SKIMS ◽  
2020 ◽  
Vol 23 (1) ◽  
pp. 22-26
Author(s):  
Yawar Nissar ◽  
Peerzada Umar Farooq Baba ◽  
Lenah Bashir ◽  
Khawar Nissar
Keyword(s):  
Cystic Duct ◽  
Operative Time ◽  
Harmonic Scalpel ◽  
Bile Leakage ◽  
Effective Alternative ◽  
Surgical Clip ◽  
Postoperative Drainage ◽  
The Mean ◽  
Closure Method

BACKGROUND: Laparoscopic cholecystectomy (LC) is accepted as the ‘‘gold standard’’ surgical treatment of gallstones. Although surgical clip (SC) is known to be a safe closure method for cystic duct and artery, bile leakage due to clip displacement from the cystic duct stump is a potential complication. In recent years, some energy sources have been tried for the closure of the cystic duct. After the beginning of the use of a harmonic scalpel (HS) for sealing of the cystic artery, surgeons started to investigate the role of HS for sealing the cystic duct. The aim of this study was to assess the efficacy and safety of the use of HS in performing LC. OBJECTIVE: To assess the safety and efficacy of HS, as an effective alternative to clipping, for achieving perfect haemobilliary stasis in LC. MATERIAL AND METHODS: This study was carried out on 70 patients over a period of 2 years. It included 29 males and 41 females with a mean age of 40.6±12.3 years. Most of the cases (42.9%) were operated within 35-44 minutes with a range of 25-64 minutes. RESULTS: LC was successful in all patients, with no need to convert into open technique. Gall bladder (GB) perforation occurred in 8.6% of cases. None of the patients had intraoperative cystic duct leaks. Postoperative drainage was haemoserous in all patients with no bile or frank blood. The mean hospital stay was 1.3±0.72 days. CONCLUSION: Harmonic scalpel is a safe and effective alternative to clipping for LC, ensuring perfect haemobilliary stasis. It has the advantages of a lower incidence of GB perforation and shorter operative time. The major limitation is its cost and apprehension of insecurity in using it in mega cystic duct >6 mm.

Clinical aspects and surgical technique in Mirizzi syndrome: A systematic review

2020 ◽  
pp. 35871-35873
Keyword(s):  
Surgical Technique ◽  
Cystic Duct ◽  
Hepatic Duct ◽  
Signs And Symptoms ◽  
Mirizzi Syndrome ◽  
Common Hepatic Duct ◽  
Clinical Aspects ◽  
Main Diagnosis ◽  
Biliary Surgery ◽  
Electronic Library

Mirizzi syndrome is described in the 1940s as follows: partial obstruction of the secondary common hepatic duct by gallstones, impacted on the cystic duct or gallbladder infundibulum, associated with the inflammatory response that involved the cystic duct and the common hepatic duct. As it is a rare and delicate condition, differential diagnosis is extremely important, in which the patient's clinical condition is verified through anamnesis and complementary exams, where immediately after the surgical intervention can be performed. This work aims to describe, through a literature review, the clinical aspects and the surgical technique in Mirizzi Syndrome. Were used as a database for research sites containing scientific articles available online such as Virtual Health Library (VHL), Scientific Electronic Library Online (Scielo) and PubMed. 154 articles were found through the descriptors, where after applying the inclusion and exclusion criteria 11 articles remained to write the work. According to the articles surveyed, it is clear that most of them do not report the syndrome as the main diagnosis, possibly because it is a pathology with signs and symptoms very close to other diseases of the bile duct, therefore leaving the syndrome sometimes described in the context of these other diseases. Finally, it concludes that even though the preoperative diagnosis is rare, it should be suspected in individuals undergoing biliary surgery.

scholarly journals Role of MSCT in the diagnosis of perforated gall bladder (a retrospective study)

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Mohamed M. Harraz ◽  
Ahmed H. Abouissa
Keyword(s):  
Computed Tomography ◽  
Retrospective Study ◽  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Acute Diverticulitis ◽  
Wall Thickening ◽  
Free Fluid ◽  
Iodinated Contrast ◽  
Contrast Enhanced

Abstract Background Although gall bladder perforation (GBP) is not common, it is considered a life-threating condition, and the possibility of occurrence in cases of acute cholecystitis must be considered. The aim of this study was to assess the role of multi-slice computed tomography (MSCT) in the assessment of GBP. Results It is a retrospective study including 19 patients that had GBP out of 147, there were 11 females (57.8%) and 8 males (42.1%), aged 42 to 79 year (mean age 60) presented with acute abdomen or acute cholecystitis. All patients were examined with abdominal ultrasonography and contrast-enhanced abdominal MSCT after written informed consent was obtained from the patients. This study was between January and December 2018. Patients with contraindications to contrast-enhanced computed tomography (CT) (pregnancy, acute kidney failure, or allergy to iodinated contrast agents) who underwent US only were excluded. Patients with other diagnoses, such as acute diverticulitis of the right-sided colon or acute appendicitis, were excluded. The radiological findings were evaluated such as GB distention; stones; wall thickening, enhancement, and defect; pericholecystic free fluid or collection; enhancement of liver parenchyma; and air in the wall or lumen. All CT findings are compared with the surgical results. Our results revealed that the most important and diagnostic MSCT finding in GBP is a mural defect. Nineteen patients were proved surgically to have GBP. Conclusion GBP is a rare but very serious condition and should be diagnosed and treated as soon as possible to decrease morbidity and mortality. The most accurate diagnostic tool is the CT, MSCT findings most specific and sensitive for the detection of GBP and its complications.

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