scholarly journals Laparoscopic Treatment of Type III Mirizzi Syndrome by T-Tube Drainage

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Fahri Yetışır ◽  
Akgün Ebru Şarer ◽  
H. Zafer Acar ◽  
Yılmaz Polat ◽  
Gokhan Osmanoglu ◽  
...  
Keyword(s):  
Cystic Duct ◽  
Normal Liver ◽  
Liver Function Tests ◽  
Mirizzi Syndrome ◽  
Laparoscopic Treatment ◽  
Tube Drainage ◽  
Type Iii ◽  
T Tube ◽  
Impacted Stone

Mirizzi syndrome (MS) is an impacted stone in the cystic duct or Hartmann’s pouch that mechanically obstructs the common bile duct. We would like to report laparoscopic treatment of type III MS. A 75-year-old man was admitted with the complaint of abdominal pain and jaundice. The patient was accepted as MS type III according to radiological imaging and intraoperative view. Laparoscopic subtotal cholecystectomy, extraction of impacted stone by opening anterior surface of dilated cystic duct and choledochus, and repair of this opening by using the remaining part of gallbladder over the T-tube drainage were performed in a patient with type III MS. Application of reinforcement suture over stump was done in light of the checking with oliclinomel N4 injection trough the T-tube. At the 18-month follow-up, he was symptom-free with normal liver function tests.

scholarly journals Laparoscopic Resection of Cholecystocolic Fistula and Subtotal Cholecystectomy by Tri-Staple in a Type V Mirizzi Syndrome

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Fahri Yetişir ◽  
Akgün Ebru Şarer ◽  
Hasan Zafer Acar ◽  
Omer Parlak ◽  
Basar Basaran ◽  
...  
Keyword(s):  
Laparoscopic Resection ◽  
Normal Liver ◽  
Liver Function Tests ◽  
Mirizzi Syndrome ◽  
Intermittent Fever ◽  
Subtotal Cholecystectomy ◽  
Type V ◽  
First Time ◽  
Cholecystocolic Fistula

The Mirizzi syndrome (MS) is an impacted stone in the cystic duct or Hartmann’s pouch that mechanically obstructs the common bile duct (CBD). We would like to report laparoscopic subtotal cholecystectomy (SC) and resection of cholecystocolic fistula by the help of Tri-Staple™in a case with type V MS and cholecystocolic fistula, for first time in the literature. A 24-year-old man was admitted to emergency department with the complaint of abdominal pain, intermittent fever, jaundice, and diarrhea. Two months ago with the same complaint, ERCP was performed. Laparoscopic resection of cholecystocolic fistula and subtotal cholecystectomy were performed by the help of Tri-Staple. At the eight-month follow-up, he was symptom-free with normal liver function tests. In a patient with type V MS and cholecystocolic fistula, laparoscopic resection of cholecystocolic fistula and SC can be performed by using Tri-Staple safely.

Mirizzi Syndrome: Experience in Diagnosis and Treatment of 25 Cases

2012 ◽  
Vol 78 (1) ◽  
pp. 61-65 ◽  
Author(s):  
Hua Zhong ◽  
Jian-Ping Gong
Keyword(s):  
Magnetic Resonance ◽  
Preoperative Diagnosis ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Mirizzi Syndrome ◽  
Diagnosis And Treatment ◽  
Type I ◽  
Tube Insertion ◽  
Operative Strategy ◽  
T Tube

The objective of this study is to summarize the experience in diagnosis and treatment of Mirizzi syndrome (MS) and reduce the incidence of operative complications. Twenty-five cases of Mirizzi syndrome from January 2005 to January 2010 were retrospectively analyzed. There were 11 male patients and 14 female patients, ranging in ages from 26 to 80 years with a median age of 51.3. Preoperative radiological diagnosis was achieved in 10 patients: ultrasonography (n = 5) and magnetic resonance cholangiopancreatography (n = 10). The others were diagnosed intra-operatively. Fifteen patients had Type I MS. Two were treated with laparoscopic cholecystectomy successfully. The laparoscopic procedure had to be converted to open procedure in one patient. Seven patients had open complete cholecystectomy, three had subtotal cholecystectomy, and two had removal of stones from the gall bladder and choledochostomy after cholecystotomy was performed, with secondary cholecystectomy 3 months later. Six patients had Type II MS. Five underwent cholecystectomy, common bile duct (CBD) repair, and T-tube insertion. One was managed with transection of CBD and Roux-en-Y hepaticojejunostomy. Two patients with Type III MS underwent cholecystectomy, CBD repair, and T-tube insertion. Cholecystectomy and Roux-en-Y hepaticojejunostomy was performed in the two patients with Type IV MS. All the patients recovered from the operation. The follow-up period ranged from 5 years to 5 months. One patient developed obstructive jaundice more than 2 years after the operation, and recovered after the secondary operation. The follow-up of others were uneventful. Preoperative diagnosis of MS is very difficult. Magnetic resonance cholangiopancreatography is very helpful in preoperative diagnosis, and a high index of clinical suspicion is required to make a preoperative or intra-operative diagnosis, which can lead to correct operative strategy to manage Mirizzi syndrome.

scholarly journals A clinical randomized trial comparing T-tube drainage versus choledochojejunostomy in hepatolithiasis patients with sphincter of Oddi laxity: a study protocol (NCT04218669)

2020 ◽  
Author(s):  
Jiangming Chen ◽  
Xiyang Yan ◽  
Tao Zhu ◽  
Zixiang Chen ◽  
Yijun Zhao ◽  
...  
Keyword(s):  
Biliary Stricture ◽  
Sphincter Of Oddi ◽  
Biliary Complications ◽  
Eligibility Criteria ◽  
Tube Drainage ◽  
T Tube ◽  
Stone Recurrence ◽  
Long Term Follow Up

Abstract Background: Residual and recurrent stones remain one of the most important challenges of hepatolithiasis and is reported in 20% to 50% of patients treated for this condition. To date, the two most common surgical procedures performed for hepatolithiasis are choledochojejunostomy and T-tube drainage for biliary drainage. The goal of the present study was to evaluate the therapeutic safety and perioperative and long-term outcomes of choledochojejunostomy versus T-tube drainage for hepatolithiasis patients with sphincter of Oddi laxity (SOL).Methods/Design: In total, 210 patients who met the following eligibility criteria were included and were randomized to the choledochojejunostomy arm or T-tube drainage arm in a 1:1 ratio: (1) diagnosed with hepatolithiasis with SOL during surgery, (2) underwent foci removal, stone extraction and stricture correction during the operation, (3) provided written informed consent, (4) was willing to complete a 3-year follow-up, and (5) aged between 18 and 70 years. The primary efficacy endpoint of the trial will be the incidence of biliary complications (stone recurrence; biliary stricture; cholangitis) during the 3 years after surgery. The secondary outcomes will be the surgical, perioperative and long-term follow-up outcomes.Discussion: This is a prospective, single-centre and randomized controlled two-group parallel trial designed to demonstrate which drainage method (Roux-en-Y hepaticojejunostomy or T-tube drainage) can better reduce biliary complications (stone recurrence; biliary stricture; cholangitis) in hepatolithiasis patients with SOL.Trial Registration: Clinical Trials.gov: NCT04218669; Registered January 6, 2020, https://clinicaltrials.gov/ct2/show/NCT04218669.

scholarly journals Strategies for Management of Bile Duct Injury During Laparoscopic Cholecystectomy

2001 ◽  
Vol 7 (2) ◽  
pp. 55-61 ◽  
Author(s):  
Tatsuya Aoki ◽  
Akihiko Tsuchida ◽  
Hitoshi Saito ◽  
Yuichi Nagakawa ◽  
Keiichi Kitamura ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Duct Injury ◽  
Cystic Duct ◽  
Hepatic Duct ◽  
Common Hepatic Duct ◽  
Tube Drainage ◽  
T Tube ◽  
Aberrant Bile Duct

We encountered 10 patients with bile duct injuries during laparoscopic cholecystectomy. Their causes were electrocautery in 2 patients, misjudgment in 2, mechanical injury in 3, aberrant bile duct in 2, and weakness of the bile duct wall in one. The sites of injury were cystic duct in 4 patients, common bile duct in 2, aberrant bile duct in 2, common hepatic duct in one, and common bile duct plus right hepatic duct in one. Treatments for the injuries discovered intraoperatively consisted of T-tube drainage above in 2 patients, re-ligation of the cystic duct in one, ligation of an aberrant bile duct in one, simple suture and T-tube in one, and choledochojejunostomy in one. In the remaining 4 patients discovered postoperatively, 2 were conservatively treated by endoscopic retrograde biliary drainage. The duration of hospitalization was 9–12 days in the 4 patients with simple suture or ligation, 10–21 days in 2 cases of bile drainage, and 34–43 days in 3 with T-tube drainage. The patient with choledochojejunostomy suffered repeated cholangitis, resulting in hepatic abscess with hospitalization for 6 months. Since laparoscopic surgery should be minimally invasive, meticulous attention is necessary before and during surgery to avoid bile duct injury.

scholarly journals Mirizzi Syndrome: An Experience in Laparoscopic Era

2021 ◽  
Vol 11 (4) ◽  
pp. 165-167
Author(s):  
Syed Hussain ◽  
Asrar Ahmad ◽  
Muhammad Mughal ◽  
Irum Saleem ◽  
Saqib Islam
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Mirizzi Syndrome ◽  
Military Hospital ◽  
Type I ◽  
Type Ii ◽  
Surgical Department ◽  
Type Iii ◽  
T Tube ◽  
Type Iv ◽  
Tube Closure

Objective:To assess the presentation and surgical management of Mirrizi syndrome patients who underwent LaparoscopicCholecystectomy. Study Design and Setting:Retrospective Descriptive Study was conducted at Surgical Department Combined MilitaryHospital Rawalpindi and Combined Military Hospital Quetta from 1st Jan 2010 to 20th Jan 2016. Methodology:Patients undergoing laparoscopic cholecystectomy during this period were retrospectively reviewed. Allcases of Mirizzi Syndrome (MS) were identified and data analysed. Results:A total of 5500 patients underwent laparoscopic cholecystectomy during this period. Approximately 26(0.47%)cases were identified to be having MS. Out of these 26 cases only 8 (30%) were males while 18 (70%) were females. Ageranged from 25 to 80 years. Three patients (11%) had an endoscopic retrograde cholangiopancreaticography (ERCP) done.Type-I MS was found in 19 cases (73 %), Type-II in 3 cases (11%), Type-III and Type-IV in 2 cases each (7.69 %).Conversion to open surgery was carried out in 15 cases (57.6 %). All type-I MS had cholecystectomy except one casewhere partial cholecystectomy was done. T-tube closure of common bile duct was done in all Type-II MS. Similarly T-tube closure was possible in two cases of type-III while one hadRoux-en-Y hepaticojejunostomy. All cases of type-IV MS had Roux-en-Y hepaticojejunostomy. One patient out of 26 (3.8 %) had carcinoma gallbladder. There was no mortality. Conclusion:Type-I MS can be managed with laparoscopic cholecystectomy in selected patients.Type-II and type-III MS may need placement of T-tube while most of type-IV MS are managed with Roux-en-Y hepaticojejunostomy.

scholarly journals Double versus single T-tube drainage for frank cysto-biliary communication in patients with hepatic cystic echinococcosis: a retrospective cohort study with median 11 years follow-up

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Paizula Shalayiadang ◽  
Tiemin Jiang ◽  
Yusufu Yimiti ◽  
Bo Ran ◽  
Abudusalamu Aini ◽  
...  
Keyword(s):  
Cystic Echinococcosis ◽  
Retrospective Cohort ◽  
Biliary Complications ◽  
Tube Drainage ◽  
T Tube ◽  
Cystic Cavity ◽  
Biliary Communication ◽  
Drainage Group

Abstract Background Partial peri-cystectomy (PPC) is one of the major surgical approaches for hepatic cystic echinococcosis (CE) and has been practiced in most centers worldwide. Cysto-biliary communication (fistula, leakage, rupture) is a problematic issue in CE patients. T-tube is a useful technique in situations where an exploration and decompression are needed for common bile duct (CBD). However, postoperative biliary complications for cystic cavity still remains to be studied in depth. Methods A retrospective cohort analysis of CE cases in our single center database from 2007 March to 2012 December was performed. Patients (n = 51) were divided into two cohorts: double T-tube drainage (one at CBD for decompression and one at the fistula for sustaining in cystic cavity, n = 23) group and single T-tube drainage cohort (only one at CBD for decompression, n = 28). Short-/long-term postoperative complications focusing on biliary system was recorded in detail and they were followed-up for median 11 years. Results Overall biliary complication rates for double and single T-tube drainages were 17.4% vs. 39.3% (P > 0.05). Short-term complications ranged from minor to major leakages, cavity infection and abscess formation, and prevalence was 17.4% vs. 21.4% (P > 0.05) respectively for double and single T-tube groups; most importantly, double T-tube drainage group had obvious advantages regarding long-term complications (P < 0.05), which was biliary stricture needing surgery and it was observed only in single T-tube drainage group. Conclusions Double T-tube drainage had better outcomes without procedure-specific postoperative biliary complications than single T-tube drainage. Meanwhile, we recommend long-term follow-up when comparing residual cavity related biliary complications in CE patients as it could happen lately.

scholarly journals Double versus single T-tube drainage for frank cysto-biliary communication in patients with hepatic cystic echinococcosis: A retrospective cohort study with median 11 years follow-up

2020 ◽  
Author(s):  
Paizula Shalayiadang ◽  
Tiemin Jiang ◽  
Yusufu Yimiti ◽  
Bo Ran ◽  
Abudusalamu Aini ◽  
...  
Keyword(s):  
Cystic Echinococcosis ◽  
Retrospective Cohort ◽  
Biliary Complication ◽  
Biliary Complications ◽  
Tube Drainage ◽  
T Tube ◽  
Cystic Cavity ◽  
Biliary Communication

Abstract Background: Partial peri-cystectomy is one of the major surgical approaches for hepatic cystic echinococcosis (CE) and has been practiced in most centers worldwide. Cysto-biliary communication (fistula, leakage, rupture) is a problematic issue in CE patients. T-tube is a useful technique in situations where exploration and decompression are needed for common bile duct (CBD), however, postoperative biliary complications for cystic cavity still remains to be studied in depth. Materials and Methods: A retrospective cohort analysis of CE cases in our single center database from 2007 March to 2012 December was performed. Patients (n=51) were divided into two cohorts: double T-tube drainage (one at CBD for decompression and one at the fistula for sustaining in cystic cavity, n=23) group and single T-tube drainage cohort (only one at CBD for decompression, n=28). Short-/long-term postoperative complication focusing on biliary system was recorded in detail and they were followed-up for median 11 years.Results: Overall biliary complication rates for double and single T-tube drainages were 17.4% vs. 35.7%. Short-term complications ranged from minor to major leakages, cavity infection and abscess formation, and prevalence was 17.4% vs. 21.4% respectively for double and single T-tube groups; most importantly, double T-tube drainage group had predominant advantage regarding long-term complications (0% vs. 14.3%), which was biliary stricture needing surgery and it was observed in single T-tube drainage group.Conclusions: Double T-tube drainage had better outcomes without procedure specific postoperative biliary complications than single T-tube drainage. Meanwhile, we recommend long-term follow-up when comparing residual cavity related biliary complication in CE patients as it could happen lately.

Hepatic abnormalities identified by staging MRI and accuracy of MRI of patients with uveal melanoma

2018 ◽  
Vol 103 (9) ◽  
pp. 1266-1271 ◽  
Author(s):  
Jasmine H Francis ◽  
Federica Catalanotti ◽  
Jonathan Landa ◽  
Christopher A Barker ◽  
Alexander N Shoushtari ◽  
...  
Keyword(s):  
Uveal Melanoma ◽  
Normal Liver ◽  
Liver Function Tests ◽  
Metastatic Lesion ◽  
Cancer Center ◽  
Newly Diagnosed ◽  
Single Centre ◽  
First Finding ◽  
Institutional Review

BackgroundMetastases to the liver are often the first finding in patients with uveal melanoma with extraocular disease, but little has been published on the utility of staging MRI at initial diagnosis. We aimed to evaluate the proportion of abnormal hepatic findings on baseline MRI and accuracy of MRI in patients with newly diagnosed uveal melanoma.MethodsThis is a single-centre, retrospective, institutional review board-approved study of 145 consecutive patients diagnosed with uveal melanoma, at Memorial Sloan Kettering Cancer Center between 2004 and 2016, who had staging MRI within 1 month of diagnosis. Scans were classified as normal or abnormal, and further distinguished as abnormal non-metastatic, uncharacterisable lesions and suspicious for metastasis. Where available, follow-up MRI (at ~1 year) or biopsies were reviewed.ResultsMRI in 145 patients revealed 62% (90) with abnormal hepatic findings; out of these 87% (78) had non-metastatic benign findings, 6.7% (6) had unclassifiable lesions and 6.7% (6) were suspicious for metastasis (6). Abnormal non-metastatic findings included 72 focal (36 solitary and 36 multiple) and 12 diffuse lesions. Lesions suspicious for metastases were found in 6 of 145 patients (4%), despite normal liver function tests. Of these, five had confirmed liver metastases and one patient had a stable, presumed non-metastatic lesion on follow-up. In this study, the sensitivity and specificity of staging MRI for all findings were 83.3% (95% CI 35.9 to 99.6) and 99.0% (95% CI 94.3 to 99.9), respectively.ConclusionStaging MRI of patients with newly diagnosed uveal melanoma accurately identified early metastases. Furthermore, imaging revealed hepatic abnormalities in the majority of patients, although as expected few of these represented metastatic disease.

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