scholarly journals Features of laparoscopic cholecystectomy in patients with chronic calculous cholecystitis and signs of ”non-functioning” gallbladder

2018 ◽  
Vol 23 (2) ◽  
pp. 93-99
Author(s):  
V. I. Greyasov ◽  
V. M. Chuguyevsky ◽  
N. I. Sivokon ◽  
M. A. Agapov
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Leakage ◽  
Chronic Cholecystitis ◽  
Biliary Injury ◽  
Diagnostic Measures ◽  
Postoperative Diagnosis ◽  
Extrahepatic Bile Ducts ◽  
Calculous Cholecystitis

Aim. To improve outcomes of laparoscopic cholecystectomy in patients with chronic cholecystitis and signs of “nonfunctioning” gallbladder via development of preventive, curative and diagnostic measures. Material and methods. Laparoscopic cholecystectomу was performed in 14 764 patients with chronic cholecystitis. Incidence and causes of intraoperative injury of extrahepatic bile ducts were retrospectively analyzed. Three basic forms of “non-functioning” gallbladder (hydropsy, sclerosis and atrophy, total filling by stones) were. Results. Biliary injury followed by bile leakage occurred in 38 (0.25%) cases. Intraoperative and early postoperative diagnosis was in 11 (28.9%) and 27 (71.1%) patients, respectively. Tangential trauma of common bile duct was found in 3 (7.8%) cases, complete intersection – in 8 (21%) patients. Herewith, 6 of them had sclerosis, 2 – total filling of gallbladder by stones. New diagnostic and curative approach was followed by only 2 (0.04%) cases of early postoperative bile leakage in 2010–2015. Injury of common bile duct was absent within the same period. Sclerosis and atrophy of gallbladder were diagnosed prior to surgery. Conclusion. There are 3 types of “non-functioning” gallbladder with risk of biliary trauma during laparoscopic cholecystectomy. Sclerosis and atrophy of gallbladder are predominantly followed by certain difficulties during laparoscopic cholecystectomy. New diagnostic and curative approach is useful to prevent iatrogenic biliary trauma.

scholarly journals Results of surgical treatment of extrahepatic bile duct injuries

2020 ◽  
Vol 37 (1) ◽  
pp. 63-72
Author(s):  
L. P. Kotelnikova ◽  
I. G. Burnyshev ◽  
O. V. Bazhenova ◽  
D. V. Trushnikov
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Treatment ◽  
Bile Duct ◽  
Bile Ducts ◽  
Bile Leakage ◽  
Biliary Reconstruction ◽  
Long Term Outcomes ◽  
Endoscopic Retrograde ◽  
Extrahepatic Bile Ducts

Aim. To evaluate the short-and long-term outcomes after surgical repair of iatrogenic lesions of extrahepatic bile ducts depending on the timing of diagnosis in conditions of specialized clinic. Materials and methods. Our study involved a retrospective analysis of 159 patients who were treated for iatrogenic lesions of extrahepatic bile ducts during 1987-2017. These patients were divided into two groups depending on the timing of surgical treatments: early biliary reconstruction ( 5 days after bile duct transection) and late biliary reconstruction ( 5 days post-transection). These groups were compared on the basis of postoperative morbidity and long-term outcomes. Results. Following laparoscopic cholecystectomy, 2 patients received endoscopic retrograde stents due to bile leakage from the cystic ducts, and 14 patients underwent hepaticocholedochostomy using Ker drainage. The incidence of bile leakage was observed in 14. 3 % of cases during the early post-operative period, strictures appeared in 28.6 % of cases. Hepaticojejunostomy was performed in 91 cases: in 62 with stents and in 29 without stents. Bile leakage was observed in 17.6 % of cases, and strictures in 19.8 % of cases. Our statistical analyses revealed no significant differences between the two groups (i.e., early and late timing of surgical treatment) in the rates of bile leakage and strictures. The extent of surgeons experience in bile surgery significantly correlated with positive outcomes. Conclusions. Endoscopic retrograde stent proved to be an effective and fast solution in cases of bile leakage from cystic ducts following laparoscopic cholecystectomy. Although it is preferable to perform reconstructive surgeries within the first five days after bile duct injury, our results indicated that in the presence of external bile fistula without peritonitis and severe cholangitis, reconstructive surgery can be performed in specialized surgical departments later than 5 days with satisfactory results.

scholarly journals Bile leak syndrome after laparoscopic cholecystectomy

2019 ◽  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Treatment ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Minimally Invasive ◽  
Abdominal Cavity ◽  
Bile Leak ◽  
Bile Leakage ◽  
Early Postoperative Period ◽  
Type I

Aim of the study was the assasement of surgical treatment results of patients with cholelithiasis, who had external or internal bile leakage (BL), for the optimization and improvement of diagnostic programme and surgical tactic of minimally invasive techniques usage. Materials and methods. Results of surgical treatment during the early postoperative period of patients with cholelithiasis, who underwent laparoscopic cholecystectomy (LC) were analysed. Results. In early post-operative period 67 (0,6%) patients, mean aged 56,9 ± 7,4 had BL. 54 (81,0%) of them were women, 13 (19,0%) were men. 21 (31,3%) patients underwent LC due to chronic cholecystitis, 46 (68,7%) patients had acute cholecystitis. In 54 (81,0%) cases there was drainage bile leakage, in 13 (19,0%) cases bile collection in abdominal cavity was identified several days after drains ejection, due to clinical manifestation and ultrasonography data. 23 (34,3%) patients were treated conservatively. Minimally invasive endoscopic manipulations, ultrasonography controlled percutaneous drainage and relaparotomy were effective in 35 (52,2%) patients, 9 (13,4%) patients underwent laparotomy with following surgical correction of BL. These patients had dense perivesical infiltrates, Mirizzi’s syndrome type I. 6 (9,0%) patients underwent laparotomy, abdominal cavity sanation and drainage. In 1 (1,5%) case partial right bile duct injury was identified, defect suturing and Vishnevsky common bile duct drainage. In 2 (3,0%) cases the cause of BL was more than 2/3 diameter injury of common bile duct. These patients underwent Roux-en-Y hepaticojejunostomy. Conclusion. Installation of drainage into the hepatic space and the right flank provide early diagnosis of postoperative complications, one of which is bile flow syndrome. Ultrasound examination of abdominal organs and endoscopic retrograde cholangiopancretography are performed to determine the cause and localization of the syndrome of the BL syndrome, depending on the volume of the BL. Repeated laparoscopy is indicated for the phenomena of bile peritonitis, significant accumulation of bile in the abdominal cavity. The complex usage of relaparoscopy, transduodenal endoscopic interventions and puncture techniques can significantly reduce the number of laparotomy operations to correct complications.

scholarly journals ROLE OF EARLY LAPAROSCOPIC CHOLECYSTECTOMY IN PREVENTING COMPLICATIONS OF ACUTE CHOLECYSTITIS

2020 ◽  
pp. 1-3
Author(s):  
Mukesh Kumar ◽  
Sanjay Kumar Suman ◽  
Pawan Kumar Jha ◽  
Debarshi Jana
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Conservative Treatment ◽  
Common Bile Duct ◽  
Acute Cholecystitis ◽  
Common Bile Duct Stone ◽  
Bile Duct Stone ◽  
The Other ◽  
Study Results ◽  
Delayed Group

Background: Cholecystectomy is the standard and the only curative treatment for acutecholecystitis. The complications of acute cholecystitis are disastrous to the patients; on the other hand, conservative treatment is associated with recurrence of symptoms and other complications as common bile duct stone. The aim of this study is to weight out the complication of emergency surgery against the complications of conservative treatment in patients with acute cholecystitis. Materials andmethods: A total of 80 patients were included in the study. All Patients underwent early laparoscopiccholecystectomy or interval laparoscopic cholecystectomies for acute calcularcholecystitis from October 2017 to September 2019 were included in the study. Results: The overall complication rate was 15% (6 of 40 in early group and 10% (4 of 40) in the delayed group. One case of delayed group suffering recurrent acute attack and the other one suffering common bile duct stone, there was no major bile duct injury in the delayed group. Conclusion: Laparoscopic cholecystectomy is a safe and cost-effective approach for the treatment of acute cholecystitis within 72 h after the onset of attack.

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