scholarly journals DIAGNOSTICS AND SURGICAL TREATMENT OF POSTTRAUMATIC CICATRICIAL STRICTURES OF THE EXTRAHEPATIC BILE DUCTS

2021 ◽  
pp. 72-76
Author(s):  
A. D. Shatalov ◽  
V. V. Khatsko ◽  
S. A. Shatalov ◽  
D. M. Kosse ◽  
I. F. Polulyakh-Chоrnovol ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Bile Duct ◽  
Postoperative Complications ◽  
Bile Ducts ◽  
Hepatic Duct ◽  
Main Research ◽  
Iatrogenic Injuries ◽  
The Past ◽  
Reconstructive Operations ◽  
Extrahepatic Bile Ducts

Summary. The aim of the work is to improve the results of surgical treatment of iatrogenic injuries of the extrahepatic bile ducts. Materials and methods. The experience of treating 362 patients with iatrogenic injuries of the extrahepatic bile ducts, obtained mainly in other hospitals over the past 18 years, is presented. In the clinic, these patients are reoperated. Among them were 258 (71.3 %) women and 104 (28,7 %) men aged 20 to 80 years. Results and discussion.Damage and stricture of the bile duct were noted during laparotomic (299) and laparoscopic (63) cholecystectomy. Damage to the hepatic duct was seen in 235 patients, choledochus — in 127. The main research methods were: percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography, fistulocholangiography. In the clinic, all 362 patients were operated. In 47 of them were performed restorative operations, and in 315 of them were performed reconstructive ones. At the first stage (until 2004), restorative and reconstructive operations (with transhepatic frame drainage) were used more often. At the 2nd stage (since 2005), the operation of choice was a high hepaticoduodenostomy in 2 modified versions. Over the past 7 years, the number of postoperative complications has been reduced by 8,3 %, mortality from 6,8 to 1,5 %. Conclusions. The operation of choice in case of complete damage to the bile duct is the formation of a high hepaticojejunoanastomosis according to our modified methods. Reconstructive operations are indicated only in case of partial damage to the bile duct. A multidisciplinary approach to the correction of duct damage is advisable, which should be carried out in specialized surgical hepatological centers. The use of modified methods of reconstructive surgery contributed to a decrease in postoperative complications by 8,3 % and mortality by 5,3 % (95 % CI, p <0.05).

scholarly journals Proximal Extrahepatic Bile Ducts: Comprehensive Review

2021 ◽  
Vol 4 (1) ◽  
pp. 74-93
Author(s):  
M. A. Shorikov ◽  
O. N. Sergeeva ◽  
M. G. Lapteva ◽  
N. A. Peregudov ◽  
B. I. Dolgushin
Keyword(s):  
Bile Duct ◽  
Bile Flow ◽  
Bile Ducts ◽  
Extrahepatic Bile Duct ◽  
Hepatic Duct ◽  
Biliary Tree ◽  
Comprehensive Review ◽  
Extrahepatic Bile Ducts ◽  
And Function ◽  
Variant Anatomy

Proximal extrahepatic bile ducts are the biliary tree segment within formal boundaries from cystic ductcommon hepatic duct junction to sectoral hepatic ducts. Despite being a focus of attention of diagnostic and interventional radiologists, endoscopists, hepatobiliary surgeons and transplantologists they weren’t comprehensively described in available papers. The majority of the authors regard bile duct confluence as a group of merging primitively arranged tubes providing bile flow. The information on the proximal extrahepatic bile duct embryonal development, variant anatomy, innervation, arterial, venous and lymphatic supply is too general and not detailed. The present review brought together and systemized exiting to the date data on anatomy and function of this biliary tract portion. Unique, different from the majority of hollow organs organization of the proximal extrahepatic bile duct adapts them to the flow of the bile, i.e. viscous aggressive due to pH about 8.0 and detergents fluid, under higher wall pressure than in other parts of biliary tree. 

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 Cystic form of biliary atresia. Treatment experience

2020 ◽  
Vol 10 (1) ◽  
pp. 17-24
Author(s):  
Irina I. Borisova ◽  
Anatoliy V. Kagan ◽  
Svetlana A. Karavaeva ◽  
Aleksey N. Kotin
Keyword(s):  
Surgical Treatment ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Biliary Atresia ◽  
Bile Ducts ◽  
Surgical Intervention ◽  
Ultrasound Examination ◽  
Duct Cyst ◽  
Cystic Form ◽  
The Common

Background. The cystic form of biliary atresia is a rare form of atresia of the biliary tract, which is a relatively favorable variant of the defect and can be diagnosed antenatally. In practice, it is important not only to suspect this diagnosis, but also to differentiate this variant of impaired development of the external bile duct from the cyst of the common bile duct. This is due to the difference in approaches and methods of surgical treatment of choledochal cysts and biliary atresia. Obliteration (atresia) of the bile ducts in the absence of timely surgical intervention quickly leads to the progression of cirrhosis and the development of liver failure. The method of choice in the treatment of AD is Kasai surgery, often palliative in nature, but allowing to delay the time until liver transplantation. The cyst of the common bile duct rarely requires early surgical treatment, and the risk of cirrhosis is significantly lower. Surgical intervention is aimed at removing the cyst and restoring the flow of bile by anastomosing the external bile ducts with the intestines, which is a radical method of treatment and leads to the recovery of the child. External similarity in ultrasound examination of the fetus and newborn baby of the cystic form of biliary atresia of the bile ducts with a cyst of the common bile duct does not always allow differentiation of one defect from another, which can lead to untimely correction of the defect and an unfavorable outcome. Aim. Demonstrate a rare type of biliary atresia. Materials and methods. Between 2001 and 2019, 33 patients with biliary atresia were treated in the Childrens City Multidisciplinary Clinical Specialized Center for High Medical Technologies in St. Petersburg, only two patients had a cystic form. Both children were initially treated as patients with bile duct cyst. Children were operated on at the age of 2 and 3.5 months. The first patient underwent surgery Kasai, the second hepaticoyunoanastomosis. Results. During the observation period (9 years and 4 years), the synthetic function of the liver is normal, and there are currently no indications for transplantation. Conclusion. If a fetus or a newborn with neonatal jaundice is detected during ultrasound examination of a cystic formation in the gates of the liver, it is very important to correctly and quickly make a differential diagnosis between the cystic form of biliary atresia of the biliary tract and the common bile duct cyst.

Biliary Atresia

1989 ◽  
Vol 11 (2) ◽  
pp. 57-62
Author(s):  
Elizabeth A. Wanek ◽  
Frederick M. Karrer ◽  
Carlos T. Brandt ◽  
John R. Lilly
Keyword(s):  
Biliary Atresia ◽  
Biliary Obstruction ◽  
Bile Flow ◽  
Bile Ducts ◽  
Current Treatment ◽  
Histopathologic Examination ◽  
The Past ◽  
The World ◽  
Hepatic Portoenterostomy ◽  
Extrahepatic Bile Ducts

Biliary atresia is a pathologic entity in which there is obliteration of some portion of the extrahepatic bile ducts. In the past, occlusion of the proximal ducts (at the liver hilus) was referred to as "noncorrectable" (Fig 1). If only the distal duct is occluded (and the proximal duct is patent), the lesion was referred to as "correctable." The distinction is academic because current treatment and prognosis are identical. The disease is panductular, ie, both extrahepatic and intrahepatic ducts are involved. Early in the disease, however, occlusion is complete only in the extrahepatic system. Without intervention, intrahepatic biliary obstruction and, subsequently, cirrhosis supervene. In the past, except for a few cases of the correctable variant, surgical procedures were unsuccessful until Morio Kasai performed a hepatic portoenterostomy, which was first reported in English in 1968. Bile flow was effectively reestablished in both correctable and noncorrectable forms of biliary atresia. The operation was only successful when done before the patient was 4 months of age. Subsequent confirmation of Kasai's results were reported throughout the world. ETIOLOGY/PATHOLOGY Biliary atresia was originally thought to be a congenital malformation. Careful histopathologic examination of excised surgical specimens indicate that this is not the case; instead, the disease is a dynamic, progressive panductular sclerotic process that may continue in the intrahepatic ducts even after surgical relief of biliary obstruction.

scholarly journals Multiple Biliary Papillomatosis

HPB Surgery ◽  
1992 ◽  
Vol 6 (2) ◽  
pp. 125-128 ◽  
Author(s):  
Mustafa Tireli ◽  
Adam Uslu
Keyword(s):  
Bile Duct ◽  
Obstructive Jaundice ◽  
Bile Ducts ◽  
Malignant Potential ◽  
Low Grade ◽  
Biliary Papillomatosis ◽  
Extrahepatic Bile Ducts

Diffuse biliary papillomatosis is a rare bile duct tumour. We report a case of multiple biliary papillomatosis treated surgically with a transhepatic stent.Diffuse biliary papillomatosis involving intra and extrahepatic bile ducts is extremely rare. It is regarded as having low grade malignant potential. In this report a case of diffuse biliary papillomatosis with obstructive jaundice is presented.

scholarly journals Results of laparoscopic for the management of bile duct stones

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Quoc Phong Le ◽  
Keyword(s):  
Bile Duct ◽  
Postoperative Complications ◽  
Bile Ducts ◽  
Clinical Characteristics ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Bile Duct Stones ◽  
Stone Clearance ◽  
Open Conversion ◽  
Laparoscopic Choledochotomy

Abstract Introduction: To describe clinical and para-clinical characteristics of bile duct stones and results of laparoscopic choledochotomies in management of bile duct stones. Materials and methods: Retrospective and prospective study in 152 bile duct stones patient, who underwent laparoscopic choledochotomy with or without usage of flexible bile ducts scope and electrohydraulic technique, from January 2009 to May 2019 at Hue Central Hospital. Results: Mean age 54,2 (22 - 84), 66 male and 86 female, mean operative time: 135 minutes (90 - 235), intraoperative complications: 3,29%, open conversion: 5,92%. Complete stone clearance was achieved in 91,6% patients. Postoperative complications: 7,69%. Conclusions: Managementofbileductstonesbylaparoscopiccholedochotomy is safe and effective with high percentage of stones clearence, as well as low intraoperative and postoperative complications. This procedure can achieve good results if bile ducts scope and electrohydraulic technique were concomitantly applied.

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