Advantage and disadvantage of laparoscopic choledochal cyst excision

2018 ◽  
Vol 8 (2) ◽  
Author(s):  
Thanh Xuân Nguyễn
Keyword(s):  
Choledochal Cyst ◽  
Clinical Manifestations ◽  
Postoperative Outcome ◽  
Epidemiological Data ◽  
Postoperative Treatment ◽  
Biliary Leakage ◽  
Cyst Excision ◽  
Operation Duration ◽  
Tu 5 ◽  
High Level

Tóm tắt Đặt vấn đề: Đánh giá những thuận lợi và khó khăn trong phẫu thuật nội soi cắt nang ống mật chủ. Phương pháp nghiên cứu: Gồm 70 người bệnh nang ống mật chủ được chẩn đoán và điều trị bằng phẫu thuật nội soi tại Bệnh viện Trung ương Huế từ tháng1/2012 đến tháng 12/2017. Kết quả: Thuận lợi: Thời gian phẫu thuật trung bình (219,79 ± 64,88 phút) ngắn hơn so với thời gian phẫu thuật của nhiều nghiên cứu khác. Không có người bệnh tái khám sau mổ từ 10 ngày đến 3 tháng có đánh giá kết quả điều trị trung bình hoặc xấu. 94,1% người bệnh được rút dẫn lưu trong vòng 1 - 4 ngày sau mổ. 71,4% số người bệnh nằm viện sau mổ từ 5 - 10 ngày. Có 94,9% người bệnh hài lòng với kết quả điều trị sau mổ từ 10 ngày đến 3 tháng. Khó khăn: Có 5 trường hợp dò mật sau mổ trong đó 3 trường hợp theo dõi sau 5 ngày người bệnh ổn định, 2 trường hợp dò mật kéo dài phải mổ lại để làm lại miệng nối. Có 2 người bệnh phải truyền máu do kích thước nang lớn, dính nhiều tổ chức xung quanh và thời gian phẫu thuật kéo dài. Kết luận: Phẫu thuật nội soi trong điều trị cắt nang ống mật chủ là phương pháp an toàn, hiệu quả và khả thi ở các trung tâm y tế lớn, tuy nhiên đòi hỏi cao về kỹ năng của phẫu thuật viên, trình độ gây mê cũng như trang thiết bị phòng mổ. Abstract Introduction: Evaluating the advantage and disadvantage of the laparoscopic choledochal cyst excision. Material and Methods: We analysed 70 patients who were treated at the Hue Central Hospital from January 2012 to December 2017 with statistical analysis of epidemiological data, clinical manifestations, diagnosis, treatment and postoperative outcome. Results: Advantages: Average operation duration (219.79 ± 64.88 minutes) was shorter than typical intervention. Postoperative treatment results were evaluated from 10 days to 3 months after surgery: No average or bad result. 94.1% of patients were withdrawn drains within 1- 4 days after surgery. There were 71.4% of patients who hospitalized from 5 - 10 days postoperatively and 94.9% of patients were satisfied with the results. Disadvantages: 5 cases of postoperative biliary leakage were found, including 3 cases that were stabilized after 5 days of medical treatment and 2 cases requiring surgical intervention for prolonged anastomotic leakage. Blood transfusions were seen in 2 cases because the large size of the cyst, adherences to surrounding tissues and prolonged operation duration. Conclusion: Laparoscopic surgery for choledochal cyst resection is a safe and effective method. However, it requires a high level of anaesthesia and operating room equipment. Keyword: Laparoscopic choledochal cyst excision, Advantage and disadvantage.

scholarly journals Choledochal cyst in childhood: review of 30 cases

2014 ◽  
Vol 41 (5) ◽  
pp. 331-335 ◽  
Author(s):  
Danielle Nunes Forny ◽  
Saulo Marcos Rebello Ferrante ◽  
Vinícius Gomes da Silveira ◽  
Ivonete Siviero ◽  
Vera Lucia Antunes Chagas ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Choledochal Cyst ◽  
Clinical Manifestations ◽  
Epidemiological Data ◽  
Abdominal Ultrasound ◽  
Small Children ◽  
Bilioenteric Anastomosis ◽  
Classic Triad ◽  
Number Of Patients ◽  
Female Predominance

Objective: To analyze and discuss the clinical data, diagnosis and treatment of a number of patients with cystic dilatation of the common bile duct of a Brazilian pediatric hospital.Methods: We analyzed 30 patients treated at the Martagão Gesteira Institute of Pediatrics and Child Care of the Federal University of Rio de Janeiro for 23 years ,with statistical analysis of epidemiological data, clinical manifestations, diagnosis, treatment and postoperative outcome.Results: We observed a marked female predominance (73.4% of cases), the diagnosis being made in the first decade of life in 90% of patients. The most prevalent clinical manifestation was jaundice (70% of cases) and the classic triad of choledochal cyst was not observed. Abdominal ultrasound was the first imaging examination performed, with a sensitivity of 56.6%, with diagnostic definition in 17 children. Two patients (6.6%) had prenatal diagnosis. All patients underwent surgical treatment, cyst resection with Roux-en-Y hepaticojejunostomy being performed in 80% of cases. The incidence of postoperative complications was 13.3% and the mortality rate was 6.6%, ie two patients were diagnosed with Caroli's disease.Conclusion: The non-observance of the classic triad of choledochal cyst suggests that its incidence is lower than that reported in the medical literature. The surgical treatment of choledochal cysts, with resection and bilioenteric anastomosis, is safe even for small children.

OUTCOME OF THE LAPAROSCOPIC CHOLEDOCHAL CYST EXCISION

2017 ◽  
pp. 239-244
Author(s):  
Thanh Xuan Nguyen ◽  
Dinh khanh Le ◽  
Huu Thien Ho
Keyword(s):  
Bile Duct ◽  
Choledochal Cyst ◽  
Postoperative Treatment ◽  
High Tech ◽  
Type I ◽  
Duct Cyst ◽  
Drain Pipe ◽  
Cyst Excision ◽  
Bile Duct Cyst ◽  
Laparoscopic Excision

Objectives: To study the clinical and subclinical characteristics, and the treatment results of the laparoscopic choledochal cyst excision. Subjects and Methods: patients with bile duct cyst were diagnosed and treated by laparoscopic excision at the Hue Central Hospital from 6/2013 to 9/2017. Result: The common bile duct cyst was type I with highest ratio (90.77%), in which type Ic occupied the rate was 53.84%. The most common clinical manifestation was abdominal pain which occupied 87.69% of cases. The average time of opreation was 197.58 ± 46.57. Drain pipe was removed within 1-4 days after surgery. The average time of postoperative treatment was 8.7 ± 3.8 days. The rate of early complications after surgery was 3.07%. The rate of postoperative complications was 1.54%. Conclusion: Laparoscopic treatment of choledochal cyst is safe, feasible and efficient in medical high-tech center Key words: laparoscopic, bile duct cyst

scholarly journals Clinical significance of intrapancreatic choledochal cyst excision in surgical management of type I choledochal cyst

2018 ◽  
Vol 46 (3) ◽  
pp. 1221-1229 ◽  
Author(s):  
Fei Fan ◽  
Da-Peng Xu ◽  
Zheng-Xiang Xiong ◽  
Hai-Jia Li ◽  
Hai-Bei Xin ◽  
...  
Keyword(s):  
Surgical Management ◽  
Choledochal Cyst ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Post Treatment ◽  
Partial Resection ◽  
Biliary Duct ◽  
Type I ◽  
Cyst Excision ◽  
Associated Symptoms

Objective To investigate the effectiveness of intrapancreatic choledochal cyst excision in treating type I choledochal cyst, and increase understanding of the need for thorough surgical management of the disease. Methods Primary and secondary (including multiple) surgical cases, treated between 2005 and 2015, were retrospectively analysed, and follow-up data of post-treatment effectiveness to date were reviewed. Differences in curative effects were compared between whole and partial excision of the choledochal cyst. Results Out of 350 cases, patients with whole excision of the choledochal cyst ( n = 272) experienced no associated symptoms in the long-term (3/272 [1.1%] experienced stomach ache or fever). Patients with partial resection of the choledochal cyst ( n = 78) developed associated symptoms, including new cyst, calculus of the bile duct (51/78 [65.4%]), and carcinogenesis (11/78 [14.1%]) in the residual intrapancreatic biliary duct. Post-treatment clinical manifestations were significantly different between patients with partial resection versus whole excision of the choledochal cyst ( P<0.05). Conclusion Surgical re-excision should be considered in patients with a residual intrapancreatic portion of the choledochal cyst due to prior incomplete surgery, regardless of clinical symptoms.

Laparoscopic management of type VI choledochal cyst with common bile duct stone: report of a case and review of literature

2021 ◽  
Vol 14 (10) ◽  
pp. e244393
Author(s):  
G Revathi ◽  
Brijesh Kumar Singh ◽  
Yashwant Singh Rathore ◽  
Sunil Chumber
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Choledochal Cyst ◽  
Cystic Duct ◽  
Incidental Finding ◽  
Laparoscopic Approach ◽  
Biliary Colic ◽  
Type I ◽  
Laparoscopic Management ◽  
Cyst Excision

A young adult male presented with biliary colic and intermittent jaundice for 1 year. Abdomen findings were unremarkable. Routine investigations revealed a raised total bilirubin. On abdominal ultrasonography, common bile duct (CBD) dilatation with multiple stones was noted. On further imaging with magnetic resonance cholangiopancreatography, type I choledochal cyst (CDC) was suspected. A laparoscopic approach was planned. Intraoperatively, dilatation of cystic duct was noted which constitute type VI CDC. Partial malrotation of the gut and accessory right hepatic artery were also noted as incidental finding. Laparoscopic cholecystectomy with CBD exploration and removal of stones, biliary stent placement, cystic duct cyst excision and primary repair of CBD was done. Postoperatively, the patient improved symptomatically with a fall in bilirubin to normal range. We are describing the laparoscopic management of a rare case of type IV CDC which was diagnosed intraoperatively.

scholarly journals Laparoscopic treatment of congenital choledochal cyst and hepaticojejunostomy with extracorporeal Roux-en-Y anastomosis: technical aspects and early experience with three cases

2016 ◽  
Vol 38 (2) ◽  
Author(s):  
Mario Lima ◽  
Tommaso Gargano ◽  
Giovanni Ruggeri ◽  
Francesca Destro ◽  
Michela Maffi
Keyword(s):  
Choledochal Cyst ◽  
Laparoscopic Approach ◽  
Rare Condition ◽  
Early Experience ◽  
Cyst Excision ◽  
Intrahepatic Bile Ducts ◽  
First Case ◽  
Laparoscopic Excision ◽  
Extracorporeal Anastomosis ◽  
Laparoscopic Removal

Choledochal cyst (CDC) is a congenital dilatation of the extra and/or intrahepatic bile ducts and it is a rare condition in western countries. Classical treatment consists of cyst excision and hepaticojejunostomy. The first case of a laparoscopic CDC excision was described in 1995 and since that time an increasing number of institutions have adopted this technique, with good success. We describe our early experience of 3 cases of CDC treated with laparoscopic approach. We used a 10 mm umbilical port for the camera, and four 3-5 mm operative ports. We performed the laparoscopic removal of the cyst and gallbladder, videoassisted preparation of the Roux-en-Y loop and laparoscopic hepaticjejunostomy. No post-operative complications occurred. Laparoscopic excision of CDCs has been supposed to give better observation, a better cosmetic result, potentially less postoperative pain, and a shorter recovery. The main argument for performing an extracorporeal anastomosis is that it decreases the operative time. We recommend caution to prevent injury to the pancreatic duct and biliary structures during dissection and anastomosis. Lifelong surveillance is mandatory, even after resection of the choledochal cyst.

scholarly journals Prevalence of Chlorhexidine-Resistant Methicillin-Resistant Staphylococcus aureus following Prolonged Exposure

2014 ◽  
Vol 58 (8) ◽  
pp. 4404-4410 ◽  
Author(s):  
Carey D. Schlett ◽  
Eugene V. Millar ◽  
Katrina B. Crawford ◽  
Tianyuan Cui ◽  
Jeffrey B. Lanier ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Molecular Analysis ◽  
Prolonged Exposure ◽  
Controlled Trial ◽  
Epidemiological Data ◽  
Methicillin Resistant ◽  
Content Type ◽  
Mupirocin Resistance ◽  
High Level ◽  
Study Participants

ABSTRACTChlorhexidine has been increasingly utilized in outpatient settings to control methicillin-resistantStaphylococcus aureus(MRSA) outbreaks and as a component of programs for MRSA decolonization and prevention of skin and soft-tissue infections (SSTIs). The objective of this study was to determine the prevalence of chlorhexidine resistance in clinical and colonizing MRSA isolates obtained in the context of a community-based cluster-randomized controlled trial for SSTI prevention, during which 10,030 soldiers were issued chlorhexidine for body washing. We obtained epidemiological data on study participants and performed molecular analysis of MRSA isolates, including PCR assays for determinants of chlorhexidine resistance and high-level mupirocin resistance and pulsed-field gel electrophoresis (PFGE). During the study period, May 2010 to January 2012, we identified 720 MRSA isolates, of which 615 (85.4%) were available for molecular analysis, i.e., 341 clinical and 274 colonizing isolates. Overall, only 10 (1.6%) of 615 isolates were chlorhexidine resistant, including three from the chlorhexidine group and seven from nonchlorhexidine groups (P> 0.99). Five (1.5%) of the 341 clinical isolates and five (1.8%) of the 274 colonizing isolates harbored chlorhexidine resistance genes, and four (40%) of the 10 possessed genetic determinants for mupirocin resistance. All chlorhexidine-resistant isolates were USA300. The overall prevalence of chlorhexidine resistance in MRSA isolates obtained from our study participants was low. We found no association between extended chlorhexidine use and the prevalence of chlorhexidine-resistant MRSA isolates; however, continued surveillance is warranted, as this agent continues to be utilized for infection control and prevention efforts.

scholarly journals Cholangiocarcinoma Derived from Remnant Intrapancreatic Bile Duct Arising 32 Years after Congenital Choledochal Cyst Excision: A Case Report

2015 ◽  
Vol 8 (2) ◽  
pp. 265-273 ◽  
Author(s):  
Kentaro Ishikawa ◽  
Sadahisa Ogasawar ◽  
Tetsuhiro Chiba ◽  
Dai Sakamoto ◽  
Naoya Kanogawa ◽  
...  
Keyword(s):  
Case Report ◽  
Bile Duct ◽  
Choledochal Cyst ◽  
Congenital Choledochal Cyst ◽  
Cyst Excision ◽  
Intrapancreatic Bile Duct

scholarly journals Risk of Lyme disease development after a tick bite

2010 ◽  
Vol 67 (5) ◽  
pp. 369-374 ◽  
Author(s):  
Jovan Mladenovic ◽  
Radovan Cekanac ◽  
Novica Stajkovic ◽  
Milena Krstic
Keyword(s):  
Lyme Disease ◽  
Absolute Risk ◽  
Clinical Manifestations ◽  
Infectious Agent ◽  
Epidemiological Data ◽  
Relevant Information ◽  
Tick Bite ◽  
Healthcare Personnel ◽  
Tick Attachment ◽  
The Way

Background/Aim. Despite numerous research of Lyme disease (LD), there are still many concerns about environmental of infectious agent of LD, as well as its prophylaxis, diagnosis and treatment. The aim of this work was to determine the risk of LD in relation to the way of removing ticks and duration of tick attachment. Methods. In the period from 2000 to 2007 a prospective study was conducted including persons with tick bite referred to the Institute of Epidemiology, Military Medical Academy, and followed for the occurrence of early Lyme disease up to six months after a tick bite. Epidemiological questionnaire was used to collect relevant information about the place and time of tick bites, the way of a removing tick, duration of tick attachment, remnants of a tick left in the skin (parts of the mouth device) and the signs of clinical manifestations of LD. Duration of tick attachment was determined on the basis of size of engorged tick and epidemiological data. Removed ticks were determined by the key of Pomerancev. Professional removing of attached tick was considered to be removing of tick with mechanical means by healthcare personnel. Fisher's exact test, Chi squares test and calculation of the relative risk (RR) were used for data analysis. Results. Of 3 126 patients with tick bite, clinical manifestations of LD were demonstrated in 19 (0.61%). In the group of subjects (n = 829) in which a tick was not removed professionally there were 17 (2.05%) cases with LD, while in the group of respondents (n=2 297) in who a tick was removed professionally there were 2 (0.09%) cases with LD after tick bite (RR, 23.55; p < 0.0001). The disease was most frequent in the group of respondents with incompletely and unprofessionally removed ticks (2.46%). In the groups of patients with unprofessionally but completely removed ticks LD occurred in 0.89%, while in the group of subjects with a tick removed by an expert, but incompletely in 0.78% cases. The disease occurred rarely in the group with a tick removed completely and professionally (0.05%). There was no case of LD in the group of patients with a tick removed within 24 hours. The longer time of exposure after 24 hours, the higher absolute risk of disease was reported. Conclusion. In prevention of Lyme disease it is important to urgent remove a tick, to use a correct procedure of removing and to remove the whole tick without any remnants.

scholarly journals Expression of the apoptosis-releated genes in patients with newly diagnosed chronic lymphocytic leukemia in clinical data context

2018 ◽  
Vol 17 (2) ◽  
pp. 41-46 ◽  
Author(s):  
S. G. Zakharov ◽  
A. K. Golenkov ◽  
A. V. Misyurin ◽  
E. V. Kataeva ◽  
A. A. Rudakova ◽  
...  
Keyword(s):  
Gene Expression ◽  
Clinical Manifestations ◽  
Multivariate Regression Analysis ◽  
Lymphocytic Leukemia ◽  
Newly Diagnosed ◽  
Expression Of Genes ◽  
Gene Level ◽  
Genes Encoding ◽  
Group Ii ◽  
High Level

Introduction.The given data of fundamental studies of apoptosis processes in B-cell lymphocytic leukemia (B-CLL) testifies about the complexity and variety of mechanisms affecting the kinetics of normal cells and tumor lymphocytes in this disease. It is important to study the severity of clinical manifestations of the disease depending on the expression of the genes that modulate apoptosis.The purposeof the study is to compare the activity of genes encoding apoptosis modulators, the cell cycle and cancer-testicular PRAME protein with clinical manifestations of the disease in primary patients with B-CLL.Materials and methods.The level of expression of the proapoptotic genes FAS, TRAIL, TNFR2, DR4/5 and DR3, as well as the HSP27, XIAP genes, blocking apoptosis was determined in 23 patients with newly diagnosed chronic B-CLL. In addition, expression of genes TP53 and P21 and cancer-testis gene PRAME are tested.Results.According to the multivariate regression analysis, the FAS gene expression in the onset of the disease had the greatest impact on the clinical characteristics of the disease. In this connection, the patients were divided into groups with normal (group) and low gene level (group II). A low level of FAS expression (Me 387 %) was associated with stage II disease (p = 0.03), a large number of lympho cytes (p = 0.001), fewer erythrocytes (p = 0.08), and a lower level of TNFR2 gene expression (p = 0.08), high level of expression of XIAP, HSP27, P21. Overall, the anti-apoptotic potential in Group II patients was higher, which was accompanied by more pronounced clinical manifestations of the disease.Conclusions.The increased anti-apoptotic potential of tumor lymphocytes in newly diagnosed B-CLL is accompanied by a larger tumor mass and greater clinical and hematological manifestation of the disease.

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