Result of cholangioscopic electrohydraulic lithotripsy through a percutaneous T-tube for hepatolithiasis at Military Hospital 103

Abstract Bacground: Hepatolithiasis is common in Vietnam. Percutaneous endoscopic electrohydraulic lithotripsy (EHL) is a method of choice for treatment of hepatolithiasis. This study evaluates 10 years of experience using a flexible fiber-optic choledochoscopic to assist in the fragmentation of hepatolithiasis by EHL. Patients and methods: 854 patients with hepatolithiasis were performed percutaneous EHL through T-tube from January 2010 to January 2020 at Military Hospital 103. Patients’demographic, operative and follow-up data after perfoming EHL were retrospectively and prospectively collected for analysis. Results: After EHL, the fragmentation rate was 100% and the complete clearance of stone was 86.53%. The average number of EHL session/patient was 1.79 ± 1.13. Post- EHL complications rate was 9.1%. During long-term follow-up evaluation, recurrent stones accounted for 10.1%. Conclusions: Cholangioscopic electrohydraulic lithotripsy through a percutaneous T-tube for hepatolithiasis was an effective and safe therapy. Key word: Percutaneous endoscopy, EHL, flexible fiber-optic choledochoscopy, hepatolithiasis. Tóm tắt Đặt vấn đề: Sỏi trong gan là một bệnh lý phổ biến ở Việt Nam, gây nhiều biến chứng phức tạp. Nội soi tán sỏi bằng điện thủy lực (Electrohydraulic lithotripsy- EHL) là một phương pháp xâm nhập tối thiểu được lựa chọn để điều trị sỏi trong gan. Nghiên cứu này đánh giá 10 năm kết quả sử dụng hệ thống nội soi ống mềm để điều trị sỏi trong gan bằng EHL qua đường hầm dẫn lưu Kehr. Đối tượng và phương pháp nghiên cứu: Mô tả cắt ngang, hồi cứu kết hợp tiến cứu, không đối chứng trên 854 người bệnh (NB) sỏi đường mật được nội soi tán sỏi bằng điện thủy lực qua đường hầm dẫn lưu Kehr, từ tháng 01 năm 2010 đến tháng 01 năm 2020 tại bệnh viện Quân Y 103. Kết quả: Sau khi thực hiện EHL, 100% NB đều tán được sỏi trong gan. Khả năng tiếp cận sỏi bằng nội soi ống mềm đạt 73,19%; tỷ lệ sạch sỏi 86,53%; sót sỏi 13,47%. Số lần tán sỏi trung bình trên 1 NB là 1,79 ± 1,13 lần; Tỷ lệ biến chứng sau EHL là 9,13%. Trong quá trình theo dõi lâu dài, tỷ lệ sỏi tái phát là 10,11%. Kết luận: Nội soi tán sỏi qua đường hầm dẫn lưu Kehr bằng điện thủy lực là một phương pháp an toàn và hiệu quả để điều trị sỏi trong gan. Từ khóa: Nội soi tán sỏi,EHL, nội soi ống mềm, sỏi trong gan.

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Long-Term Follow-up Study of Biliary Reconstructions and Complications After Adult Living Donor Liver Transplantation: Feasibility of Duct-to-Duct Reconstruction With a T-Tube Stent

Transplantation Proceedings ◽

10.1016/j.transproceed.2008.10.039 ◽

2009 ◽

Vol 41 (1) ◽

pp. 265-267 ◽

Cited By ~ 6

Author(s):

T. Kobayashi ◽

Y. Sato ◽

S. Yamamoto ◽

H. Oya ◽

Y. Hara ◽

...

Keyword(s):

Liver Transplantation ◽

Living Donor ◽

Living Donor Liver Transplantation ◽

Donor Liver ◽

Donor Liver Transplantation ◽

T Tube ◽

Follow Up Study ◽

Long Term Follow Up

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

10.21203/rs.3.rs-18548/v1 ◽

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.

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Results of Medium Seventeen Years’ Follow-Up after Laparoscopic Choledochotomy for Ductal Stones

Gastroenterology Research and Practice ◽

10.1155/2016/9506406 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Silvia Quaresima ◽

Andrea Balla ◽

Mario Guerrieri ◽

Giovanni Lezoche ◽

Roberto Campagnacci ◽

...

Keyword(s):

Biliary Drainage ◽

Abdominal Ultrasound ◽

Endoscopic Retrograde ◽

T Tube ◽

Laparoscopic Choledochotomy ◽

Long Term Follow Up ◽

Correct Technique ◽

Lost To Follow Up

Introduction. In a previously published article the authors reported the long-term follow-up results in 138 consecutive patients with gallstones and common bile duct (CBD) stones who underwent laparoscopic transverse choledochotomy (TC) with T-tube biliary drainage and laparoscopic cholecystectomy (LC). Aim of this study is to evaluate the results at up to 23 years of follow-up in the same series.Methods. One hundred twenty-one patients are the object of the present study. Patients were evaluated by clinical visit, blood assay, and abdominal ultrasound. Symptomatic patients underwent cholangio-MRI, followed by endoscopic retrograde cholangiopancreatography (ERCP) as required.Results. Out of 121 patients, 61 elderly patients died from unrelated causes. Fourteen patients were lost to follow-up. In the 46 remaining patients, ductal stone recurrence occurred in one case (2,1%) successfully managed by ERCP with endoscopic sphincterotomy. At a mean follow-up of 17.1 years no other patients showed signs of bile stasis and no patient showed any imaging evidence of CBD stricture at the site of choledochotomy.Conclusions. Laparoscopic transverse choledochotomy with routine T-tube biliary drainage during LC has proven to be safe and effective at up to 23 years of follow-up, with no evidence of CBD stricture when the procedure is performed with a correct technique.

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Biliary stone extraction through T-tube tract using flexible fiberoptic choledochoscope

Vietnam Journal of Endolaparoscopic Surgery ◽

10.51199/vjsel.2019.2.1 ◽

2019 ◽

Vol 9 (2) ◽

Author(s):

Quan Anh Tuấn Lê

Keyword(s):

Clearance Rate ◽

Fiber Optic ◽

Biliary Strictures ◽

Stone Extraction ◽

Biliary Stones ◽

Biliary Stone ◽

T Tube ◽

Electrohydraulic Lithotripsy ◽

Flexible Fiber ◽

The Mean

Tóm tắt Đặt vấn đề: Còn sỏi sau mổ sỏi đường mật là một vấn đề thường gặp và là một vấn đề khó khăn đối với các phẫu thuật viên gan mật. Mục tiêu: Đánh giá hiệu quả của lấy sỏi mật qua đường hầm ống Kehr với ống soi mềm, kết hợp tán sỏi điện thủy lực. Phương pháp nghiên cứu: Nghiên cứu can thiệp, tiến cứu, không nhóm chứng. Chúng tôi sử dụng ống soi mềm đường mật 5mm, kết hợp với tán sỏi điện thủy lực. Kết quả: Từ tháng 01 năm 2010 đến tháng 01 năm 2013, chúng tôi thực hiện trên 164 bệnh nhân. Tuổi trung bình là 50. Tất cả các trường hợp (TH) đều có sỏi trong gan. Trong đó có 63 bệnh nhân có sỏi ống mật chủ kèm theo. Số lần lấy sỏi trung bình là 4,5 lần (từ 1 đến 10 lần). Có 139 TH (84,8%) phải tán sỏi điện thủy lực vì sỏi to hay dính chặt vào đường mật. Tỉ lệ hết sỏi sau khi lấy qua đường hầm ống Kehr trên cả 3 phương tiện bao gồm nội soi đường mật, siêu âm và X quang sau mổ là 90,9%. Nguyên nhân không lấy hết sỏi do đường mật nhỏ, gập góc hay có hẹp đường mật. Tỉ lệ hẹp đường mật là 34,8% (57 TH). Không có tai biến và biến chứng nặng. Thời gian nằm viện trung bình là 10 ngày. Kết luận: Lấy sỏi mật qua đường hầm ống Kehr kết hợp với tán sỏi điện thủy lực là cách giải quyết sỏi sót và sỏi đường mật trong gan rất hiệu quả và an toàn với tỉ lệ hết sỏi cao và không có biến chứng nặng. Đây là phương pháp tối ưu cho những bệnh nhân còn sỏi sau mổ có mang ống Kehr. Abstract Introduction: Retained biliary stones remain a common clinical problem in patients after surgery and a challenge for hepatobiliary surgeons. Objectives: The aim of this study is to evaluate the efficacy of biliary stone extraction via T-tube tract using a flexible fiber optic choledochoscope and electrohydraulic lithotripsy. Material and Methods: This is a prospective, interventional case series study. A 5mm flexible fiber optic choledochoscope was used in accompanied with electrohydraulic lithotripsy. Results: From January 2010 to January 2013, there were 164 included in this study. The mean age was 50. All of the patients had intrahepatic stones. Among them, 63 patients had common bile duct stones. Stone extractions on average were 4.5 (from 1 to 10 times). Electrohydraulic lithotripsy was necessary in 139 patients (84.8%) because of large or impacted stones. Complete clearance rate was 90.9% consisting of cholagioscopic, ultrasonographic and cholangioghaphic clearances. The most common factors related to failure of stone extraction are small associated with angulated intrahepatic bile ducts and biliary strictures. Biliary strictures were noticed in 57 patients (34.8%). There were no major accidents and complications. The mean hospital stay was 10 days. Conclusion: Biliary stone extraction via T-tube tract with electrohydraulic lithotripsy is a safe and efficient procedure for retained biliary stones and intra-hepatic stones with a high complete clearance rate and no major complications. This is the method of choice for treatment of retained biliary stones in patients with a T-tube in situ. Keywords: Biliary stone extraction, T tube tract.

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Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

Behavioral and Brain Sciences ◽

10.1017/s0140525x1800105x ◽

2019 ◽

Vol 42 ◽

Cited By ~ 2

Author(s):

John P. A. Ioannidis

Keyword(s):

Mental Health ◽

Mental Disease ◽

Brain Disorders ◽

Social Stressors ◽

Labor Education ◽

Mental Diseases ◽

Long Term Follow Up ◽

Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

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