scholarly journals An Artificial Bile Duct Made of Bioabsorbable Polymer: A Viable Substitute for Narrowed Portion of the Extrahepatic Bile Duct

2015 ◽  
Vol 100 (11-12) ◽  
pp. 1408-1413 ◽  
Author(s):  
Mitsuo Miyazawa ◽  
Masayasu Aikawa ◽  
Katsuya Okada ◽  
Yukihiro Watanabe ◽  
Kojun Okamoto ◽  
...  
Keyword(s):  
Bile Duct ◽  
General Anesthesia ◽  
Polylactic Acid ◽  
Cystic Duct ◽  
Total Bilirubin ◽  
Extrahepatic Bile Duct ◽  
Bioabsorbable Polymer ◽  
Anastomosis Site ◽  
Chemical Studies ◽  
Post Implantation

The aim of this study was to investigate whether an artificial bile duct made of bioabsorbable polymer could serve as a substitute for narrowed portions of the bile duct. The experiments were performed using hybrid pigs (n = 11). After laparotomy under general anesthesia, the extrahepatic bile duct was identified and ligated around the confluence with the cystic duct. A week later, repeat laparotomy was performed on the animals, and the bile duct on the hepatic side of the ligature was resected. The cut end was connected to the duodenum using a bioabsorbable artificial bile duct fabricated from a copolymer of polycaprolactone and polylactic acid fibers. The grafts were recovered for gross, histologic, and blood chemical studies at 4 months after the surgery. All recipient pigs survived until they were humanely killed for collection of the implants. A week of ligation of the extrahepatic bile duct dilated the duct to approximately 1 cm in diameter and increased total bilirubin. Total bilirubin had returned to the pre-implantation level in all animals at 4 months post implantation. Examinations of the grafts revealed complete freedom of stricture and the regeneration of a neo-bile duct of approximately 1 cm in diameter from the graft site in 10 of 11 animals. Gross observation of the graft from the 1 remaining animal revealed stricture at the anastomosis site and poor bile duct epithelization. We have concluded that this bioabsorbable polymer bile duct can serve as a replacement for narrowed portions of the bile duct.

AN ARTIFICIAL BILE DUCT MADE OF BIOABSORBABLE POLYMER CAN SERVE AS A SUBSTITUTE FOR NARROWED PORTIONS OF THE EXTRAHEPATIC BILE DUCT

2008 ◽  
Vol 86 (Supplement) ◽  
pp. 47
Author(s):  
M Miyazawa ◽  
M Aikawa ◽  
Y Toshimitsu ◽  
K Okada ◽  
K Okamoto ◽  
...  
Keyword(s):  
Bile Duct ◽  
Extrahepatic Bile Duct ◽  
Bioabsorbable Polymer

scholarly journals Case Report: Isolated Cystic Dilatation of the Cystic Duct: A Misdiagnosed Case Preoperatively

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiankang Zhang ◽  
Zeming Hu ◽  
Xuan Lin ◽  
Dongliang Zhang ◽  
Hao Wang ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Choledochal Cyst ◽  
Cystic Duct ◽  
Extrahepatic Bile Duct ◽  
Cystic Dilatation ◽  
Liver Transaminase ◽  
Caudal Portion ◽  
The Common

A 33-year-old female with a mild elevation of liver transaminase was sent to the general surgery department for medical services due to upper-right abdominal pain for 2 weeks. A liquid dark area ~4 × 3 × 3 cm in size in the theoretical location of the pancreatic segment of the common bile duct was detected by abdominal CT with no enhancement of the cystic wall found in the enhanced CT scan. The patient was then diagnosed with a choledochal cyst based on the results of the radiological images preoperatively. During the operation, the isolated cystic dilatation was found in the middle part of the cystic duct, and its caudal portion was found behind the head of the pancreas and converged into the common bile duct at an acute angle and low insertion. According to the intraoperative evaluation, the female was then diagnosed with a cystic duct cyst (CDC). The surgery was converted to a laparotomy for the unclear structure and the possibility of anatomic variation of the bile duct. The caudal portion of the cystic duct was found communicated with the common bile duct with a narrow base, and the extrahepatic bile duct was not cystic. The CDC was removed in the surgery. One week later, the patient was discharged from the hospital for the disappearance of abdominal pain and normal liver transaminase and did not report any discomfort in the 1-month-long follow-up. The lessons drawn from this case were as follows: (1) the distinction between the relatively frequent choledochal cyst and the isolated CDC should always be taken in mind; (2) a surgical strategy should be given priority for an intraoperatively confirmed CDC; (3) a common bile duct exploration is recommended for patients with choledocholithiasis or jaundice.

scholarly journals Morphological expression of the extrahepatic bile duct. A study in a sample of Colombian mestizo population

10.3823/2585 ◽  
2018 ◽  
Vol 11 ◽  
Author(s):  
Bladimir Saldarriaga Tellez ◽  
Edgar Giovanni Corzo Gomez ◽  
Pedro Luis Forero Porras ◽  
Luis Ernesto Ballesteros Acuña
Keyword(s):  
Bile Duct ◽  
Cystic Duct ◽  
Extrahepatic Bile Duct ◽  
Hepatic Duct ◽  
Descriptive Study ◽  
Great Variability ◽  
Common Hepatic Duct ◽  
Medium Length ◽  
Three Samples ◽  
Morphological Expression

  Background: The great variability of the extrahepatic bile duct (EBD) has clinical-surgical implications. The objective of this study was to characterize the morphological expressions of EBD. Methods and findings This descriptive study, done by injecting a semi-synthetic (Palatal GP40L 85%; styrene 15%) impregnated with mineral green dye into the gallbladder, to determine the anatomical characteristics and the biometrics of EBD in 33 blocks formed from the supra-mesocolic floor.The gallbladder presented a length of 66.9 ± 1.7 mm. The Hartmann´s Pouch was observed in 16 specimens (50%). The lengths of the cystic duct (CD), common hepatic duct (CHD) and common bile duct (choledoch duct) were 27.8 ± 1.6 mm, 28.6 ± 11.39 mm and 60.6 ± 11.6 mm respectively. The presence of accessory hepatic ducts (AHD) was found in three samples (9.1%). In 29 specimens  (87.9%) the cystic duct  presented medium length, while in 4 cases (12.1%) the CD was long (P < 0, 05). The trajectory of the lateral oblique of CD was present in 23 cases (69.7%), with statistically significant differences in relation to the other trajectories of the CD (P <0, 05). In 18 samples (55%) the cystic-hepatic union appeared at the level of the middle third of the EBD, while in 15 (45%) cases the union of the CD was low (P<0,05). Conclusions The mathematical distribution of the segments of the EBD, carried out in this study, provides reliability to the assessment of the cystic-hepatic junction level. The presence of CHA and the level of the cysto-hepatic junction are important anatomical references, especially in emergency room procedures.

scholarly journals Spread of Intraductal Papillary Neoplasm Arising from the Cystic Duct of the Biliary Tree

2016 ◽  
Vol 10 (1) ◽  
pp. 7-16 ◽  
Author(s):  
Yoshihiko Kadowaki ◽  
Yuki Yokota ◽  
Satoshi Komoto ◽  
Nobuhito Kubota ◽  
Takahiro Okamoto ◽  
...  
Keyword(s):  
Bile Duct ◽  
Cystic Duct ◽  
Extrahepatic Bile Duct ◽  
Bile Duct Carcinoma ◽  
Biliary Tree ◽  
Duct Carcinoma ◽  
Intraductal Growth ◽  
Intraductal Papillary Neoplasm ◽  
Extrahepatic Bile Duct Resection ◽  
Papillary Neoplasm

Intraductal papillary neoplasm of the bile duct (IPNB) is a variant type of the bile duct carcinoma characterized by intraductal growth. IPNB is also recognized as a precursor of invasive carcinoma. We describe herein an extremely rare case of IPNB arising from the cystic duct. A 68-year-old man was admitted to our hospital for investigation of epigastralgia and abnormal levels of biliary tract enzyme. Computed tomography and magnetic resonance imaging showed a mass lesion spreading from the cystic duct to the upper-middle bile duct. Endoscopic retrograde cholangiography demonstrated diffuse duct dilation with a grossly visible intraductal mass and amorphous blobs, suggesting the presence of mucobilia or scattered tumors. We performed extrahepatic bile duct resection with lymphadenectomy. Macroscopically, a friable papillary tumor originated from the cystic duct grows intraluminally into the bile duct. Pathologically, the tumor was found to be intramucosal adenocarcinoma spreading to the whole extrahepatic bile duct, which was compatible with IPNB. We should discuss the features and progression processes of IPNB through this precious case.

Analysis of patterns of failure and prognostic factors in resected extrahepatic bile duct cancer: Implications for postoperative adjuvant radiotherapy.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 266-266
Author(s):  
Jae-Sung Kim ◽  
Tae Ryool Koo
Keyword(s):  
Prognostic Factors ◽  
Bile Duct ◽  
Cystic Duct ◽  
Bile Duct Cancer ◽  
Adjuvant Radiotherapy ◽  
Extrahepatic Bile Duct ◽  
Patterns Of Failure ◽  
Extrahepatic Bile Duct Cancer ◽  
Tumor Bed ◽  
Duct Cancer

266 Background: This study is aimed to analyze the patterns of failure and evaluate the prognostic factors in the patients with extrahepatic bile duct cancer (EBDC) for the potential role of postoperative adjuvant radiotherapy (PORT). Methods: We retrospectively reviewed the medical records of 106 patients with EBDC who received curative intent surgical resection. The definitions of tumor location were as follows: proximal EBDC (n = 29) from the confluent portion of the bilateral hepatic bile ducts to the junction of cystic duct, and distal EBDC (n = 77) from the junction of cystic duct to intrapancreatic portion. Nine patients underwent adjuvant chemoradiotherapy or chemotherapy. Results: The median follow-up time was 24 months for the surviving patients. Forty patients experienced locoregional failure (LRF) initially; 13 (45%) with proximal EBDC and 27 (35%) with distal EBDC. The hepatoduodenal ligament (HL) and tumor bed were the most common LRF sites. Distant metastasis (DM) occurred in 10 patients (34%) with proximal EBDC and 15 patients (19%) with distal EBDC. The liver was the most common organ of DM. In the multivariate analysis, perineural invasion (PNI) and postoperative high carbohydrate antigen (CA) 19-9 were associated with poor LRPFS. Conclusions: Both proximal and distal EBDC showed remarkable proportion of LRF. Because the HL and tumor bed are where routinely covered by PORT, it can be speculated that the addition of PORT can improve LRPFS in these patients. Especially PORT needs to be considered in patients with PNI and postoperative high CA 19-9 to improve locoregional control.

Cystic duct remnant carcinoma with widespread invasion along the extrahepatic bile duct wall: dynamic CT findings

2003 ◽  
Vol 28 (1) ◽  
pp. 79-82 ◽  
Author(s):  
T. Gabata ◽  
O. Matsui ◽  
J. Sanada ◽  
M. Kadoya ◽  
K. Ohmura ◽  
...  
Keyword(s):  
Bile Duct ◽  
Cystic Duct ◽  
Extrahepatic Bile Duct ◽  
Dynamic Ct ◽  
Bile Duct Wall ◽  
Ct Findings ◽  
Duct Wall

scholarly journals An artificial bile duct made of bioabsorbable polymer: a viable substitute for narrowed portion of the extrahepatic bile duct

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e524
Author(s):  
M. Miyazawa ◽  
M. Aikawa ◽  
K. Okada ◽  
Y. Watanabe ◽  
K. Ikamoto
Keyword(s):  
Bile Duct ◽  
Extrahepatic Bile Duct ◽  
Bioabsorbable Polymer

Postoperative Liver Failure Criteria for Predicting Mortality after Major Hepatectomy with Extrahepatic Bile Duct Resection

2018 ◽  
Vol 36 (2) ◽  
pp. 158-165 ◽  
Author(s):  
Takeshi Kawamura ◽  
Takehiro Noji ◽  
Keisuke Okamura ◽  
Kimitaka Tanaka ◽  
Yoshitsugu Nakanishi ◽  
...  
Keyword(s):  
Bile Duct ◽  
Liver Failure ◽  
Total Bilirubin ◽  
Major Hepatectomy ◽  
Extrahepatic Bile Duct ◽  
Study Cohort ◽  
Bile Duct Resection ◽  
Predictive Values ◽  
Extrahepatic Bile Duct Resection ◽  
Related Mortality

Background: Post-hepatectomy liver failure (PHLF) is a serious complication after major hepatectomy with extrahepatic bile duct resection (Hx with EBDR) that may cause severe morbidity and even death. The purpose of this study was to compare several criteria systems as predictors of PHLF-related mortality following Hx with EBDR for perihilar cholangiocarcinoma (PHCC). Methods: The study cohort consisted of 222 patients who underwent Hx with EBDR for PHCC. We compared several criteria systems, including previously established criteria (the International Study Group of Liver Surgery (ISGLS) criterion; and the “50-50” criterion), and our institution’s novel systems “Max T-Bili” defined as total bilirubin (T-Bili) >7.3 mg/dL during post-operative days (POD) 1–7, and the “3-4-50” criterion, defined as total bilirubin >4 mg/dL and prothrombin time <50% on POD #3. Results: Thirteen patients (5.8%) died from PHLF-related causes. The 3-4-50 criterion showed high positive predictive values (39.1%), the 3-4-50, Max T-Bili, and 50-50 criterion showed high accuracies (91.7, 86.9, and 90.5%, respectively) and varying sensitivities (69.2, 69.2, and 38.5% respectively). Conclusions: The 3-4-50, Max T-Bili, and 50-50 criterion were all useful for predicting PHLF-related mortality after Hx with EBDR for PHCC.

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