Mirizzi syndrome is a rare complication of gallbladder disease that can be difficult to treat. In particular, endoscopic treatment often fails because of the inability to access or to capture the impacted cystic duct stone. We report a case of Mirizzi syndrome grade III that was successfully managed by digital single-operator peroral cholangioscopy-guided electrohydraulic lithotripsy with endoscopic nasogallbladder drainage and interval laparoscopic cholecystectomy. Based on our experience, digital single-operator peroral cholangioscopy-guided electrohydraulic lithotripsy with endoscopic nasogallbladder drainage is a feasible minimally invasive approach for the management of high-grade Mirizzi syndrome.
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Difficult Biliary Stones: A Comprehensive Review of New and Old Lithotripsy Techniques Edoardo Troncone, Michelangela Mossa, Pasquale De Vico, Giovanni Monteleone, Giovanna Del Vecchio Blanco Medicina.2022; 58(1): 120. CrossRef
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Background /Aims: Bile leak is a common complication of cholecystectomy, and it is also observed in other conditions such as ruptured liver abscess, hydatid cyst, and trauma. Endoscopic retrograde cholangiopancreatography (ERCP) is the first-line management for such conditions. However, studies on the outcomes of endoscopic management for bile leaks with etiologies other than post-cholecystectomy injury are extremely limited.
Methods We conducted a retrospective review of patients with symptomatic bile leak who were referred to a tertiary care center and who underwent ERCP between April 2016 and April 2019. The primary outcome was complete symptomatic resolution without extravasation of the contrast medium during the second ERCP conducted after 6 weeks.
Results In total, 71 patients presented with symptomatic bile leak. The etiologies of bile leak were post-cholecystectomy injury in 34 (47.8%), liver abscess in 20 (28.1%), and post-hydatid cyst surgery in 11 (15.4%) patients. All patients were managed with ERCP, sphincterotomy, and stent placement for 6 weeks, except for one who underwent surgery. The primary outcome was achieved in 65 (91.5%) of 71 patients. There was no significant difference in terms of outcome in relation to the interval between the diagnosis of bile leak and ERCP.
Conclusions Most patients with bile leak can be successfully managed with ERCP even when performed on an elective basis.
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A critical appraisal of the ISGLS definition of biliary leakage after liver resection Svenja Sliwinski, Jan Heil, Josephine Franz, Hanan El Youzouri, Michael Heise, Wolf O. Bechstein, Andreas A. Schnitzbauer Langenbeck's Archives of Surgery.2023;[Epub] CrossRef
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Background /Aims: There are some options which exist in the optimal treatment of Common Bile Duct (CBD) stones. The management of CBD stones by a preoperative Endoscopic Sphincterotomy (EST) and a Laparoscopic Cholecystectomy (LC) remains controveraial. This study intends to investigate the value of an EST before an LC in patients with CBD stones compared with a conventional Open Cholecystectomy (OC) with a Common Bile Duct Exploration (CBDE). Methods: Sixty three patients underwent an EST before an LC, while 65 patients received an OC with a CBDE were reviewed retrospectively for a 42 month period from January, 1993 to June, 1996. Results: There was no statistical significance of stone numbers and sizes in both groups (p>0.05), but the EST before the LC group a showed a shorter hospital stay (12.2 days:19.8 days, p < 0.05). The complication rate in conventional OC with the CBDE group was greater but it was not statistically significant(p>0.05). Rate of stone recurrence and remnant stones in the OC with CBDE group (50.8%) was ater than the EST before LC group (25.4%)(p <0.05). The total hospitalization fee in the EST before LC group was lesser than the OC with CBDE group (p<0.05). Conclusions: An EST before an LC is a valuable option for patients with gall stones and simultaneous choledocholithiasis and is suitable according to recent trends in the minimal invasive approach. It needs however, larger group evaluation in order to determine the accurate indications and proper patient selection for this procedure. (Korean J Gastrointest Endosc 18: 340-344, 1998)
Background /Aims: Perioperative endoscopic retrograde cholangiopancreatography (ERCP) and en copic sphincterotomy (EST) offer the ability to remove common bile duct (CBD) stones and it ean make laparoscopic cholecystectcqny possible instead of open cholecystectomy. Although ERCP accurately detects CBD stones, the associated financial costs and potential morbidity argue against its indiscriminate use. Thus, we undertook the current retrospective study to analyze our own experience in the identification of preoperative indicators of CBD stones in patients managed by laparoscopic cholecystectomy. Methods: Between October 1994 and October 1996, 503 laparoscopic cholecystectomy were performed at Samsung Medical Center. We analyzed the value of serum biochemical tests and findings of ultrasonography in patients ted by laparoscopic cholecystectomy. Results: A total of 117 patients underwent perigperative ERCP; 113 patients underwent preoperative ERCP with 2/113 (1.8%) failing to cannulate the ampulla; 21 patients (18.0%) had choledocholithiasis; and all patients with CBD stones were cleared by EST without major complications. The indication of ERCP for prediction of CBD stones were categorized as 4 groups; abnormal liver function tests (LFT) and duct dilatation in ultrasonography 61.9% (13/22), only abnormal liver function tests 13.6% (6/44), only duct dilatation in ultrasonography 5,9% (1/17), and normal liver function tests with normal findings in ultrasonopaphy 2.9% (1/35) in this study. In patients with CBD stones, there was no significant difference to predict CBD stones in total bilirubin, alkaline phosphatase, and alanine aminotransferase. Gallstone pancreatitis patients who had hyperamylasemia and abnornal LFT that were resolved or resolving before ERCP revealed no CBD stones (0/10, 0%). Conclusions: ERCP before laparoscopic cholecystectomy is needed in selected patients who have abnormal liver function and/or CBD dilatation on ultrasonography. Gallstone pancreatitis that is resalving or resolved clinically may not require preoperative ERCP. ERCP with EST and laparoscopic cholecystectomy is a safe and effective method for the management of symptomatic eholelithiasis and choledocholithiasis. (Korean J Gastrointest Endosc 17: 15~22, 1997)
Cholelithiasis and cholecystitis frequently necessitate cholecystectomy. Experience is increasing with laparoscopic cholecystectomy, a technique that avoids much of the morbidity, pain, prolonged hospital day, and recovery complications associated with the traditional approach. And the safety of laparoscopic cholecystectomy was confirmed. Besides appendectomy, cholecystectomy is the second most common nonobstetric procedure performed in pregnant women. We have performed one case of a successful laparoscopic cholecystectomy in the second trimester of pregnancy. Pregnancy was once a contraindication of laparoscopic operation, but no longer.
Laparascapic Cholecystectomy is a recentely rapidly emerged, minimally invasive procedure whereby the gallbladder is removed using laparoscopic techniques. The procedure offers the patient reduced hospital stay, faster to work, less pain, less complication, less expensiveness, and improved cosmetic results over the traditional open cholecystectomy. (continue...)
Surgical advance on the general surgical department as minimal access procedure was changed into the laparoscopic cholecystectomy from open cholecystectomy for treatment of cholelithiasis. Laparoscopic cholecystectomy is far less invasive, less painful, less expensive, less complicative, high cosmetic and high eonservative procedure, and reduced hospitalization than open surgery. (continue...)
To identify the efficacy of laparoscopic cholecystectomy, we retrospectively analyzed 600 cases of laparoscopic cholecystectomy who were treated at the Department of Surgery, Chung Ang University from September 1990 to December l992. We intentionally divided periods into 3 groups to observe the frequency of morbidity and mortality, early and late complications, duration of operation and postoperative hospitalization with accumulaton of surgical experiences and techniques. The most prevalent age group was 6th decades, male to female ratio was 1: 1.47 and associated diseases were hypertension, obesity, pulmonary tuberculosis in order of frequency and previous abdominal operations were appendectomy, TAH, C-section in order of frequency. The duration of operation was 38.6 minutes and postoperative hospitalization was 6.2 days. The most frequent pathologic diagnosis was chronic cholecystitis. The postoperative complications were noted in 15 cases(2.5%) including 5 cases of bleeding 4 cases of bile leakage. The number of patients who needed parenteral narcotics was decreased in later peiod. According to oral cholecystogram, opacification correlated with duration of operation of laparoscopic cholecystectomy.
With advancement of endoscopical instruments and technique, gallstone diseases can be managed with laparoscopic cholecystectomy which has rapidly and radically changed the surgical treatment of gallstone diseases. The ideas of laparoscopic surgery was introduced by Germany gynecologist Semm, in 1967 and was first performed by French surgeon Mouret, Dubois in 1987. Although many reports of early laparoscopic cholecystectomy were excellent, many surgeons want to know the surgical results of laparoscopic cholecystectomy are enough good to perform comparing with the conventional cholecystectomy, especially in early complications and late complications. (continue...)