Características anatómicas del conducto cístico en una muestra de cadáveres del anfiteatro de una institución universitaria en Bogotá (Colombia) / Anatomic Characteristics of the Cystic Duct in a Sample of Cadavers from the Amphitheater of a University Institution in Bogotá ­ Colombia / Características anatômicas do ducto cístico em uma amostra de cadáveres do anfiteatro de uma instituição universitária em Bogotá Colômbia

en comparación con otros países, en Colombia son escasos los estudios sobre las características anatómicas del conducto cístico. En este artículo se describen sus características anatómicas en una muestra de 60 especímenes cadavéricos de una institución universitaria de Bogotá. Materiales y métodos: se realizó un estudio descriptivo analítico transversal donde se empleó y disecó el conducto cístico de 60 bloques digestivos humanos. Resultados: siguiendo la clasificación de Taybi, se encontraron las variaciones: con implantación alta (75 %), baja (25 %), en espiral anterior (1.6 %), espiral posterior (1.6 %), conducto cístico accesorio (1.6 %) y doble conducto cístico (3.2 %). En cuanto a las dimensiones del conducto cístico, se evidenció una longitud promedio de 19.4 mm y un diámetro promedio de 3.3 mm. Las características anatómicas usuales fueron similares a las reportadas en la literatura. Conclusiones: la anatomía usual está presente en el 92 % de los casos, y las variantes anatómicas, en el 8 %. La longitud y el diámetro del conducto cístico están dentro del promedio reportado en la literatura.

Compared with other countries, few studies in Colombia have explored the anatomical characteristics of the cystic duct. In this study, the anatomical characteristics of the cystic duct were described in a sample of 60 cadaveric specimens from a university institution in Bogotá. Materials and methods: A cross-sectional analytical descriptive study was performed, in which the cystic duct of 60 human digestive blocks was used and dissected. Results: Based on the Taybi classification, the following variations of the cystic duct were found: high implantation (75%), low implantation (25%), anterior spi-ral (1.6%), posterior spiral (1.6%), accessory cystic duct (1.6%), and double cystic duct (3.2%). Regarding the dimensions of the cystic duct, an average length of 19.4 mm and an average diameter of 3.3 mm were evidenced. The usual anatomical characteristics were similar to those reported in the literature. Conclusions: The usual anatomy was present in 92% of cases and anatomical variants in 8%. The length and diameter of the cystic duct were within the average limits as reported in the literature.

em comparação com outros países, os estudos sobre as características anatômicas do ducto cístico são escassos na Colômbia. Neste estudo, as características anatômicas do ducto cístico são descritas em uma amostra de 60 espécimes cadavéricos de uma instituição universitária de Bogotá. Materiais e métodos: foi realizado um estudo descritivo analítico transversal onde foi utilizado e dissecado o ducto cístico de 60 blocos digestivos humanos. Resultados: seguindo a classificação de Taybi, foram encontradas as seguintes variações, com implantação alta (75%), implantação baixa (25%), espiral anterior (1.6%), espiral posterior (1.6%), ducto cístico acessório (1.6%) e cístico duto duplo (3.2%). Quanto às dimensões do ducto cístico, evidenciou-se comprimento médio de 19.4 mm e diâmetro médio de 3.3 mm. As carac-terísticas anatômicas usuais foram semelhantes às relatadas na literatura. Conclusões: a anatomia usual está presente em 92% dos casos e as variantes anatômicas em 8%. O comprimento e o diâmetro do ducto cístico estão dentro da média relatada na literatura.

Application of septum incision technique in laparoscopic transcystic common bile duct exploration / 中华肝胆外科杂志

Objective:To investigate the role of septum incision technique in laparoscopic transcystic common bile duct exploration (LTCBDE).Methods:The data of 22 patients with choledocholithiasis undergoing LTCBDE by septum (a membrane-like wall of the cystic duct running parallel to the common hepatic duct) incision technique at the Suzhou Ninth Hospital Affiliated to Soochow University from April 2020 to March 2023 were retrospectively analyzed, including 13 males and 9 females, aged (54.4±20.3) years. The operative time, postoperative hospital stay, postoperative complications (bile leakage, abdominal hemorrhage, abdominal infection, etc.) and follow-up data were collected and analyzed.Results:All 22 patients (including two patients undergoing common bile duct exploration through the residual cystic duct) underwent the exploration of common hepatic duct, left and right hepatic duct openings, and secondary branch openings successfully. It was confirmed using this procedure that there were no obstruction of the common hepatic duct and intrahepatic bile ducts, or residual stones. The operation time was (79.6±23.2) min and the postoperative hospital stay was (6.3±1.7) d. No complications such as biliary leakage, abdominal hemorrhage or infection occurred after surgery. No cases of biliary stricture or residual stones were observed during short-term postoperative follow-ups.Conclusion:The septum incision technique improved the visualization of hilar bile duct in LTCBDE, which could be a safe and effective procedure to facilitate the LTCBDE and increase its success rate.

Comparative evaluation of three laparoscopic cholecystectomy techniques in rabbit's model

Purpose: The aim of this randomized study was to compare the complications and perioperative outcome of three different techniques of laparoscopic cholecystectomy (LC). Changes in the liver function test after LC techniques were investigated. Also, we compared the degree of postoperative adhesions and histopathological changes of the liver bed. Methods: Thirty rabbits were divided into three groups: group A) Fundus-first technique by Hook dissecting instrument and Roeder Slipknot applied for cystic duct (CD) ligation; group B) conventional technique by Maryland dissecting forceps and electrothermal bipolar vessel sealing (EBVS) for CD seal; group C) conventional technique by EBVS for gallbladder (GB) dissection and CD seal. Results: Group A presented a longer GB dissection time than groups B and C. GB perforation and bleeding from tissues adjacent to GB were similar among tested groups. Gamma-glutamyl transferase and alkaline phosphatase levels increased (p ≤ 0.05) on day 3 postoperatively in group A. By the 15th postoperative day, the enzymes returned to the preoperative values. Transient elevation of hepatic transaminases occurred after LC in all groups. Group A had a higher adherence score than groups B and C and was associated with the least predictable technique. Conclusions: LC can be performed using different techniques, although the use of EBVS is highly recommended.

Resección laparoscópica de dilatación quística congénita del conducto cístico en un paciente pediátrico / Laparoscopic Resection of Congenital Cystic Dilatation of the Cystic Duct in a Pediatric Patient

Introducción: La dilatación quística congénita del conducto cístico o dilatación tipo VI de la clasificación de Todani, es una variante rara de dilatación congénita de la vía biliar. Objetivo: Explicar la metodología diagnóstica y terapéutica empleada en un caso pediátrico con esta entidad, y destacar la ventaja de su tratamiento oportuno por vía mínimamente invasiva. Presentación del caso: Paciente masculino de 6 años con sintomatología sugestiva de enfermedad vesicular, referido desde la atención secundaria por sospecha de quiste de colédoco. En el ultrasonido se detectaba una lesión ecolúcida adyacente a la vesícula biliar, sin dilatación de las vías biliares intrahepáticas. Se realizó colangiografía laparoscópica y se confirmó una dilatación quística aislada del conducto cístico, la cual se resecó por vía laparoscópica, igualmente. Conclusiones: La incidencia de la dilatación quística del conducto cístico es muy baja y se puede presentar en niños con sintomatología variable. El diagnóstico generalmente es tardío, puede sospecharse mediante la ecografía abdominal y confirmarse con la colangiografía laparoscópica, aun en ausencia de otros medios diagnósticos más modernos. Su reconocimiento y correcta clasificación permiten realizar el tratamiento quirúrgico definitivo exitosamente, de preferencia por vía laparoscópica(AU)

Introduction: Congenital cystic duct dilatation, or Todani classification type VI dilatation, is a rare variant of congenital bile duct dilatation. Objective: To explain the diagnostic and therapeutic methodology used in a pediatric case with this entity, and to highlight the advantage of its timely minimally invasive treatment. Case presentation: Six-year-old male patient with symptoms suggestive of gallbladder disease, referred from secondary care for suspicion of a common bile duct cyst. Ultrasound showed an echolucent lesion adjacent to the gallbladder, without dilatation of the intrahepatic bile ducts. Laparoscopic cholangiography was performed and confirmed an isolated cystic dilatation of the cystic duct, which was resected laparoscopically, likewise. Conclusions: The incidence of cystic dilatation of the cystic duct is very low and may present in children with variable symptomatology. Diagnosis is usually late, can be suspected by abdominal ultrasound and confirmed by laparoscopic cholangiography, even in the absence of other more modern diagnostic tools. Its recognition and correct classification permit a successful definitive surgical treatment, preferably laparoscopically(AU)

Post-Cholecystectomy Surgical Re-intervention for Cystic Duct Remnant - An Experience.

Background: In laparoscopic cholecystectomy, cystic duct is typically separated closer to the gallbladder to prevent iatrogenic common bile duct damage, leaving behind a long cystic duct remnant that can potentially lead to postcholecystectomy syndrome. Methods: A retrospective analysis of the data from 2010 to 2021 was undertaken at SKIMS Medical College, Srinagar, Kashmir, India, of all the cases who had been surgically re-explored for cystic duct remnants post-laparoscopic cholecystectomy. Results: Twenty cases of both genders underwent surgical reintervention for cystic duct remnant. The mean time of presentation after an index cholecystectomy was 2 years. Surgical operations were conducted through an open approach in 17 (85%) and by laparoscopy in 3 (15%). 95% of patients were symptom-free in the follow-up period. Conclusions: Cystic duct remnants should be considered if a patient report with symptoms suggestive of postcholecystectomy syndrome. The condition once diagnosed, can be managed safely by surgical reintervention.

Síndrome de Mirizzi grado IV. Presentación de un caso

El Síndrome de Mirizzi es una afección derivada del impacto de un lito en el conducto cístico o infundíbulo de la vesícula biliar. La enfermedad litiásica, crónica y complicada de la vesícula biliar es un factor determinante. Se presenta el caso de un paciente con historia de íctero obstructivo, al cual se le diagnosticó inicialmente tumor periampular. Fue reevaluado y se le realizaron varias pruebas diagnósticas, hasta llegar al diagnóstico de Síndrome de Mirizzi, corroborado en el acto quirúrgico. El SM es una enfermedad rara de la vía biliar cuyo tratamiento es quirúrgico. La vía laparoscópica para la realización de la colecistectomía es la de elección para casos grado I y en casos seleccionados grado II. La colecistectomía y derivación bilioentérica (hepaticoyeyunostomía) conforman el tratamiento para el resto de los casos.

Mirizzi Syndrome is a condition derived from the impact of a stone in the cystic duct or infundibulum of the gallbladder. Chronic and complicated stone disease of the gallbladder is a determining factor. A patient with a history of obstructive jaundice, who was initially diagnosed with a periampullary tumor is presented. He was reassessed and several diagnostic tests were performed, until reaching the diagnosis of Mirizzi Syndrome, corroborated in the surgical act. MS is a rare disease of the bile duct whose treatment is surgical. The laparoscopic approach to perform cholecystectomy is the one of choice for grade I cases and in selected cases grade II. Cholecystectomy and bilioenteric bypass (hepaticojejunostomy) are the treatment for the rest of the cases.

Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography: A Retrospective Study With 265 Patients

Background: Anatomical variations of cystic duct (CD) are frequently unrecognized. It is important to be aware of these variations prior to any surgical, percutaneous, or endoscopic intervention procedures. Objectives: The purpose of our study was to demonstrate the imaging features of cystic duct and its variants using magnetic resonance cholangiopancreatography (MRCP) and document their prevalence in our population. Materials and Methods: This study included 265 patients who underwent magnetic resonance cholangiopancreatography due to different indications and variations of cystic duct were documented. Results: Normal lateral insertion of cystic duct at middle third of common hepatic duct was seen in 29.43% of cases. Medial insertion was seen in 2.63% of cases, 2.26% were low medial insertions. Low insertion of cystic duct was noted in 1.51 % of cases. Parallel course of cystic duct was present in 0.38% of cases. High insertion was noted in 0.38% cases and no case of short cystic duct was noted. No case of cystic duct draining into right hepatic duct was seen. Conclusion: Cystic duct variations are common and MRCP is an optimal imaging modality for demonstration of cystic duct anatomy.

Double Cystic Ducts With The Single Gallbladder

Background: Cystic duct is forming one of the boundaries of triangle of cholecystectomy. The variations in cystic duct anatomy are of considerable importance during surgical excision of the gallbladder. A double cystic duct is very rare and poses a challenge for surgeons during cholecystectomy operation. If duplication of cystic ducts is present, it is associated with a double gallbladder 80% of the time. Presence of duplication of cystic duct associated with a single gallbladder is a extremely rare variant. Most of the times this variation is not picked up on routine preoperative investigations of patients planned for a laparoscopic cholecystectomy and often present as an unusual ‘surprise’ during surgery and creates a challenge to the surgeons. If they fail to identify this very rare variation they may create iatrogenic injury to these cystic ducts, which leads to bile leakage and other complications. Aim of the study: To find out the incidence of variations in the number of cystic duct in cadavers. Materials and Methods: Present study was done in 50 adult cadavers in the Department of Anatomy, Government Tiruvannamalai medical college, Tamil nadu. Meticulous dissection was done in the hepatobiliary system of these cadavers, and the variations in the number of cystic duct were noted. Observations: Presence of double cystic ducts were seen in three cadavers. Conclusion: If an anomaly of the biliary ductal system is not identified before or during surgery, it may turn out to be a bile duct injury which leads to bile leak. Hence Surgeons should keep in mind about the possibility of this rare variant double cystic ducts with a single gallbladder while performing cholecystectomy surgery.

Morphometric study of extra-hepatic biliary pathways: study in human corpses / Estudio morfométrico de las vías biliares extrahepáticas: estudio en cadáveres humanos

SUMMARY: Adverse events (AE) contribute significantly to postoperative morbidities and comorbidities. Many AEs occur due to a lack of anatomical knowledge and its variants. Latrogenic bile duct injuries, for instance, represent a serious surgical complication of laparoscopic cholecystectomy. Anatomical knowledge for the identification and adequate drainage of all ducts is relevant and fundamental in order to avoid future errors. The objective of the study was to morphometrically analyze the bile ducts in adult human corpses. 13 livers were extracted from adult human corpses to obtain the ducts: choledochal, common hepatic and cystic. After morphological analysis, duct measurements (length and diameter) were continued using a digital caliper. The data obtained were tabulated in SPSS 21 program, performing descriptive analysis with mean and standard deviation. The averages of bile ducts were 61.05 (± 16.43) mm in length and 3.86 (± 0.72) mm in diameter. The cystic duct length and diameter averages were 33.59 (± 12.29) mm and 3.40 (± 0.79) mm, respectively. The common hepatic ducts had an average of 30.02 (± 7.19) mm in length and 3.74 (± 1.18) mm in diameter. The analyzed samples presented different values ?? from those already described in the literature, where the length of the cystic ducts was greater, while the length of the common hepatic ducts was numerically smaller. This work is very significant, as the morphometric variability of the bile ducts allows for varying morphological situations that can compromise the hepatobiliar physiology.

RESUMEN: Los eventos adversos (EA) contribuyen significativamente a las morbilidades y comorbilidades postoperatorias. Muchos EA se deben a la falta de conocimiento de la anatomía y sus variaciones. Por ejemplo, las lesiones iatrogénicas de las vías biliares representan una complicación quirúrgica grave de la colecistectomía laparoscópica. El conocimiento anatómico para la identificación y drenaje adecuado de todos los conductos es relevante y fundamental para evitar futuros errores. El objetivo del estudio fue analizar morfométricamente las vías biliares en cadáveres humanos adultos. Se extrajeron 13 hígados de cadáveres humanos adultos y se retiraron los conductos: colédoco, hepático común y cístico. Después del análisis morfológico, se continuó con las mediciones de los conductos (longitud y diámetro) utilizando un calibrador digital. Los datos fueron tabulados en el programa SPSS 21, mediante análisis descriptivos con media y desviación estándar. Los promedios de las vías biliares fueron de 61,05 (± 16,43) mm de longitud y 3,86 (± 0,72) mm de diámetro. Los promedios de longitud y diámetro del conducto cístico fueron 33,59 (± 12,29) mm y 3,40 (± 0,79) mm, respectivamente. Los conductos hepáticos comunes tenían un promedio de 30,02 (± 7,19) mm de longitud y 3,74 (± 1,18) mm de diámetro. Las muestras analizadas presentaron valores diferentes a los ya descritos en la literatura, donde la longitud de los conductos císticos era mayor, mientras que la longitud de los conductos hepáticos comunes fue numéricamente menor. Este trabajo es significativo, debido a que la variabilidad morfométrica de las vías biliares y permite identificar situaciones morfológicas que pueden comprometer la fisiología hapatobiliar.

Clip Occlusion Versus Extracorporeal Suture Ligation (Roeder Knot) of the Cystic Duct in Laparoscopic Cholecystectomy – A Comparative Study

Introduction: Laparoscopic cholecystectomy today hasbeen rapidly embraced worldwide as the procedure of choicefor cholecystectomy. Conventionally, titanium clips areused to ligate the cystic duct. Recently, various methods ofsuture ligation of the cystic duct both intra corporeal andextra corporeal have been described during laparoscopiccholecystectomy. Only limited number of studies have beencarried out prospectively to compare the various methods. Thepresent study was thus designed to compare clip occlusionversus extra corporeal suture ligation (Roeder knot) of thecystic duct in laparoscopic cholecystectomy.Material and methods: This study was a single blindedrandomized controlled trial conducted on 150 adult patientsundergoing laparoscopic cholecystectomy. They wererandomized into two groups of 75 each to compare theprocedures of clip occlusion versus extracorporeal sutureligation (Roeder knot) of the cystic duct with respect to theoperative time, complications, associated morbidity, operativecost and hospital stay.Results: There was no significant (p>0.05) differencein duration of surgery between the groups (Clipligation=40.44±4.63 minutes, suture ligation=43.32±4.44minutes). Bile leakage due to slippage of ligature was presentin 2 (2.7%) patients with clip ligation as compared to 0% insuture ligation. This difference was found to be statisticallysignificant (p=0.03). Obstructive jaundice due to accidentalligation of CBD was present in 2 (2.7%) patients with clipligation as compared to 0% in suture ligation. This differencewas also found to be statistically significant. (p=0.03). Thecost of Clip ligation (Rs.369.07±8.08) was higher than sutureligation (Rs.300.00±0.00).Conclusion: The results of this study indicate thatextracorporeal (Roeder’s knot) is a safe, cost effectivealternative with a low complication rate as compared totitanium clip ligation of the cystic duct in laparoscopiccholecystectomy

Three port versus four port laparoscopic cholecystectomy: a prospective comparative clinical study

Background: Although, traditional laparoscopic cholecystectomy is performed using four-port technique, various modifications were made to further enhance the advantages of laparoscopic cholecystectomy. Aim of the study is to compare the results of three-port and four-port laparoscopic cholecystectomy at single center in terms of technical feasibility, safety of the procedure, operative time, intra-operative complications, postoperative pain and post-operative analgesia requirementMethods: It was a  prospective comparative study conducted  in the department of surgery Skims Medical college Srinagar, India from July 2015 to March 2017. The study was performed on all adult patients with ultrasound documented cholelithiasis and gall bladder Polyposis. The total number of patients studied was 100 which were divided into two groups of 50 each.Results: The average operative time in three port group was 29.2 minutes (range, 15-37) compared to 30.66 minutes (range, 15-42) in four port group, which was statistically insignificant. The final visual analog scores for pain in the postoperative period was 2.30 vs 2.86 in three port and four port group respectively, with a P value=0.008, which was statistically significant.Conclusions: The three-port technique is as safe as the standard four-port technique and can be a viable alternative to four port cholecystectomy with an advantage of less pain and less analgesic requirement and better cosmetic results.

Quiste de conducto cístico / Cystic duct cyst

Los quistes congénitos de la vía biliar son infrecuentes y se definen por la dilatación quística del árbol biliar en cualquiera de sus porciones. Los quistes del conducto cístico son aún menos frecuentes. Su etiología permanece incierta y el tratamiento consiste en la resección debido a su potencial desarrollo de malignidad. Presentamos el caso de una paciente en la que se diagnosticó dilatación del conducto cístico y fue tratada por vía laparoscópica.

Congenital biliary duct cysts are rare and are defined as cystic dilatations of the biliary tree in any of its portions. Cystic duct cysts are more uncommon. Their etiology remains uncertain and they should be resected due to the possible development of malignancy. We report the case of a female patient with a diagnosis of dilation of the cystic duct that was treated with laparoscopic surgery.

Uso del Ligasure® para el sellado del conducto cístico en pacientes intervenidos por colecistectomía laparoscópica / Ligasure® use for cystic duct sealing in patients who underwent laparoscopic cholecystectomy

Con el objetivo de describir el uso del LigaSure® para el sellado del conducto cístico en pacientes intervenidos por colecistectomía laparoscópica en la Sociedad Anticancerosa del Estado Lara, durante el lapso junio 2012-junio 2017, se realizó un estudio descriptivo transversal de recolección retrospectiva de datos de 62 historias clínicas de pacientes intervenidos por colecistectomía laparoscópica asistida por sellado del conducto cístico con LigaSure® los cuales se caracterizaron por un promedio de edad de 47,58 ± 14,11 años, predominio del sexo femenino (64,52%) y un tiempo promedio quirúrgico de 41,74 ± 7,99 minutos. No se registraron complicaciones intraoperatorias ni postoperatorias y la estancia postquirúrgica en 77,42% de los pacientes fue de 24 horas. En conclusión, el uso del LigaSure® para el sellado del conducto cístico resultó una técnica segura para pacientes intervenidos por colecistectomía laparoscópica.

In order to describe LigaSure® use for sealing of the cystic duct in patients who underwent laparoscopic cholecystectomy in the Sociedad Anticancerosa del Estado Lara during the period June 2012-June 2017 we conducted a descriptive transversal study with retrospective data collection of 62 medical charts. Results show that the average patient age was 47.58 ± 14.11 years with a female predominance (64.52%) and an average surgical time of 41.74 ± 7.99 minutes. There was no intraoperative or postoperative complications and the postsurgical stay in 77.42% of patients was 24 hours. In conclusion, the use of LigaSure® for cystic duct sealing is a safe technique for patients who undergo laparoscopic cholecystectomy.

Clipless Laparoscopic Cholecystectomy: Our Experience

Background:Laparoscopic cholecystectomy (LC) is acceptedas the gold standart treatment of gallstones. Various methodshave been developed to close the cystic duct (CD) and cysticartery (CA), but titanium clip application is currently themost frequently used technique. High-tech electrosurgicalinstruments, such as Harmonic Scalpel (HS), have been usedboth for dissection of the cystic artery and Cystic duct. Thepresent study was conducted to observe and establish efficacyof clipless cholecystectomy, by use of harmonic scalpel as analternative, for division and sealing of cystic artery and cysticduct.Methods: This study was a hospital based, retrospectivestudy, conducted in Govt. Medical College, Srinagar, usingmedical records. A total of 114 patients included in the study,having been operated by a single surgeon over time period of5 years from February 2014 to january 2019.Results: In our study of 114 patients 82 (71.92%) werefemales and 32 (28.07%) were males with average age of41.4years (16-72 yr). No patient was converted to open withaverage operating time of 24.2 minutes (18-46 minutes). Meanhospital study was 1.42 days (1-8 days) with no mortality.Postoperative complications were found in 6 (5.2%) patientswith bile leak from duct of Lushka in 1 (0.8%) patient, portsite infection in 2 (1.7%) patients and fever in 3 (2.6%)patients.Gallbladder perforation intraoperatively was seen in7 (6.2%) patients.Conclusions:Use of harmonic scalpel is an excellent optionfor the cystic duct closure with less time consumption and lesscomplications

Anatomical Variations Of The Cystic Duct And Their Surgical Implications In Sudanese Population: A Cadaveric Study

Background: Anatomic variations of cystic ducts are common and continuously encountered during Surgical andradiological interventions. Failure to identify these clinically important variations may result in complicationsduring surgical or endoscopic procedures.Patients and methods: This is an observational descriptive cross-sectional study. 65 cadavers in the dissectingrooms of the medical colleges, in which the length and mode of insertion of cystic duct (CD) into common bileduct (CBD) were observed.Results: The mean length of the CD in the cadavers examined was (2.06 ± 1.03) with a minimum length of d” 0.5 cmand a maximum of 5 cm. Regarding the mode of insertion of CD into the CBD; 53.8% were found to have a lowjunction between the CD and common hepatic duct (CHD) which is considered the normal insertion. 46.2% foundto be abnormal variations of insertion; short CD (d”0.5 cm) observed in 10.8%; whereas in 13.8% of cadavers wefound that the CD is adherent to the CHD and runs in parallel to it. In 7.8% there was a high junction between theCD and CBD and in 9.2% we found that CD courses anterior or posterior to CBD and joins it medially.Conclusion: CD variations are not uncommon and it is important to identify these anatomical variations. Adetailed knowledge of the extra hepatic biliary tract, as well as of its variations, is important for the diagnosticand therapeutic success in many clinical situations since they allow the surgeon prompt identification ofcertain pathologies, making surgical procedures more accurate and affective.

Radiological and pulmonary function test assessment in clinically stable bronchiectasis patients

Background: Bronchiectasis is a disease in which patients spends morbid life having dyspnoea and productive, often foul-smelling sputum which produces social isolation and depressive states. The mortality rate in bronchiectasis patients 2, states the mortality rate of bronchiectasis in 12 years follow up period is 29.7% in the age group at 52 in 1years. 70% cause of death in bronchiectasis is due to respiratory tract infection leading to respiratory failure. Aim of the study: To evaluate the Bronchial inflammatory response and its relationship to bacterial colonization through radiological evaluation. Materials and methods: This study was done for a period of 7 months from February 2016 to August 2016 in the Department of Thoracic Medicine, Government Villupuram Medical College, Villupuram. The Bacterial flora from Lower Respiratory tract of Bronchiectasis patients who attended Thoracic Medicine Outpatient Department with diagnosis confirmed by a radiologist was studied. Bronchoalveolar lavage was done as an invasive procedure in 90 patients with bronchiectasis and from 6 patients admitted with chronic upper respiratory symptoms as laboratory control in Interleukin-8 estimation for all the patients radiological and pulmonary function test assessment done. Results: Among the 90 patients in this study Cylindrical types were 53%, Cystic types were 35%, Varicose types were 4.4 %, Traction bronchiectasis were 3% and 3% were mixed types i.e. Cystic A. Sundrarajaperumal, R. Nedunchezhian, D. Ranganathan, V Sundar. Radiological and pulmonary function test assessment in clinically stable bronchiectasis patients. IAIM, 2019; 6(6): 87-91. Page 88 plus cylindrical and Traction plus cylindrical. Spirometry pattern distribution showing Normal spirometer in 14% of patients, Obstructive pattern observed in 64% of patients, Restrictive pattern observed in 15% of patients and the mixed pattern was observed in 7% of patients. Conclusion: Increased incidence of bronchiectasis in females (58%). Cylindrical bronchiectasis was the commonest type followed by Cystic bronchiectasis. Regarding etiology of Bronchiectasis, 42% of bronchiectasis was Idiopathic followed by post infectious 21%. The pulmonary function FEV1< 70% was associated with microorganisms colonization of bronchiectasis airways.

The cause of adhesion in cholecystic triangle and its influence on laparoscopic cholecystectomy / 中国医师杂志

The adhesion in the gallbladder triangle is the most important factor influencing the conversion to laparotomy in laparoscopic cholecystectomy (LC).The degree of adhesion in the cholecystic triangle is closely related to the difficulty of LC operation.With the reduction of cholecystic triangle adhesion,the treatment of gallbladder during LC will be easy and the rate of conversion to laparotomy will decrease accordingly.In order to investigate the causes of cholecystic triangle adhesion and its influence on LC,this paper reviews the current research progress.

The Value and Discussion of Cystic Duct Variation Diagnosed by MRCP / 昆明医科大学学报

Objective To observe the normal anatomy and variation of cystic duct by MRCP, and to explore the correlation between anatomic variation and gallbladder stones. Methods To have a retrospective analysis of 371 MRCP patients which meet the requirement of imaging, and to compare the differences between anatomic variation and gallbladder stones with normal cystic duct. Results Among 371 patients, 63 had anatomic variations, A among which,22 had compound variations with 85 variation points in total.The percentage of mutation rate was 16.98%. 53 patients with variation of cystic duct had gallbladder stones, and 182 patients without variation of cystic duct had gallbladder stones. Conclusions MRCP can clearly display different variations of cystic duct, and the patients with variation of cystic duct have higher risks in gallbladder stones than the patients without variations.

Endoscopic Treatment of Mirizzi Syndrome in a Patient with Low Lying Cystic Duct and Remnant Cystic Duct Stone / 대한췌담도학회지

Mirizzi syndrome is a rare complication, resulting in bile duct obstruction and jaundice that usually arise from impacted gallstone in the cystic duct or neck of the gallbladder. It is vitally important to confirm underlying cystic duct anomaly in Mirizzi syndrome since it can produce surgical difficulty and higher complications. Generally, Mirizzi syndrome is treated surgically while endoscopic treatment is limited. Herein, we present Mirizzi syndrome with low lying cystic duct and remnant cyst duct calculi treated successfully by biliary stent and administration of choleretic agent, following by balloon dilatation on cystic duct and balloon extraction of the stone.

Endoscopic Treatment of Mirizzi Syndrome in a Patient with Low Lying Cystic Duct and Remnant Cystic Duct Stone / 대한췌담도학회지

Mirizzi syndrome is a rare complication, resulting in bile duct obstruction and jaundice that usually arise from impacted gallstone in the cystic duct or neck of the gallbladder. It is vitally important to confirm underlying cystic duct anomaly in Mirizzi syndrome since it can produce surgical difficulty and higher complications. Generally, Mirizzi syndrome is treated surgically while endoscopic treatment is limited. Herein, we present Mirizzi syndrome with low lying cystic duct and remnant cyst duct calculi treated successfully by biliary stent and administration of choleretic agent, following by balloon dilatation on cystic duct and balloon extraction of the stone.