Risk factors and outcomes of bile leak after laparoscopic surgery for congenital biliary dilatation.

PURPOSE: One of the main causes of stricture at hepaticojejunostomy site after surgery for congenital biliary dilatation is inflammation or infection associated with bile leak. The aim of this study was to determine the risk factors and outcomes of bile leak after laparoscopic surgery. METHODS: We retrospectively reviewed the demographics and outcomes of patients who underwent laparoscopic surgery for congenital biliary dilatation between September 2013 and December 2019. Data from patients with bile leak were compared to data from patients without bile leak. RESULTS: Fourteen of 78 patients had bile leak. Hepatic duct diameter at anastomosis was the only risk factor of bile leak. Patients with the diameter ≤ 10 mm had higher incidence of bile leak than in patients with the diameter > 10 mm (P = 0.0023). Among them, bile leak occurred more frequently in patients operated on by non-qualified surgeons based on the Japan Society for Endoscopic Surgery endoscopic surgical skill qualification system than by qualified surgeons (P = 0.027). However, none of the patients with bile leak developed anastomotic stricture afterwards. CONCLUSION: Although good technical skill is necessary to avoid bile leak in narrow hepatic duct cases (≤ 10 mm), slight bile leak may not result in anastomotic stricture.

Prenatal sonographic diagnosis of biliary tract malformations.

Congenital anomalies of the biliary tract include a variety of pathologic conditions, such as biliary atresia, choledochal cysts, gallbladder agenesis, congenital cholelithiasis, and gallbladder duplication. Although most of these malformations are rare and benign conditions, they may occasionally represent a major threat to extrauterine life. Visualization of a normal-sized gallbladder should be a mandatory component of the second-trimester anomaly ultrasound scan. Advances in prenatal sonography enable the detection of biliary tract congenital malformations. In this review, we discuss the detection rates, sonographic features, and prognosis of the most frequently prenatally diagnosed biliary tract malformations.

Dilatación quística de la vía biliar Todani Ic / Todani Ic cystic dilatation of the bile duct

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Endoscopic biliary drainage management for children with serious cholangitis caused by congenital biliary dilatation.

Congenital biliary dilatation (CBD) is usually associated with complications such as recurrent cholangitis, manifested as abdominal pain, vomiting, and jaundice. If cholangitis cannot be controlled by conservative treatment, a good therapeutic effect can be obtained through percutaneous biliary drainage or open T-tube drainage. We aimed to evaluate our experiences in biliary drainage through endoscopic retrograde cholangiopancreatography in children with cholangitis caused by CBD. From January 2014 to December 2017, 167 children with CBD were treated in our hospital. 17 patients (10.18%) with serious cholangitis caused by CBD underwent ERCP. There were 4 males and 13 females with an age range of 10-120 months (average 56.4 months). Placement of a biliary stent was attempted for biliary drainage through endoscopic retrograde cholangiopancreatography. Of the 17 patients studied, 13 children had jaundice and 15 had elevated aminotransferases. ERCP showed CBD in all patients and a common biliopancreatic duct in 12 of 17 patients (70.6%). Five patients underwent nasobiliary drainage and 12 patients underwent biliary drainage through double pigtail tubes. All patients achieved successful biliary drainage. Postoperative pancreatitis occurred in one patient. Biochemical indicators decreased significantly in 12 patients (70.6%) on the second postoperative day. The average length of hospital stay after surgery was 4.5 (range 3-7) days. No major complications related to ERCP were observed and all children had a good prognosis so far. Endoscopic biliary drainage is a safe, simple, and reliable technique. It can be used to resolve CBD-associated cholangitis, evaluate the biliary tract and pancreatobiliary duct junction, and guide pediatric surgeons to choose the right time and the correct procedure for CBD.

Ultrasound of congenital and inherited disorders of the pediatric hepatobiliary system, pancreas and spleen.

Ultrasound is often the initial imaging examination performed of the solid organs of the pediatric abdomen. The sonographic appearance of the hepatobiliary system, pancreas and spleen changes with growth and development. This article reviews the normal US appearance of these organs in children and illustrates, through case examples, congenital and inherited conditions that affect them.

Japanese clinical practice guidelines for congenital biliary dilatation.

Until now, there have been no practical clinical guidelines for congenital biliary dilatation (CBD). In this review article, the Japanese Study Group on Congenital Biliary Dilatation (JSCBD) propose to establish clinical practice guidelines for CBD. Because the evidence-based literature is relatively small, we decided to create guidelines based on the consensus of experts, using the medical literature for reference. A total of 20 clinical questions (CQs) were considered by the members of the editorial committee responsible for the guidelines. The CQs included the distinct aspects of CBD: (1) Concepts and Pathology (three CQs); (2) Diagnosis (six CQs); (3) Pancreaticobiliary Complications (three CQs); Treatments and Prognosis (eight CQs). Each statements and comments for CQs were made by the guidelines committee members. CQs were finally approved after review by members of the editorial committee and the guidelines evaluation board of CBD. These guidelines were created to provide assistance in the clinical practice of CBD management; their contents focus on clinical utility, and they include general information on CBD to make this disease more widely recognized.

[Characteristics of Leydig cells in the newborn posterity of female rats with chronic injury of the hepatobiliary system of various genesis].

Morphological and functional features of interstitial endocrine cells (Leydig cells) in the posterity of female rats with experimental liver injury of various genesis in the neonatal period were analized. Found that in experimental rats are a reduction in the number of Leydig cells, the ratio between active and inactive endocrinocytes and as a consequence, reduction of its cell activity index.

Laparoscopically assisted extrahepatic bile duct excision with ductoplasty and a widened hepaticojejunostomy for complicated hepatobiliary dilatation.

BACKGROUND: Complicated hepatobiliary dilatation is characterized by congenital cystic dilatation of the biliary tree extending to involve the intrahepatic biliary channels. Some studies have reported on laparoscopic excision for common choledochal cyst, yet there are little reports on laparoscopic surgery for congenital choledochal cyst with intrahepatic bile duct dilatation. In this paper, we present our experiences in laparoscopic extrahepatic bile duct excision combined with ductoplasty and hepaticojejunostomy for complicated hepatobiliary dilatation. METHODS: We retrospectively studied 153 children (age ranged between 3 months and 12 years) who had undergone laparoscopic cholangiopancreatography and radical choledochal resection in our institute from 2002 to 2012. A co-existing extra- and intra-hepatic dilatation was found in 26 patients. After resecting the extrahepatic dilated duct and widening the portohepatic or intrahepatic ductal lumen (ductoplasty) under the laparoscopic video, a widened hepaticojejunostomy at the hilum was performed using a Roux-en-Y jejunal limb. RESULTS: Laparoscopic procedures were successfully performed in all children with complicated hepatobiliary dilatation and their ductal stenoses at the hilum were corrected. In 13 patients with a stricture that converged into the common hepatic duct, the stenotic segment was incised and a wide hepaticojejunostomy was completed at the porta hepatis. A constrictive confluence of the right and left hepatic duct was observed in eight cases, a bi-ductal portojejunostomy was achieved at the bifurcation after making incision in the bilateral stenotic hepatic ducts to create a large stoma. A downstream stricture of the left hepatic duct was identified and incised from the hilum to the dilated segment along the lateral wall in three cases, so that a long hepaticojejunostomy to left intrahepatic duct lay in an oblique orientation. In two cases, a septum was found in the right hepatic ductal terminal and excised through the hilar orifice. Postoperative complications were observed in two children including temporary bile leakage and hepaticojejunal anastomotic stricture each one. The intrahepatic duct dilatation was remarkably reduced in size during the follow-up. CONCLUSIONS: Laparoscopic cholangiopancreatography is a valuable method in offering an accurate delineation of complicated hepatobiliary dilatation associated pancreaticobiliary maljunction and only necessitates simple equipments. With the aid of the magnified laparoscopic view, the radical resection of extrahepatic biliary duct and correction of the portohepatic bile ductal stenosis can be exactly performed. Laparoscopic hepaticojejunostomy at the hilum is effective and safe for children with complicated hepatobiliary dilatation.

Congenital biliary tract malformation resembling biliary cystadenoma in a captive juvenile African lion (Panthera leo).

A captive 3-mo-old white African lion (Panthera leo) presented with clinical signs of acute pain and a distended abdomen. Despite emergency treatment, the lion died a few hours after presentation. Postmortem examination revealed gross changes in the liver, spleen, and lungs and an anomalous cystic structure in the bile duct. Histologic examination identified severe generalized multifocal to coalescent necrotizing and neutrophilic hepatitis, neutrophilic splenitis, and mild interstitial pneumonia, consistent with bacterial septicemia. The abnormal biliary structures resembled biliary cystadenoma. However, due to the age of the animal, they were presumed to be congenital in origin. Biliary tract anomalies and cystadenomas have been reported previously in adult lions, and this case suggests that at least some of these examples may have a congenital basis. It is unclear whether the lesion was an underlying factor in the development of hepatitis.

Macroscopic pancreatic heterotopia on a congenital biliary dilatation.

Pancreatic heterotopia is generally asymptomatic and occurs in gut-related sites. An antenatally detected subhepatic cyst was finally diagnosed to be a congenital biliary cystic dilatation (without a caudal duodenal communication) with macroscopic Heinrich Type 2 pancreatic heterotopia. The embryogenesis and pathology of the malformation are discussed.

[Laparoscopic reconstructive surgery by biliary tract malformations in children].

Treatment results of 18 children operated on various biliary tract malformations were analyzed. Laparoscopic portoenteroanastomosis by Kasai was performed in 10 patients with biliary atresia aged from 10 days to 3,5 months. Average weight of the operated children was 3640 +/- 124 g. 8 patients aged from 2 to 15 years operated on cystic common bile duct malformation. Laparoscopic dissection of cystic deformated biliary ducts with Roux-en-Y hepaticoenterostomy was performed in these cases. 5 troacars were used for both operations. First stage of portoenteroanastomosis formation represented of laparoscopic portal fibrous plate separation. By cystic common bile duct malformations, altered bile ducts were dissected. The second stage--Roux-en-Y enteroenteroanastomosis--was performed through a paraumbilical microincision. Portal anastomosis or common bile duct anastomosis was performed also laparoscopically. Recovery of patients was observed in all cases. Early postoperative course demonstrated a low invasiveness of the method. Thus, laparoscopic access can become a method of choice in treatment of biliary tract malformations in children.

Effects of the administration of pentoxifylline and prednisolone on the evolution of portal fibrogenesis secondary to biliary obstruction-an experimental study in growing animals.

BACKGROUND: Many chronic liver diseases lead to progressive hepatic fibrosis, a condition that can ultimately result in loss of organ function and severe portal hypertension necessitating hepatic transplantation. Within the last few decades, studies have been conducted to demonstrate the possibility of drug modulation of hepatic fibrogenesis. Regarding biliary obstruction, it has been suggested that administration of corticosteroids could promote better late outcomes for children with biliary atresia submitted to Kasai's portoenterostomy. Models used to test potential antifibrogenic drugs such as pentoxifylline (PTX) have not included growing animals. METHODS: In this experimental study, 119 young rats (21st or 22nd days) were submitted to laparotomy and common bile duct ligation (CBDL) or to sham surgery (SHAM). Animals were allocated into 5 groups, according to surgical procedure, and administered the following solutions: (1) CBDL + distilled water, (2) SHAM + distilled water, (3) CBDL + PTX, (4) CBDL + prednisolone (PRED), and (5) CBDL + PTX + PRED (PTX + PRED). Each group was further divided into 2 subgroups according to the length of the experiment (15 or 30 days). At the end of the defined period, animals were weighed, and a hepatic fragment was collected from each one for analyses. RESULTS: The PTX animals exhibited increased weight gain compared to animals in the PRED or PTX + PRED groups. Animals from the 3 therapeutic groups (PTX, PRED, and PTX + PRED) showed diminished collagen-filled area in portal spaces. Total portal space area was increased in the PTX group. CONCLUSIONS: Hepatic fibrosis induced by bile duct ligation in young rats could be modulated by pharmacologic interventions. Administration of PTX or PRED, or the combination of both, resulted in diminished collagen-filled areas in portal spaces.

Magnetic resonance cholangiopancreatography: techniques and applications.

Magnetic resonance cholangiopancreatography (MRCP) has become established as an essential modality in the evaluation of pancreatic and biliary abnormalities in children. New advances, such as faster imaging parameters, newer sequences, and contrast agents, are available to improve image quality. This article discusses conventional and advanced MRCP techniques used in children and applications of the techniques in evaluating common diseases of the pancreas and biliary tree.