Cystic duct stones in postcholecystectomy Mirizzi syndrome - A novel endoscopic treatment.

Mirizzi syndrome is a rare type of cholelithiasis, and the main treatment is still surgery. The development of endoscopic technology has made surgeons more active in the management of rare diseases of the biliary tract and pancreas. Here we report that our center applied the new endoscopic method to treat a Mirizzi patient with residual cystic neck duct stones after laparoscopic cholecystectomy.

Laparoscopic cholecystectomy for remnant gall bladder.

Laparoscopic cholecystectomy is one of the most frequently performed minimally invasive interventions. Inflammation during acute or subacute cholecystitis and fear of biliary duct injury can lead to unintentional remnant gall bladder retention. Diagnosing a remnant gall bladder can be challenging, and misdiagnosis or delayed diagnosis is common. Once diagnosed, completion of the cholecystectomy is recommended, which can be performed laparoscopically.

Utilidad de la colangiopancreatografía retrógrada endoscópica en el diagnóstico y tratamiento de las lesiones yatrogénicas de vía biliar tras colecistectomía / The role of endoscopic retrograde cholangiopancreatography in the management of iatrogenic bile duct injury after cholecystectomy

Introducción: la lesión yatrogénica de la vía biliar (LYVB) es una complicación con elevada morbilidad tras la colecistectomía. En los últimos años la endoscopia ha adquirido un papel fundamental en el manejo de esta patología. Métodos: estudio retrospectivo de LYVB tras colecistectomía abierta (CA) o colecistectomía laparoscópica (CL) tratadas en nuestro centro entre 1993 y 2017. Se analizaron los datos referentes a las características clínicas, tipo de lesión según la clasificación de Strasberg-Bismuth, diagnóstico, técnica de reparación y seguimiento. Resultados: se estudian 46 pacientes. La incidencia LYVB fue de 0,48%, 0,61% para las CL y 0,24% para las CA. El diagnóstico se realizó de forma intraoperatoria en 12 casos (26%) y mediante colangiopancreatografía retrógrada endoscópica (CPRE) en 10 (21,7%). Las características más comunes a todos los pacientes con LYVB fueron la colecistitis aguda (20/46, 43,5%), ingreso previo por patología biliar (16/46, 43,2%) y realización de CPRE previa a la colecistectomía (7/46, 18,9%). Los tipos de LYVB más frecuentes fueron el D (17/46, 36,9%) y el A (15/46, 32,6%). El tratamiento más empleado fue sutura primaria (13/46, 28,3%) seguido de CPRE (11/46, 23,9%) con esfinterotomía y/o endoprótesis. Además, la CPRE se utilizó en el postoperatorio inmediato de 6 pacientes (13%) con reparación quirúrgica de la LYVB para solucionar complicaciones inmediatas. Conclusión: la CPRE es útil en el manejo de la LYVB no diagnosticada intraoperatoriamente. Permite localizar la zona lesionada de la vía biliar, realizar maniobras terapéuticas y tratar de manera satisfactoria algunas complicaciones postoperatorias

Introduction: iatrogenic bile duct injury (IBDI) is a complication with a high morbidity after cholecystectomy. In recent years, endoscopy has acquired a fundamental role in the management of this pathology. Methods: a retrospective study of IBDI after open cholecystectomy (OC) or laparoscopic cholecystectomy (LC) of patients treated in our center between 1993 and 2017 was performed. Clinical characteristics, type of injury according to the Strasberg-Bismuth classification, diagnosis, repair techniques and follow-up were analyzed. Results: 46 patients were studied and IBDI incidence was 0.48%, 0.61% for LC and 0.24% for OC. A diagnosis was made intraoperatively in 12 cases (26%) and by endoscopic retrograde cholangiopancreatography (ERCP) in 10 (21.7%) cases. The most common IBDI patient characteristics were acute cholecystitis (20/46, 43.5%), previous admission due to biliary pathology (16/46, 43.2%) and ERCP prior to cholecystectomy (7/46, 18.9%). The most frequent types of IBDI were D (17/46, 36.9%) and A (15/46, 32.6%). The most commonly used treatment was primary suture (13/46, 28.3%) followed by ERCP (11/46, 23.9%) with sphincterotomy and/or stents. In addition, ERCP was performed during the immediate postoperative period in 6 (13%) patients with a surgical IBDI repair in order to resolve immediate complications. Conclusion: ERCP is useful in the management of IBDI that is not diagnosed intraoperatively. This procedure facilitates the localization of the injured area of the bile duct, therapeutic maneuvers and successful outcomes in postoperative complications

Intraoperative detection of the remnant cystic duct during robot-assisted surgery using near-infrared fluorescence imaging: a case report.

BACKGROUND: Post cholecystectomy syndrome is characterized as recurrence of symptoms as experienced before cholecystectomy. In rare cases, a remnant cystic duct is causing these symptoms and occasionally surgical resection is performed. During surgery, visualization of the biliary ducts could be difficult due to inflammation and dense adhesions. CASE PRESENTATION: In this article, we presented a 36-year old woman with post-cholecystectomy syndrome in which we evaluated the feasibility of near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) for visualization of the remnant cystic and common bile duct during robot-assisted surgery. Intraoperative visualization of the remnant biliary duct and other important structures was feasible, and resection of the remnant cystic duct was successfully performed under fluorescence guidance, without any complications. CONCLUSIONS: NIR fluorescence imaging of the biliary ducts using ICG does not prolong the operating time, and could potentially decrease the operation time in difficult procedures, because of easy and fast detection of the biliary tract. Furthermore, it is a non-hazardous and non-invasive technique, as it does not require use of radiation and cannot cause bile duct injury. This case illustrated that ICG NIR fluorescence imaging during difficult robot-assisted surgical procedures of the bile ducts is effective and therefore highly recommended.

The best approach to treat concomitant gallstones and common bile duct stones. Is ERCP still needed?

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Síndrome de sumidero secundario a colédoco-duodenostomía USE-guiada mediante prótesis de aposición luminal / Endoscopic sump syndrome secondary to EUS-guided choledocho-duodenostomy with a lumen-apposing metal stent

El síndrome de sumidero se asocia a disfunción de una colédoco-duodenostomía quirúrgica por acúmulo de detritus, barro biliar y restos alimentarios en el colédoco distal suprapapilar. La prevalencia de este tras colédoco-duodenostomías laparoscópicas es baja. En la actualidad, el drenaje mediante ecoendoscopia con prótesis metálica de aposición luminal (PMAL) constituye una nueva alternativa mínimamente invasiva para la estenosis biliar en pacientes en los que la colangiopancreatografía retrógrada endoscópica (CPRE) no resulta factible. La creciente realización de colédoco-duodenostomías mediante prótesis de aposición luminal por ecoendoscopia convierte al síndrome de sumidero en una potencial complicación hasta ahora no reportada

Sump syndrome (SS) is associated with choledocho-duodenostomy (CDD) dysfunction, which occurs due to accumulation of detritus, biliary mud and food remains in the suprapapillary distal common bile duct. The prevalence is low after CDD. Currently, biliary drainage endoscopic ultrasound (EUS)-guided with a lumen-apposing metal stent (LAMS) is a new minimally invasive alternative for biliary stenosis for patients in whom endoscopy retrograde cholangial-pancreatography (ERCP) is not feasible. CDD via EUS-guided LAMS is increasing. Thus, SS has become a potential associated complication that was previously unreported in the literature

Post-laparoscopic cholecystectomy Mirizzi syndrome induced by polymeric surgical clips: a case report and review of the literature.

BACKGROUND: Laparoscopic cholecystectomy is the gold standard treatment of gallbladder disease. Post-cholecystectomy syndrome is a severe postoperative complication which can be caused by multiple mechanisms and can present with multiple disorders. The wide use of laparoscopy induces the need to understand more clearly the presentation and pathophysiology of this syndrome. Post-cholecystectomy Mirizzi syndrome is one form of this syndrome and, according to literature, this is the first report that clearly describes it. CASE PRESENTATION: We describe the case of a 62-year-old Greek woman who underwent laparoscopic cholecystectomy because of gallstone disease. A few days after surgery, post-cholecystectomy syndrome gradually developed with mild bilirubin increase in association with epigastric pain, nausea, and vomiting. After performing ultrasound, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiopancreatography, we conducted a second laparoscopic surgery to manage the obstruction, which was converted to open surgery because of the remaining inflammation from the post-endoscopic retrograde cholangiopancreatography acute pancreatitis. Four polymeric laparoscopic clips were removed because they were identified as the cause of her post-cholecystectomy syndrome. She had a quick recovery without further complications. CONCLUSIONS: Postoperative Mirizzi syndrome induced by the migration of polymer laparoscopic clips is a rare (only one case referring to polymeric clips has been published in the literature) but a well-identified complication of laparoscopic cholecystectomy which can confuse the diagnostic and therapeutic field requiring simultaneous immediate management.

THE VALUE OF DEFORMATION OF THE BILE DUCTS IN THE DEVELOPMENT OF POSTCHOLECYSTECTOMY SYNDROME.

The aim of this study was to study meaning of bile ducts angulation in postcholecystectomical syndrome developing. MATERIALS AND METHODS: There were 27 patients to be followed-up, 15 of them were performed long-term multi-stent placement in order to pursue bile ducts angulation to be liquidate and angles. After that control estimation was having versus 12 patients of control group. RESULTS: Author have seen diminish average amount of angles, their increased and accelerate of evacuation contrast speed into duodenum. That all have correlate with severe of postcholecystectomical syndrome and positive dynamic. CONCLUSION: The bile ducts angulation have meaning in postcholecystectomical syndrome developing and long-term multi-stent placement is effective way of its treatment.

Utility of endoscopic ultrasound to diagnose remnant stones in symptomatic patients after cholecystectomy.

BACKGROUND AND STUDY AIMS: Stones in the cystic duct stump (CDS) or gallbladder remnant after cholecystectomy are difficult to identify. The aim of this study was to evaluate the utility of endoscopic ultrasound (EUS) in the diagnosis of stones in the CDS or gallbladder remnant in patients with postcholecystectomy syndrome. METHODS: A prospective study was conducted between January 2011 and December 2012 in consecutive patients with pancreaticobiliary-type pain or acute pancreatitis (n = 112) following cholecystectomy. Diagnostic modalities including EUS were used to diagnose the cause of postcholecystectomy syndrome. RESULTS: A total of 11 patients (10 %) were found to have stones in the gallbladder remnant (n = 8), CDS (n = 2), or both (n = 1). In eight patients, EUS was the first imaging procedure to make the diagnosis. Seven patients agreed to undergo repeat surgery, and six of them remained free of symptoms postoperatively after a median follow-up period of 4 months (range 1 - 13 months). CONCLUSION: EUS may be an important procedure to consider in the study of patients with symptoms after cholecystectomy, as the diagnosis of residual stones is frequently missed by other imaging modalities.

Surgical and endoscopic management of remnant cystic duct lithiasis after cholecystectomy--a case series.

INTRODUCTION: Postcholecystectomy syndrome (PCS) as a result of remnant cystic duct lithiasis (RCDL), or gallstones within the cystic duct after cholecystectomy, can cause persistent or recurrent symptoms after cholecystectomy. STUDY DESIGN: A retrospective descriptive analysis was performed for all patients with RDCL at a single institution between 2001 and 2012. Details of presentation, diagnosis, and surgical and endoscopic treatments, and outcomes were collected and analyzed. RESULTS: Twelve patients with RCDL were identified. The interval between cholecystectomy to RCDL discovery was 34.2 months (range 0.5-168 months). On a standard liver enzyme panel, 75% of patients had derangements in ≥1 indices, with the most common single laboratory test abnormality occurring in gamma-glutamyl transferase (GGT) (80%). Eight operative reports noted that the cystic duct was noticeably dilated at the time of cholecystectomy. Two patients developed a cystic duct leak (Strasberg type A bile duct injury) postoperatively, which was managed nonoperatively. Six cases of RCDL required surgery, and six were managed endoscopically. CONCLUSION: RCDL is a potential cause of postcholecystectomy syndrome, but the true incidence is unknown. Laboratory analysis and imaging are helpful in establishing the diagnosis of RCDL. Endoscopic therapy has a role in the treatment of RCDL, but surgical excision of the remnant cystic duct lithiasis may be required.

[The role of pathological changes of biliopancreatoduodenal zone in development of postcholecystectomy syndrome].

UNLABELLED: Study of the role of biliopancreatoduodenal pathological changes in the development of postcholecystectomy syndrome. MATERIAL AND METHODS: Diagnostic complex, including endosonography has been performed in 138 patients with calculous cholecystitis with a significant risk of choledocholithiasis and 112 patients with postcholecystectomy syndrome. RESULTS: The same spectrum of pathological changes of biliopancreatoduodenal zone in both groups was discovered. CONCLUSIONS: The pathological changes of biliopancreatoduodenal zone in patients with postcholecystectomy syndrome most likely to appear before the operation.

[Forced resection of the liver right lobe in the patient with cholelithiasis].

There is a case of cholelithic illness complicated by cholangiolithiasis, the treatment of which resulted in resection of the right hepatic lobe.

[Pathogenetic and diagnostic aspects of postcholecystectomy syndrome].

In the review up-to-date information about postcholecystectomy syndrome was adduced. The main underlying pathogenetic links of different functional disturbs and organic pathology were considered. Necessity of this nosologic unit common diagnostic algorithm elaboration was proved by own and literature data analysing.