Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 440
Filtrar
1.
Nihon Shokakibyo Gakkai Zasshi ; 117(11): 1001-1007, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33177252

RESUMO

An 88-year-old patient had undergone endoscopic stenting for the treatment of acute cholangitis caused by choledocholithiasis. After a year and two months, he presented with cholangitis caused by common bile duct stones that formed a stent-stone complex. Another stent was observed adjacent to the old stent;however, the cholangitis relapsed in a short term. Thus, we planned to remove as many stones as possible. These stones were not free-floating and had affected the bile duct. Endoscopic mechanical lithotripsy was attempted;however, it failed. He was successfully treated using peroral cholangioscopy and electrohydraulic lithotripsy. After three months, he developed cholangitis because of the recurrence of choledocholithiasis. After removing as many stones as possible and performing endoscopic stenting, he was followed up as an outpatient. He had no symptoms for seven months after the procedure.


Assuntos
Coledocolitíase , Cálculos Biliares , Litotripsia , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos , Masculino , Stents , Resultado do Tratamento
4.
Chirurgia (Bucur) ; 115(4): 526-529, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876027

RESUMO

Surgical clip migration in the common bile duct with consecutive stone formation is a rare occurrence after laparoscopic cholecystectomy, less than 100 cases being reported so far. We report a case of a 55-year-old woman with obstructive jaundice due to bile duct stone formed around a migrated surgical clip 9 years after laparoscopic cholecystectomy. The patient presented with pain in the upper abdomen and jaundice. Abdominal ultrasound diagnosed dilation of the common bile duct and intrahepatic bile ducts. The diagnosis was confirmed by computed tomography which revealed a metal clip in the distal part of the common bile duct. The patient was managed successfully by endoscopic retrograde cholangiopancreatography (ERCP) and the surgical clip was retrieved using the Dormia basket. The exact mechanism of clip migration is not fully understood but may be explained by local inflammation and ineffective clipping. Although a rare occurrence, clip migration should not be excluded when considering the differential diagnosis of patients presenting with obstructive jaundice or cholangitis after laparoscopic cholecystectomy. Minimally invasive management by ERCP is the procedure of choice for migrated clips related complications but surgical common bile duct exploration may be necessary.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Coledocolitíase/etiologia , Ducto Colédoco/cirurgia , Migração de Corpo Estranho/etiologia , Icterícia Obstrutiva/etiologia , Instrumentos Cirúrgicos/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia Laparoscópica/instrumentação , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Ducto Colédoco/diagnóstico por imagem , Remoção de Dispositivo , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/cirurgia , Humanos , Icterícia Obstrutiva/diagnóstico por imagem , Icterícia Obstrutiva/cirurgia , Pessoa de Meia-Idade , Resultado do Tratamento
6.
Ann R Coll Surg Engl ; 102(8): 598-600, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32538107

RESUMO

INTRODUCTION: Common bile duct stones are present in 10% of patients with symptomatic gallstones. One-third of UK patients undergoing cholecystectomy will have preoperative ductal imaging, commonly with magnetic resonance cholangiopancreatography. Intraoperative laparoscopic ultrasound is a valid alternative but is not widely used. The primary aim of this study was to assess cost effectiveness of laparoscopic ultrasound compared with magnetic resonance cholangiopancreatography. MATERIALS AND METHODS: A prospective database of all patients undergoing laparoscopic cholecystectomy between 2015 and 2018 at a district general hospital was assessed. Inclusion criteria were all patients, emergency and elective, with symptomatic gallstones and suspicion of common bile duct stones (derangement of liver function tests with or without dilated common bile duct on preoperative ultrasound, or history of pancreatitis). Patients with known common bile duct stones (magnetic resonance cholangiopancreatography or failed endoscopic retrograde cholangiogram) were excluded. Ninety-day morbidity data were also collected. RESULTS: A total of 420 (334 elective and 86 emergency) patients were suspected to have common bile duct stones and were included in the study. The cost of a laparoscopic ultrasound was £183 per use. The cost of using the magnetic resonance cholangiopancreatography unit was £365 per use. Ten postoperative magnetic resonance cholangiopancreatographies were performed for inconclusive intraoperative imaging. The estimated cost saving was £74,650. Some 128 patients had common bile duct stones detected intraoperatively and treated. There was a false positive rate of 4.7%, and the false negative rate at 90 days was 0.7%. laparoscopic ultrasound use saved 129 bed days for emergency patients and 240 magnetic resonance cholangiopancreatography hours of magnetic resonance imaging. CONCLUSION: The use of laparoscopic ultrasound during laparoscopic cholecystectomy for the detection of common bile duct stone is safe, accurate and cost effective. Equipment and maintenance costs are quickly offset and hospital bed days can be saved with its use.


Assuntos
Colecistectomia Laparoscópica , Coledocolitíase , Cuidados Intraoperatórios/economia , Laparoscopia/economia , Ultrassonografia/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia por Ressonância Magnética , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Colecistectomia Laparoscópica/estatística & dados numéricos , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Análise Custo-Benefício , Feminino , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
BMJ Case Rep ; 13(3)2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32169979

RESUMO

The management of choledocholithiasis in pregnancy can present a challenge due to radiation risk to the fetus and the possibility of severe maternal pancreatitis. We describe a case in which both these risks were avoided using a trans-cystic stent placed under endoscopic guidance during laparoscopic cholecystectomy.


Assuntos
Colecistectomia Laparoscópica/métodos , Coledocolitíase/cirurgia , Esfinterotomia Endoscópica/métodos , Adulto , Assistência ao Convalescente , Colangiopancreatografia por Ressonância Magnética/métodos , Coledocolitíase/diagnóstico por imagem , Feminino , Humanos , Gravidez , Stents , Resultado do Tratamento , Ultrassonografia/métodos
9.
J Laparoendosc Adv Surg Tech A ; 30(3): 267-272, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32053025

RESUMO

Background: Despite the effectiveness of laparoscopic common bile duct (CBD) surgery, no case series details the use and advantages of laparoscopic CBD exploration (LCBDE) without use of intraoperative cholangiography (IOC) in endoscopic retrograde cholangiopancreatography (ERCP) failure. Therefore, we present a case series regarding our success with LCBDE in managing CBD stones (CBDSs) using laparoscopic technique without IOC. Materials and Methods: We performed a descriptive retrospective observational study. Patients with CBDSs, alone or along with gallbladder stones, were treated through LCBDE with primary CBD closure after failed ERCP. Results: All patients underwent LCBDE with choledocotomy and primary duct closure. Patients with gallbladder stones underwent laparoscopic cholecystectomy (78%). All procedures were successful, and no conversions occurred. Surgery duration averaged 106 minutes. Intraoperative bleeding averaged 15 cc, and no mortalities occurred. No patients required additional surgery or intensive care unit admission. Hospitalization duration averaged 5 days. Conclusions: Therefore, a laparoscopic approach with primary CBD closure after failed ERCP for complex CBDSs is safe and effective.


Assuntos
Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Ducto Colédoco/cirurgia , Laparoscopia/métodos , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia Laparoscópica , Coledocolitíase/complicações , Colômbia , Feminino , Cálculos Biliares/complicações , Cálculos Biliares/cirurgia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Reoperação , Estudos Retrospectivos , Falha de Tratamento , Técnicas de Fechamento de Ferimentos
10.
Clin J Gastroenterol ; 13(1): 110-115, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31264080

RESUMO

We present an extremely rare case of carcinosarcoma with 4 different tumor components in an 88-year-old female. After a diagnosis of acute cholecystitis, we performed percutaneous transhepatic gallbladder drainage in the patient without success, followed by a cholecystectomy and choledocholithotomy. The mass was a 60 × 25 mm polypoid lesion of the gallbladder identified histologically as a carcinosarcoma with adenocarcinoma, neuroendocrine carcinoma, undifferentiated carcinoma and chondrosarcoma components. The biliary-type adenocarcinoma portion exhibited acinar growth patterns with columnar cells having large and markedly hyperchromatic nuclei. These tumor cells were immunohistochemically positive for MUC1 and CDX2. The neuroendocrine carcinoma, small cell type, cells were densely packed and small, with scant cytoplasm, finely granular nuclear chromatin and absence of nucleoli. The mitotic index was high. These tumor cells were immunohistochemically positive for synaptophysin, Ki-67 (index 40%), MUC1, CDX2 and c-Kit. The undifferentiated carcinoma consisted exclusively of spindle cells containing large, markedly hyperchromatic nuclei with a high mitotic index. These tumor cells were immunohistochemically positive for AE1/AE3. The chondrosarcoma was composed of blue-gray chondroid matrix and atypical chondrocytes containing large, hyperchromatic nuclei. These tumor cells were immunohistochemically positive for S100. Its attributes might be suggestive of a greater malignant potential and pathogenesis of carcinosarcoma.


Assuntos
Adenocarcinoma/patologia , Carcinoma Neuroendócrino/patologia , Carcinossarcoma/patologia , Condrossarcoma/patologia , Neoplasias da Vesícula Biliar/patologia , Tumor Misto Maligno/patologia , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/metabolismo , Idoso , Fator de Transcrição CDX2/metabolismo , Carcinoma/complicações , Carcinoma/diagnóstico por imagem , Carcinoma/metabolismo , Carcinoma/patologia , Carcinoma Neuroendócrino/complicações , Carcinoma Neuroendócrino/diagnóstico por imagem , Carcinoma Neuroendócrino/metabolismo , Carcinossarcoma/complicações , Carcinossarcoma/diagnóstico por imagem , Carcinossarcoma/metabolismo , Colecistectomia , Colecistite Aguda/complicações , Colecistite Aguda/diagnóstico por imagem , Colecistite Aguda/cirurgia , Colecistolitíase/complicações , Colecistolitíase/diagnóstico por imagem , Colecistolitíase/cirurgia , Coledocolitíase/complicações , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Condrossarcoma/complicações , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/metabolismo , Feminino , Neoplasias da Vesícula Biliar/complicações , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/metabolismo , Humanos , Antígeno Ki-67/metabolismo , Tumor Misto Maligno/complicações , Tumor Misto Maligno/diagnóstico por imagem , Tumor Misto Maligno/metabolismo , Mucina-1/metabolismo , Proteínas Proto-Oncogênicas c-kit/metabolismo , Proteínas S100/metabolismo , Tomografia Computadorizada por Raios X
12.
Langenbecks Arch Surg ; 404(8): 985-992, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31822986

RESUMO

PURPOSE: Transcystic laparoscopic common bile duct exploration (LCBDE) seems safer than transductal LCBDE and is associated with fewer biliary complications. It has traditionally been limited to smaller bile duct stones however. This study aimed to assess the ability of laser-assisted bile duct exploration by laparoendoscopy (LABEL) to increase the rate of successful transcystic LCBDE in patients with bile duct stones at the time of laparoscopic cholecystectomy. METHODS: Patients undergoing LCBDE between 2014 and 2018 were retrospectively analysed. Baseline demographic and medical characteristics were recorded, as well as intra-operative findings and post-procedure outcomes. Standard LCBDE via the transcystic route was initially attempted in all patients, and LABEL was only utilised if there was failure to achieve transcystic duct clearance. The transductal route was utilised for failed transcystic extraction. RESULTS: One hundred and seventy-nine consecutive patients underwent LCBDE; 119 (66.5%) underwent unaided transcystic extraction, 29 (16.2%) required LABEL to achieve transcystic extraction and 31 (17.3%) failed transcystic extraction (despite the use of LABEL in 7 of these cases) and hence required conversion to transductal LCBDE. As such, LABEL could be considered to increase the rate of successful transcystic extraction from 66.5% (119/179) to 82.7% (148/179). Patients requiring LABEL were however more likely to experience major complications (CD III-IV 5.6% vs 0.7%, p = 0.042) although none were specifically attributable to the laser intra-operatively. CONCLUSIONS: LABEL is an effective adjunct to LCBDE that improves the rate of successful transcystic extraction.


Assuntos
Colecistectomia Laparoscópica/métodos , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Litotripsia a Laser/métodos , Adulto , Idoso , Colecistectomia Laparoscópica/efeitos adversos , Coledocolitíase/fisiopatologia , Estudos de Coortes , Terapia Combinada , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Estados Unidos
14.
Rev Esp Enferm Dig ; 111(12): 909-913, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31633375

RESUMO

BACKGROUND: biliary complications are frequent after orthotopic liver transplantation and the management of these complications with endoscopic retrograde cholangiopancreatography (ERCP) is available. The aims of the study were to analyze the experience in the endoscopic management of biliary complications after liver transplantation in a third level center. Furthermore, the factors associated with higher rates of technical and clinical success were determined. METHODS: this was an observational retrospective study of ERCPs performed in patients with biliary complications after liver transplantation between February 2012 and January 2017. The factors analyzed were: demographics, time between transplantation and ERCP, indications for ERCP, strategy of stenting (only plastic stents, only self-expandable metallic stents, plastic followed by metallic stents and metallic followed by plastic stents), technical and clinical success and complications. RESULTS: one hundred and sixty-eight endoscopies were performed in 58 patients. Thirty-three patients (56.9%) presented with early complications. The most frequent indication for ERCP was anastomotic stenosis (57.8%). Technical success in the first ERCP was achieved in 43 patients (74.1%). Early onset of biliary complications was associated with higher rates of technical success (OR: 6.49; p: 0.036). Clinical success was obtained in 36 cases (62.1%). Patients with early complications had a higher probability of having good clinical response (OR: 11.16; p: 0.033). The results were worse in patients with only plastic stents (50% of clinical success). Eleven complications were observed among 168 ERCPs (6.54%), including two pancreatitis, five bleeding events, three cholangitis and one micro-perforation. CONCLUSIONS: ERCP is safe and useful in the management of biliary complications after liver transplantation. Early onset of complications is associated with better results. Some patients will need repeated procedures to obtain a good clinical response.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/terapia , Stents Metálicos Autoexpansíveis , Fístula Anastomótica/diagnóstico por imagem , Fístula Anastomótica/terapia , Ductos Biliares/diagnóstico por imagem , Ductos Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/terapia , Colestase/diagnóstico por imagem , Colestase/terapia , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/terapia , Dilatação/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos , Esfinterotomia Endoscópica , Fatores de Tempo
15.
J Med Case Rep ; 13(1): 320, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31656202

RESUMO

BACKGROUND: Extrahepatic bile duct duplication is an extremely rare congenital anomaly in which two common bile ducts exist. There are five different types of this anomaly and we present an unusual variant of duplication of an extrahepatic biliary system of type Va variety. CASE PRESENTATION: This case report describes a 63-year-old women from rural Nepal who presented with type Va of duplicated extrahepatic bile duct, with chronic calculous cholecystitis and choledocholithiasis. She was managed with cholecystectomy with hepatic ductoplasty and hepaticojejunostomy. CONCLUSION: A rare case of double common bile duct (type Va) complicated by choledocholithiasis, cholangitis, and chronic cholecystitis is reported here. Rare cases are sometimes overlooked by modern diagnostic techniques. Correct diagnosis helps appropriate surgical intervention.


Assuntos
Ducto Colédoco/anormalidades , Colangiopancreatografia por Ressonância Magnética , Colangite/diagnóstico , Colecistite/diagnóstico , Coledocolitíase/diagnóstico por imagem , Ducto Colédoco/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade
16.
J Laparoendosc Adv Surg Tech A ; 29(11): 1481-1485, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31566486

RESUMO

Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC) are standard of care for pediatric choledocholithiasis. Patients typically undergo separate procedures during hospitalization. Collaboration between surgical and gastroenterology services led to performance of both procedures concurrently during one anesthetic. We hypothesized that concurrent procedures would reduce costs without increasing complications as compared with separate procedures. Materials and Methods: We evaluated patients admitted to our institution from 2013 to 2018 with choledocholithiasis who underwent both ERCP and LC during the same admission. Fourteen patients underwent both procedures during concurrent anesthetic. Forty-two patients who underwent LC and ERCP under separate anesthetics were randomly selected to perform a 3:1 matched case-control study. Demographic and clinical data were collected, including imaging and laboratory findings, outcomes, and costs. Comparative analysis was completed with Fisher's exact and Mann-Whitney U tests. Results: On presentation, there was no difference in common bile duct size, total bilirubin, or white blood cell count between the concurrent and separate procedure cohorts. Significantly, there was no difference in total length of anesthesia (117.9 ± 40 minutes versus 119.6 ± 52 minutes, P = .747). There were also no differences in complications, emergency department visits, or readmissions. Patients who underwent concurrent procedures had significantly lower total cost of stay ($45,597 ± 11,513 versus $61,008 ± 17,960, P = .006). Conclusions: In pediatric patients with choledocholithiasis, performing LC and ERCP may be performed concurrently during one anesthetic, which decreases costs without increasing in anesthesia time or complications.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia Laparoscópica , Coledocolitíase/cirurgia , Adolescente , Anestesia , Estudos de Casos e Controles , Criança , Pré-Escolar , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde , Humanos , Tempo de Internação , Masculino , Duração da Cirurgia , Readmissão do Paciente , Complicações Pós-Operatórias
17.
Z Gastroenterol ; 57(10): 1196-1199, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31610582

RESUMO

Many patients with intrahepatic cholelithiasis need surgical treatment during their life. For patients with hepatolithiasis, conventional therapy methods suggest partial hepatectomy or hepatic transplantation, while both kinds of surgery carry a considerable risk and trauma. Under such conditions, percutaneous transhepatic cholangioscopic lithotripsy provides an alternative method for hepatolithiasis treatment. Conventional rigid choledochoscope applied in percutaneous transhepatic cholangioscopic lithotripsy often lack sufficient flexibility for complete intrahepatic bile duct inspection. In this article, we report a case of one patient with complex hepatolithiasis and choledocholithiasis who received percutaneous transhepatic cholangioscopic lithotripsy using the newly-developed soft fiber-optic choledochoscope. This treatment represents a safe and effective outcome. We came to the conclusion that soft fiber-optic choledochoscope guided percutaneous transhepatic cholangioscopic lithotripsy seems a promising treatment option for selected patients with hepatolithiasis, especially for those who cannot accept conventional methods.


Assuntos
Coledocolitíase , Litotripsia , Hepatopatias , Idoso , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/patologia , Ductos Biliares Intra-Hepáticos/cirurgia , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/patologia , Coledocolitíase/cirurgia , Humanos , Laparoscopia/instrumentação , Litotripsia/instrumentação , Fígado/diagnóstico por imagem , Fígado/patologia , Fígado/cirurgia , Hepatopatias/diagnóstico por imagem , Hepatopatias/patologia , Hepatopatias/cirurgia , Masculino , Resultado do Tratamento
18.
Scand J Gastroenterol ; 54(9): 1166-1171, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31526285

RESUMO

Objectives: Two-stage treatment of common bile duct stones by Endoscopic Retrograde Cholangio-Pancreatography and subsequent laparoscopic cholecystectomy is well established. In many cases multiple procedures are needed before clearance of the common bile duct is obtained. This study aimed to describe the clinical course from common bile duct stone diagnosis to successful clearance. Materials and Methods: A prospective observational study from 2011 to 2014 of consecutive patients diagnosed with common bile duct stones undergoing Endoscopic Retrograde Cholangio-Pancreatography at a public university hospital. Results: In this study 297 patients with common bile duct stones were identified. More than one Endoscopic Retrograde Cholangio-Pancreatography was performed in 174 (59%) patients and more than two in 51(17%) before clearance. A sphincterotomy was performed in 269 (91%) patients and 189 (64%) had a stent inserted. Bleeding occurred in 17 (6%) requiring injection treatment and post procedure complications occurred in 38 (13%). Subsequent laparoscopic cholecystectomy was performed in 180 (61%) patients. Overall, the patients were hospitalized for 11 (8.5) days and the length of treatment from diagnose to stone clearance was 49 (84.5) days. Overweight, pancreatitis at admission, universal anesthesia, and expert level endoscopist inversely determined common bile duct clearance failure. Conclusions: Common bile duct clearance by Endoscopic Retrograde Cholangio-Pancreatography requires multiple procedures and complications are frequent leading to prolonged treatment and hospitalization suggesting a limited efficacy.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia Laparoscópica , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/cirurgia , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/cirurgia , Dinamarca , Feminino , Hospitais Universitários , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Estudos Prospectivos
19.
Rev Esp Enferm Dig ; 111(10): 806-808, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31538486

RESUMO

Low phospholipid-associated cholelithiasis (LPAC) syndrome is characterized by early intrahepatic and symptomatic gallstones leading to cholangitis, acute pancreatitis and biliary colic. It has been associated with loss of function variants in the ABCB4 gene. ABCB4 encodes for a phospholipid translocator at the canalicular membrane of the hepatocyte, which "flops" phosphatidylcholine into bile. The autosomal recessive form is the most common, although autosomal dominant forms have also been described. We report the first family with autosomal dominant LPAC syndrome due to heterozygosity of the loss of function mutation c.2932T>C in ABCB4, identified by targeted next generation sequencing.


Assuntos
Subfamília B de Transportador de Cassetes de Ligação de ATP/genética , Colelitíase/genética , Adulto , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Colagogos e Coleréticos/uso terapêutico , Colangiopancreatografia Retrógrada Endoscópica , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/tratamento farmacológico , Colelitíase/tratamento farmacológico , Feminino , Genes Dominantes , Humanos , Perda de Heterozigosidade , Imagem por Ressonância Magnética , Masculino , Linhagem , Fosfolipídeos/deficiência , Irmãos , Ácido Ursodesoxicólico/uso terapêutico , Adulto Jovem
20.
Hepatobiliary Pancreat Dis Int ; 18(6): 557-561, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31474445

RESUMO

BACKGROUND: Laparoscopic common bile duct exploration (LCBDE) is one of the minimally invasive options for choledocholithiasis. Primary closure of the common bile duct (CBD) upon completion of laparoscopic choledochotomy is safe in selected patients. The present study aimed to evaluate the feasibility and safety of primary closure of CBD after LCBDE in patients aged 70 years or older. METHODS: A total of 116 patients (51 males and 65 females) who suffered from choledocholithiasis and underwent primary closure of the CBD (without T-tube drainage) after LCBDE from January 2003 to December 2017 were recruited. They were classified into two groups according to age: group A (≥70 years, n = 56), and group B (<70 years, n = 60). The preoperative characteristics, intraoperative details, and postoperative outcomes of the two groups were evaluated. RESULTS: The mean operative time was 172.02 min for group A and 169.92 min for group B (P = 0.853). The mean hospital stay was 7.40 days for group A and 5.38 days for group B (P < 0.001). Bile leakage occurred in two patients in group A and one in group B (3.57% vs 1.67%, P = 0.952). There were no significant differences in the rates of postoperative complications and mortality between the two groups. At median follow-up time of 60 months, stone recurrence was detected in one patient in group A and two in group B (1.79% vs 3.33%, P = 1.000). Stenosis of CBD was not observed in group A and slight stenosis in one patient in group B (0 vs 1.67%, P = 1.000). CONCLUSION: Primary closure of the CBD upon completion of laparoscopic choledochotomy is safe and feasible in elderly patients ≥70 years old.


Assuntos
Colecistectomia Laparoscópica , Coledocolitíase/cirurgia , Ducto Colédoco/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/mortalidade , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/mortalidade , Ducto Colédoco/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...