Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 92
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
World J Gastroenterol ; 25(13): 1531-1549, 2019 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-30983814

RESUMO

Surgeries for benign diseases of the extrahepatic bile duct (EHBD) are classified as lithotomy (i.e., choledocholithotomy) or diversion (i.e., choledochojejunostomy). Because of technical challenges, laparoscopic approaches for these surgeries have not gained worldwide popularity. The right upper quadrant of the abdomen is advantageous for laparoscopic procedures, and laparoscopic choledochojejunostomy is safe and feasible. Herein, we summarize tips and pitfalls in the actual procedures of choledocholithotomy. Laparoscopic choledocholithotomy with primary closure of the transductal incision and transcystic C-tube drainage has excellent clinical outcomes; however, emergent biliary drainage without endoscopic sphincterotomy and preoperative removal of anesthetic risk factors are required. Elastic suture should never be ligated directly on the cystic duct. Interrupted suture placement is the first choice for hemostasis near the EHBD. To prevent progressive laceration of the EHBD, full-layer interrupted sutures are placed at the upper and lower edges of the transductal incision. Cholangioscopy has only two-way operation; using dedicated forceps to atraumatically grasp the cholangioscope is important for smart maneuvering. The duration of intraoperative stone clearance accounts for most of the operative time. Moreover, dedicated forceps are an important instrument for atraumatic grasping of the cholangioscope. Damage to the cholangioscope requires expensive repair. Laparoscopic approach for choledocholithotomy involves technical difficulties. I hope this document with the visual explanation and literature review will be informative for skillful surgeons.


Assuntos
Coledocolitíase/cirurgia , Coledocostomia/métodos , Laparoscopia/métodos , Complicações Pós-Operatórias/prevenção & controle , Colangiografia , Coledocolitíase/diagnóstico por imagem , Coledocostomia/efeitos adversos , Coledocostomia/instrumentação , Coledocostomia/normas , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/cirurgia , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Laparoscopia/normas , Complicações Pós-Operatórias/etiologia , Guias de Prática Clínica como Assunto , Técnicas de Sutura/normas , Resultado do Tratamento
3.
J Gastrointestin Liver Dis ; 28(1): 125-128, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30851182

RESUMO

We present five cases of pylorus-preserving pancreaticoduodenectomy (PPPD) after endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CD) using a lumen-apposing metal stent (LAMS) as a bridge to surgery in patients with resectable distal malignant biliary obstruction and failed endoscopic retrograde cholangiopancreatography (ERCP). The patients underwent an EUS-CD using EC-LAMS, the bile duct being accessed using the transbulbar approach. The technical success rate of EUS-CD was 100%. No procedure-related adverse events occurred. All patients underwent PPPD with a technical success rate of 100%. The presence of a transduodenal LAMS did not impede surgery. No biliary or duodenal fistula occurred in the patients. Pancreatic fistulas with late bleeding were observed in two patients (one fatal). These few cases indicate that PPPD after EUS-CD using LAMS is feasible and safe. EUS-CD should be performed irrespective of the stage of the disease, also for patients fit for surgery. Additional larger prospective studies are required to confirm this preliminary data, in particular for possible interference with postoperative outcomes.


Assuntos
Coledocostomia/métodos , Colestase/cirurgia , Neoplasias do Sistema Digestório/cirurgia , Drenagem/métodos , Duodenostomia/métodos , Endossonografia/métodos , Cuidados Paliativos/métodos , Pancreaticoduodenectomia , Ultrassonografia de Intervenção/métodos , Idoso , Idoso de 80 Anos ou mais , Coledocostomia/instrumentação , Colestase/diagnóstico por imagem , Colestase/etiologia , Neoplasias do Sistema Digestório/complicações , Neoplasias do Sistema Digestório/diagnóstico por imagem , Drenagem/instrumentação , Duodenostomia/instrumentação , Humanos , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
4.
Transplant Proc ; 51(1): 44-49, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30736977

RESUMO

BACKGROUND AND AIMS: T-tube placement during choledochocholedochostomy (CCS) associated with liver transplantation (LT) remains controversial. This study was designed to validate the results of an earlier prospective randomized controlled trial (RCT) on use versus nonuse of the T-tube during CCS associated with LT. METHODS: Prospective cohort study. The primary outcome was the overall incidence of biliary complications (BCs). RESULTS: In total, 405 patients were included, and the median overall monitoring period was 29 months (interquartile range: 13-47 months). Selective use of the T-tube reduced BCs (23% vs 13%; P = .003), of which 75% were type IIIa or less in the Clavien-Dindo classification. The overall BC rate did not differ between patients with versus without T-tube placement. CONCLUSIONS: We confirmed that selective use of a rubber T-tube during CCS associated with LT, following the principles established in our prospective RCT, reduced the rate of BC by 10% without detriment, even after enrolling patients at an a priori greater risk of BCs than were the RCT patients.


Assuntos
Coledocostomia/instrumentação , Transplante de Fígado/instrumentação , Adulto , Coledocostomia/métodos , Feminino , Humanos , Incidência , Transplante de Fígado/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto
5.
Turk J Gastroenterol ; 29(4): 511-514, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30249569

RESUMO

We present the case of a 51-year-old woman with a history of uterine cancer who presented to the emergency room with a clinical picture of acute cholangitis. An abdominal ultrasound and a computed tomography scan were performed, revealing a gigantic lymphadenopathy mass compressing the common bile duct and the duodenum. After failure to perform an endoscopic retrograde cholangiopancreatography (ERCP) due to a modified anatomy, we performed an endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) and placed a Hot AXIOS 10Fr/10 mm stent with efficient biliary drainage. In addition, we inserted a duodenal uncoated 120/22 mm expandable metallic stent. EUS-CDS presents a valid alternative in patients with failed ERCP and should be considered as an important option for rapid biliary decompression in patients with acute cholangitis.


Assuntos
Colangite/cirurgia , Coledocostomia/instrumentação , Endossonografia/instrumentação , Stents Metálicos Autoexpansíveis , Ultrassonografia de Intervenção/instrumentação , Doença Aguda , Ductos Biliares/cirurgia , Coledocostomia/métodos , Drenagem/instrumentação , Drenagem/métodos , Endossonografia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Ultrassonografia de Intervenção/métodos
8.
Gastrointest Endosc ; 87(4): 1138-1146, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28843583

RESUMO

BACKGROUND AND AIMS: EUS-guided choledochoduodenostomy (EUS-CDS) using conventional tubular stents has been successfully performed. However, EUS-CDS carries a high risk of bile leakage with attendant adverse events. This study aimed to prospectively evaluate the long-term outcome of EUS-CDS using a dedicated lumen-apposing metal stent (LAMS). METHODS: Nineteen patients (mean age, 70.6 years; 12 men) with unresectable malignant diseases were treated in 5 tertiary referral centers. EUS-CDS was performed using a fully covered LAMS with a cautery-enhanced delivery system for EUS-CDS. RESULTS: All stents were successfully deployed without any adverse events. Jaundice improved in 79% of the patients within 7 days and finally in 95%. In 95% of patients the stents remained in good anastomotic position without migration or dislocation during the follow-up period (median, 184 days; range, 12-819). One patient had a fever the day after stent placement. During the follow-up period 5 patients had secondary stent obstruction because of food residue (n = 2), kinking (n = 1), suspected tumor ingrowth (n = 1), and spontaneous dislodgement (n = 1). Five patients developed obstruction in the second portion of the duodenum. The overall adverse event rate was 36.8% (7/19), mostly with mild severity. CONCLUSIONS: This study revealed that the novel dedicated LAMS used has high technical and clinical success rates for EUS-CDS. The adverse events and patency rates are inferior to the historically reported data of a conventional transpapillary metal stent. Development of a more suitable dedicated LAMS is anticipated.


Assuntos
Coledocostomia/métodos , Colestase/cirurgia , Neoplasias do Sistema Digestório/complicações , Stents , Idoso , Idoso de 80 Anos ou mais , Coledocostomia/efeitos adversos , Coledocostomia/instrumentação , Colestase/etiologia , Endoscopia do Sistema Digestório/efeitos adversos , Endoscopia do Sistema Digestório/métodos , Endossonografia , Feminino , Humanos , Icterícia Obstrutiva/etiologia , Icterícia Obstrutiva/cirurgia , Masculino , Metais , Pessoa de Meia-Idade , Estudos Prospectivos , Falha de Prótese , Implantação de Prótese/efeitos adversos , Implantação de Prótese/métodos , Stents/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção
9.
Med Sci Monit ; 23: 4328-4333, 2017 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-28883388

RESUMO

BACKGROUND T-tube placement in the common bile duct (CBD) is a surgical alternative to bile duct reconstruction in cholecystectomy for cholecysto-choledocholithiasis, or gallstones. The aim of this retrospective clinical study was to investigate the incidence of late complications of T-tube placement. MATERIAL AND METHODS Retrospective review identified 35 patients who had T-tube placement during cholecystectomy. Clinical data were collected on surgical indications, patient demographics, and clinical symptoms. Ultrasound (US) was used measure the diameter of the common bile duct (CBD), intrahepatic ducts, and presence or absence of stones in the CBD. Data from laboratory investigations included the aspartate aminotransferase-to-platelet ratio index (APRI), which was used as a non-invasive method to evaluate both cholestasis and liver fibrosis. RESULTS Of the 35 patients included in the study, 33 (94.3%) underwent open cholecystectomy, CBD exploration, and T-tube placement due to cholecysto-choledocholithiasis. The remaining two patients (5.7%) underwent primary CBD repair and T-tube placement secondary to CBD injury. The mean follow-up period after T-tube placement was 69 months. In patients with T-tube placement, the CBD diameters ranged from 4-21 mm, were normal in 20 patients (57.1%), dilated in 15 patients (42.9%), with the mean CBD diameter being 8.91±4.82 mm. No residual or recurrent CBD calculus and no clinical or laboratory evidence of cholangitis or cholestasis were found. CONCLUSIONS A retrospective clinical study at a single surgical center, showed that T-tube placement during open cholecystectomy and CBD exploration was a safe procedure that did not result in late complications.


Assuntos
Coledocolitíase/cirurgia , Coledocostomia/instrumentação , Colestase/cirurgia , Próteses e Implantes , Adulto , Colecistectomia Laparoscópica , Coledocostomia/métodos , Colestase/patologia , Ducto Colédoco/cirurgia , Constrição Patológica/patologia , Constrição Patológica/cirurgia , Feminino , Cálculos Biliares/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
11.
Gastrointest Endosc ; 85(5): 1067-1075, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27650270

RESUMO

BACKGROUND AND AIMS: Although fully covered self-expandable metal stents (FCSEMSs) have been commonly used for EUS-guided biliary drainage (EUS-BD), FCSEMS migration is a main limitation of this procedure. In the present study we evaluated the technical and clinical success rates, adverse events, and long-term outcomes of a newly developed hybrid stent that has been customized for EUS-BD. METHODS: From September 2011 to May 2015, 54 consecutive patients with biliary obstruction were enrolled in this prospective, observational study. These patients were candidates for alternative BD techniques because of failed ERCP. The hybrid metal stent used for EUS-BD in this study was partially covered, had anchoring flaps, and is commercially available in Korea. RESULTS: EUS-guided hepaticogastrostomy (EUS-HGS) was performed in 21 patients and EUS-guided choledochoduodenostomy (EUS-CDS) in 33 patients. The technical and clinical success rates of EUS-BD were 100% (54/54) and 94.4% (51/54), respectively. Immediate adverse events developed after EUS-BD in 9 patients (16.6%; cholangitis in 3, bleeding in 2, self-limited pneumoperitoneum in 3, and abdominal pain in 1). Proximal or distal stent migration was not observed during the follow-up period (median, 148.5 days; IQR, 79.7-244), and the mean stent patency duration was 166.3 days and 329.1 days in the EUS-HGS and EUS-CDS groups, respectively. CONCLUSIONS: EUS-BD with the hybrid metal stent is technically feasible and can effectively treat biliary obstruction after failed ERCP. EUS-BD with the hybrid metal stent can reduce stent-related adverse events, especially stent migration.


Assuntos
Ductos Biliares Intra-Hepáticos/cirurgia , Coledocostomia/instrumentação , Colestase Intra-Hepática/cirurgia , Drenagem/instrumentação , Gastrostomia/instrumentação , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos do Sistema Biliar/instrumentação , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Coledocostomia/métodos , Drenagem/métodos , Endossonografia , Feminino , Gastrostomia/métodos , Humanos , Fígado/cirurgia , Masculino , Metais , Pessoa de Meia-Idade , Estudos Prospectivos , Cirurgia Assistida por Computador/métodos , Resultado do Tratamento
13.
Pediatr Transplant ; 20(5): 647-51, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27239056

RESUMO

Routine use of transanastomotic biliary stents (RTBS) for biliary reconstruction in liver transplantation (LT) is controversial, with conflicting outcomes in adult randomized trials. Pediatric literature contains limited data. This study is a retrospective review of 99 patients who underwent first LT (2005-2014). In 2011, RTBS was discontinued at our center. This study describes biliary complications following LT with and without RTBS. 56 (56%) patients had RTBS. Median age at LT was 1.9 yr (IQR 0.7, 8.6); 55% were female. Most common indication for LT was biliary atresia (36%). Most common biliary reconstruction was Roux-en-Y choledochojejunostomy (75% with RTBS, 58% without RTBS, p = 0.09). Biliary complications (strictures, bile leaks, surgical revision) occurred in 23% without significant difference between groups (20% with RTBS, 28% without RTBS, p = 0.33). Patients with RTBS had routine cholangiography via the tube at 6-8 wk; thus, significantly more patients with RTBS had cholangiograms (91% vs. 19%, p < 0.0001). There was no difference in the number of patients who required therapeutic intervention via endoscopic or percutaneous transhepatic cholangiography (11% with RTBS, 19% no RTBS, p = 0.26). Routine use of RTBS for biliary reconstruction in pediatric LT may not be necessary, and possibly associated with need for costlier, invasive imaging without improvement in outcomes.


Assuntos
Coledocostomia/instrumentação , Transplante de Fígado/métodos , Complicações Pós-Operatórias/prevenção & controle , Stents , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
14.
World J Gastroenterol ; 22(16): 4264-9, 2016 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-27122677

RESUMO

Acute obstructive suppurative cholangitis (AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is the current gold standard for biliary decompression, it can sometimes be difficult because of failed biliary cannulation. In this retrospective case series, we describe three cases of successful biliary drainage with recovery from septic shock after urgent endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) was performed for AOSC due to biliary lithiasis. In all three cases, technical success in inserting the stents was achieved and the patients completely recovered from AOSC with sepsis in a few days after EUS-CDS. There were no procedure-related complications. When initial ERCP fails, EUS-CDS can be an effective life-saving endoscopic biliary decompression procedure that shortens the procedure time and prevents post-ERCP pancreatitis, particularly in patients with AOSC-induced sepsis.


Assuntos
Colangite/terapia , Coledocostomia/métodos , Drenagem/métodos , Endossonografia , Sepse/terapia , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica , Colangite/complicações , Colangite/diagnóstico por imagem , Coledocostomia/instrumentação , Drenagem/instrumentação , Feminino , Humanos , Masculino , Sepse/diagnóstico por imagem , Sepse/etiologia , Stents , Supuração , Resultado do Tratamento
15.
World J Gastroenterol ; 22(7): 2326-35, 2016 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-26900294

RESUMO

AIM: To investigate the optimal magnetic pressure and provide a theoretical basis for choledochojejunostomy magnetic compressive anastomosis (magnamosis). METHODS: Four groups of neodymium-iron-boron magnets with different magnetic pressures of 0.1, 0.2, 0.3 and 0.4 MPa were used to complete the choledochojejunostomy magnamosis. Twenty-six young mongrel dogs were randomly divided into five groups: four groups with different magnetic pressures and 1 group with a hand-suture anastomosis. Serum bilirubin levels were measured in all groups before and 1 wk, 2 wk, 3 wk, 1 mo and 3 mo after surgery. Daily abdominal X-ray fluoroscopy was carried out postoperatively to detect the path and the excretion of the magnet. The animals were euthanized at 1 or 3 mo after the operation, the burst pressure was detected in each anastomosis, and the gross appearance and histology were compared according to the observation. RESULTS: The surgical procedures were all successfully performed in animals. However, animals of group D (magnetic pressure of 0.4 MPa) all experienced complications with bile leakage (4/4), whereas half of animals in group A (magnetic pressure of 0.1 MPa) experienced complications (3/6), 1 animal in the manual group E developed anastomotic stenosis, and animals in group B and group C (magnetic pressure of 0.2 MPa and 0.3 MPa, respectively) all healed well without complications. These results also suggested that the time required to form the stoma was inversely proportional to the magnetic pressure; however, the burst pressure of group A was smaller than those of the other groups at 1 mo (187.5 ± 17.7 vs 290 ± 10/296.7 ± 5.7/287.5 ± 3.5, P < 0.05); the remaining groups did not differ significantly. A histologic examination demonstrated obvious differences between the magnamosis groups and the hand-sewn group. CONCLUSION: We proved that the optimal range for choledochojejunostomy magnamosis is 0.2 MPa to 0.3 MPa, which will help to improve the clinical application of this technique in the future.


Assuntos
Coledocostomia/instrumentação , Colestase/cirurgia , Magnetismo/instrumentação , Imãs , Fístula Anastomótica/sangue , Fístula Anastomótica/etiologia , Animais , Bilirrubina/sangue , Biomarcadores/sangue , Coledocostomia/efeitos adversos , Coledocostomia/métodos , Colestase/sangue , Modelos Animais de Doenças , Cães , Desenho de Equipamento , Estudos de Viabilidade , Imãs/efeitos adversos , Masculino , Pressão , Técnicas de Sutura , Fatores de Tempo
17.
Surg Innov ; 23(2): 124-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26092564

RESUMO

PURPOSE: The aim of this study was to assess the safety and effectiveness of laparoscopic common bile duct (CBD) exploration with a novel articulating forceps. METHODS: A retrospective analysis was carried out of 90 patients who underwent laparoscopic transcholedochal CBD exploration for choledocholithiasis between May 2006 and June 2014. Forty-five patients underwent laparoscopic choledocholithotomy using the routine instruments (group A). Forty-five patients underwent laparoscopic choledocholithotomy using the routine instruments plus the novel articulating forceps (group B). The 2 group populations were similar with regard to demographic data and clinical presentations. RESULTS: Laparoscopic transcholedochal CBD exploration was successful in all 90 patients. The mean diameter of the CBD was 14.42 mm in group A and 14.73 mm in group B (P > .05). The average number of stones extracted per patient was 4.22 in group A and 4.67 in group B (P > .05). The patients in group A had a significantly longer operative time than the patients in group B (109.38 vs 80.49 minutes; P < .01). The intraoperative blood loss was minimal in both groups, and no major complications were observed in either group. The mean hospitalization stay was 6.60 days in group A and 5.58 days in group B (P < .01). CONCLUSION: Laparoscopic transcholedochal CBD exploration with the novel articulating forceps is a safe and effective approach to the management of choledocholithiasis that offers a short operating time and short postoperative hospital stay.


Assuntos
Coledocolitíase/cirurgia , Coledocostomia/instrumentação , Laparoscopia/instrumentação , Adulto , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA