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2.
Eur. j. anat ; 24(1): 69-74, ene. 2020. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-186067

RESUMO

Although the cystic artery commonly originates from a right hepatic artery, variations in the origin and course of the cystic artery occur in 24.5% of people. The explanation for the variations of the cystic artery is found in the developmental pattern of the biliary system. Thus, the various origins of the cystic artery and its course concerning the Calot's triangle require the attention of surgeons in order to avoid iatrogenic injury of the bile ducts and vessels. Hence, the course of the cystic artery regarding hepatobiliary ducts has also to be noted by surgeons during cholecystectomy


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Assuntos
Humanos , Artéria Hepática/anatomia & histologia , Variação Anatômica , Sistema Biliar/anatomia & histologia , Ductos Biliares/anatomia & histologia , Cistos/etiologia , Doença Iatrogênica/prevenção & controle , Erros Médicos/prevenção & controle , Colecistectomia , Ductos Biliares/lesões , Ductos Biliares/cirurgia
3.
Chirurg ; 91(1): 18-22, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31712829

RESUMO

Bile duct injuries can occur after abdominal trauma, postoperatively after cholecystectomy, liver resection or liver transplantation and also as a complication of endoscopic retrograde cholangiopancreatography (ERCP). The clinical appearance of bile duct injuries is highly variable and depends primarily on the underlying cause. In addition to the high perioperative morbidity, following successful initial complication management, bile duct injuries can lead to significant long-term complications. The treatment requires close interdisciplinary cooperation between surgery, interventional gastroenterology and interventional radiology. The treatment of bile duct injuries depends primarily on the time of diagnosis (intraoperative/postoperative) as well as the extent of the injury and is discussed in this review.


Assuntos
Traumatismos Abdominais , Ductos Biliares , Colecistectomia Laparoscópica , Transplante de Fígado , Traumatismos Abdominais/cirurgia , Ductos Biliares/lesões , Ductos Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia , Humanos
4.
BMC Surg ; 19(1): 162, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694627

RESUMO

BACKGROUND: Iatrogenic bile duct injuries (BDIs) are mostly associated with laparoscopic cholecystectomy but may also occur following gastroduodenal surgery or liver resection. Delayed diagnosis of type of injury with an ongoing biliary leak as well as the management in a non-specialized general surgical units are still the main factors affecting the outcome. CASE PRESENTATION: Herein we present three types of BDIs (Bismuth type I, IV and V) following three different types of upper abdominal surgery, ie. Billroth II gastric resection, laparoscopic cholecystectomy and left hepatectomy. All of them were complex injuries with complete bile duct transections necessitating surgical treatment. All were also very difficult to treat mainly because of a delayed diagnosis of type of injury, associated biliary leak and as a consequence severe inflammatory changes within the liver hilum. The treatment was carried out in our specialist hepatobiliary unit and first focused on infection and inflammation control with adequate biliary drainage. This was followed by a delayed surgical repair with the technique which had to be tailored to the type of injury in each case. CONCLUSION: We emphasize that staged and individualized treatment strategy is often necessary in case of a delayed diagnosis of complex BDIs presenting with a biliary leak, inflammatory intraabdominal changes and infection. Referral of such patients to expert hepatobiliary centres is crucial for the outcome.


Assuntos
Doenças dos Ductos Biliares/etiologia , Ductos Biliares/lesões , Complicações Pós-Operatórias/cirurgia , Adulto , Colecistectomia Laparoscópica/efeitos adversos , Drenagem , Feminino , Hepatectomia/efeitos adversos , Humanos , Doença Iatrogênica , Fígado/patologia , Masculino , Pessoa de Meia-Idade
5.
BMC Surg ; 19(1): 176, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752907

RESUMO

BACKGROUND: This study aimed to propose a novel surgical reconstruction technique for complex high-location bile duct injury (CHBDI). METHODS: There were eight patients with CHBDI underwent the novel hepaticojejunostomy between Feb 2015 and Feb 2017. Seven patients underwent a primary operation and found CHBDI postoperatively in the inferior hospitals referred to our center. And four of them had received hepaticojejunostomy, but the results were not satisfying. One patient (No.8) with radiographically diagnosed hilar cholangiocarcinoma came to our center for surgical treatment and underwent the novel hepaticojejunostomy technique because CHBDI was found in operation. Perioperative and follow-up data of these patients were retrospectively reviewed. RESULTS: The mean age was 47.6 ± 10.7 years, and there was four female. The mean range of time between the injury and the repair operation in our center was 6.3 ± 4.8 months. All repair operations using the novel hepaticojejunostomy technique in our center were successfully performed. No postoperative complications, including biliary fistula, restenosis, peritonitis, and postoperative cholangitis was observed. Besides, no evidence of biliary stenosis or biliary complications happened during the follow-up (median 28 months). CONCLUSIONS: The novel hepaticojejunostomy is a reliable and convenient technique for surgical repair of multiple biliary ductal openings like CHBDI.


Assuntos
Doenças dos Ductos Biliares/cirurgia , Ductos Biliares/lesões , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Adulto , Idoso , Anastomose Cirúrgica , Constrição Patológica/cirurgia , Feminino , Humanos , Fígado/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
Arq Gastroenterol ; 56(3): 300-303, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31633729

RESUMO

BACKGROUND: Bile duct injury is a life-threatening complication that requires proper management to prevent the onset of negative outcomes. Patients may experience repeated episodes of cholangitis, secondary biliary cirrhosis, end-stage liver disease and death. OBJECTIVE: To report a single center experience in iatrogenic secondary liver transplantation after cholecystectomy and review the literature. METHODS: This was a retrospective single center study. Of the 1662 liver transplantation realized, 10 (0.60 %) were secondary to iatrogenic bile ducts injuries due cholecystectomies. Medical records of these patients were reviewed in this study. RESULTS: Nine of 10 patients were women; the median time in waiting list and between cholecystectomy and inclusion in waiting list was of 222 days and of 139.9 months, respectively. Cholecystectomy was performed by open approach in eight (80%) cases and by laparoscopic approach in two (20%) cases. The patients underwent an average of 3.5 surgeries and procedures before liver transplantation. Biliary reconstruction was realized with a Roux-en-Y hepaticojejunostomy in nine (90%) cases. Mean operative time was 447.2 minutes and the median red blood cell transfusion was 3.4 units per patient. Mortality in the first month was of 30%. CONCLUSION: Although the liver transplantation is an extreme treatment for an initially benign disease, it has its well-defined indications in treatment of bile duct injuries after cholecystectomy, either in acute or chronic scenario.


Assuntos
Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Cirrose Hepática Biliar/cirurgia , Transplante de Fígado , Adulto , Idoso , Ductos Biliares/cirurgia , Feminino , Humanos , Doença Iatrogênica , Cirrose Hepática Biliar/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
Am Surg ; 85(10): 1146-1149, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657312

RESUMO

Cirrhosis is associated with adverse outcomes after emergency general surgery (EGS). The objective of this study was to determine the safety of laparoscopic cholecystectomy (LC) in EGS patients with cirrhosis. We performed a two-year retrospective cohort analysis of adult patients who underwent LC for symptomatic gallstones. The primary outcome was the incidence of intraoperative complications. Of 796 patients, 59 (7.4%) were cirrhotic, with a median model for end-stage liver disease (MELD) score of 15 (IQR, 7). On unadjusted analysis, patients with cirrhosis were older, more likely to be male (both P < 0.01), diabetic (P < 0.001), had a higher incidence of preadmission antithrombotic therapy use (P < 0.02), and experienced a longer time to surgery (3.2 vs 1.8 days, P < 0.001). Coarsened exact matching revealed no difference in intra- or postoperative complications between groups (P = 0.67). Operative duration was longer in patients with cirrhosis (162 vs 114 minutes, P = 0.001), who also had a nonsignificant increase in the rate of conversion to an open cholecystectomy (14% vs 4%, P = 0.07). The results of this study indicate that LC may be safely performed in EGS patients with cirrhosis.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Tratamento de Emergência/efeitos adversos , Cálculos Biliares/cirurgia , Complicações Intraoperatórias/epidemiologia , Cirrose Hepática/complicações , Doença Aguda , Adulto , Fatores Etários , Ductos Biliares/lesões , Conversão para Cirurgia Aberta/estatística & dados numéricos , Tratamento de Emergência/métodos , Feminino , Fibrinolíticos/uso terapêutico , Cálculos Biliares/etiologia , Hemorragia/epidemiologia , Humanos , Incidência , Intestinos/lesões , Complicações Intraoperatórias/etiologia , Cirrose Hepática/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Segurança , Fatores Sexuais , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos
8.
Am Surg ; 85(10): 1150-1154, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657313

RESUMO

Bile duct injury represents a complication after laparoscopic cholecystectomy, impairing quality of life and resulting in subsequent litigations. A five-year experience of bile duct injury repairs in 52 patients at a community hospital was reviewed. Twenty-nine were female, and the median age was 51 years (range, 20-83 years). Strasberg classification identified injuries as Type A (23), B (1), C (1), D (5), E1 (5), E2 (6), E3 (4), E4 (6), and E5 (1). Resolution of the bile duct injury and clinical improvement represent main postoperative outcome measures in our study. The referral time for treatment was within 4 to 14 days of the injury. Type A injury was treated with endobiliary stent placement. The remaining patients required T-tube placement (5), hepaticojejunostomy (20), and primary anastomosis (4). Two patients experienced bile leak after hepaticojejunostomy and were treated and resolved with percutaneous transhepatic drainage. At a median follow-up of 36 months, two patients (Class E4) required percutaneous balloon dilation and endobiliary stent placement for anastomotic stricture. The success of biliary reconstruction after complicated laparoscopic cholecystectomy can be achieved by experienced biliary surgeons with a team approach in a community hospital setting.


Assuntos
Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/estatística & dados numéricos , Ductos Biliares/diagnóstico por imagem , Ductos Biliares Extra-Hepáticos/lesões , California , Colecistectomia Laparoscópica/estatística & dados numéricos , Feminino , Hospitais Comunitários , Humanos , Jejunostomia/métodos , Jejunostomia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/classificação , Estudos Retrospectivos , Stents/estatística & dados numéricos , Fatores de Tempo , Tempo para o Tratamento , Ferimentos e Lesões/classificação , Adulto Jovem
9.
S Afr J Surg ; 57(3): 24-29, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31392861

RESUMO

BACKGROUND: The South African healthcare system has an under-financed public sector serving most of the population and a better resourced private sector serving a small fraction of the population. This study evaluated management and outcome in patients with complex bile duct injuries (BDIs) after laparoscopic cholecystectomy referred from either private or public hospitals. METHOD: The data of patients who underwent hepaticojejunostomy repair were retrieved from a prospectively maintained central departmental BDI database. Patients were treated either in the Surgical Gastroenterology Unit at Groote Schuur Hospital, University of Cape Town (UCT) or the Digestive Diseases Centre, UCT Private Academic Hospital by the same hepatobiliary surgical team. Relevant preoperative clinical data and postoperative complications and outcomes were compared between patients originating either in the public or private sector. RESULTS: One hundred and twenty-five patients were included, 58 from the public and 67 from the private sector. The type of BDI, time to diagnosis, referral and repair were similar. Patients referred from the private sector underwent more percutaneous cholangiograms prior to referral (11.9% vs 1.7%, p = 0.037). Patients referred from the public sector underwent more CT examinations (p = 0.044) and endoscopic retrograde cholangiography (p = 0.038) after admission to our centre. There were no statistically significant differences in 30-day postoperative complications. Primary patency rates were similar for public and private referrals (90% vs 88%, respectively). There were two BDI-related mortalities at 90 days. CONCLUSION: Despite differences in public and private healthcare system resources, patients were referred early and appropriately from both sectors and had similar postoperative outcomes when treated in a specialised unit.


Assuntos
Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Hospitais Privados , Hospitais Públicos , Ferimentos e Lesões/diagnóstico por imagem , Ferimentos e Lesões/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta , Estudos Retrospectivos , África do Sul , Centros de Atenção Terciária , Fatores de Tempo , Tempo para o Tratamento , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ferimentos e Lesões/etiologia , Adulto Jovem
10.
Surgery ; 166(4): 698-702, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31439402

RESUMO

BACKGROUND: Bile duct injury during laparoscopic cholecystectomy persists as a significant problem in general surgery, resulting in complex injuries, arterial damage, and post repair strictures. METHODS: We performed a retrospective analysis between 2 eras of bile duct injury repairs: 1987 to 2001 (n = 58) and 2002 to 2016 (n = 52) using logistic regression analyses to assess presentation, repair complexity, and outcomes. RESULTS: No differences in demographics, incidence of cholecystitis, conversion, time to presentation, level of injury, or arterial injury were identified. The second era had an increase in patient age, transhepatic catheter use, prior repair, and utilization of complex repairs. This approach resulted in equivalent complications and mortality rates with increased resource utilization but a lesser incidence of post-repair strictures (P = .004). Regression modeling correlated strictures to prior operative repairs (OR 4.25; P = .016) and a protective effect of repairs performed in the second era (OR 0.23; P = .045). CONCLUSION: The second era identified a decreasing trend of attempted repairs by referring surgeons but an increase in transhepatic catheters and complex repairs resulting in lesser rates of post-repair stricture. Final regression modeling confirmed increased operative experience decreased post-repair stricture reaffirming the benefits of early identification and referral of bile duct injuries to an experienced hepatobiliary surgeon at a specialty center.


Assuntos
Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Doença Iatrogênica/epidemiologia , Complicações Intraoperatórias/cirurgia , Adulto , Idoso , Ductos Biliares/cirurgia , Colecistectomia Laparoscópica/métodos , Estudos de Coortes , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Incidência , Complicações Intraoperatórias/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
12.
Ann Surg Oncol ; 26(9): 2981-2984, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31147989

RESUMO

BACKGROUND: Bile duct injuries after cholecystectomy remain a major concern because their incidence has not changed through the years despite technical advances. This video presents a robotic left hepatectomy and Roux-en-Y hepaticojejunostomy as a treatment for a complex bile duct injury after laparoscopic cholecystectomy. METHODS: A 52-year-old man underwent laparoscopic cholecystectomy at another institution 8 years previously, which resulted in a bile duct injury. His postoperative period was complicated by jaundice and cholangitis. He was treated with endoscopic retrograde cholangiopancreatography and multiple endoprostheses for 3 years, after which the endoprostheses were removed, and he was sent to the authors' institution. Computed tomography showed that the left liver had signs of disturbed perfusion and dilation of the left intrahepatic bile duct. The patient was asymptomatic and refused any further attempt at surgical correction of the lesion. He was accompanied for 5 years. Magnetic resonance imaging showed progressive atrophy of the left liver. Finally, 3 months before this writing, he presented with intermittent episodes of cholangitis. A multidisciplinary team decided to perform left hepatectomy with Roux-en-Y hepatojejunostomy via a robotic approach. The left liver was atrophied, and left hepatectomy was performed. Fluorescence imaging was used to identify the right bile duct. At opening of the right bile duct, small stones were found and removed. Antecolic Roux-en-Y hepaticojejunostomy then was performed. RESULTS: The operative time was 335 min. Recovery was uneventful, and the patient was discharged on postoperative day 4. CONCLUSIONS: Robotic repair of bile duct injuries is feasible and safe, even when liver resection is necessary. This video may help oncologic surgeons to perform this complex procedure.


Assuntos
Anastomose em-Y de Roux/métodos , Doenças dos Ductos Biliares/cirurgia , Ductos Biliares/cirurgia , Colecistectomia Laparoscópica/efeitos adversos , Hepatectomia/métodos , Jejunostomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Doenças dos Ductos Biliares/etiologia , Ductos Biliares/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Gravação em Vídeo
13.
Gene ; 707: 9-21, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31048068

RESUMO

BACKGROUND: Cholestatic liver disease (CLD) is a highly heterogeneous hepatobiliary disease with various causes. The purpose of this research was to explore the gene expression changes throughout the course of CLD revealing potential causative molecular mechanisms and therapeutic targets. METHODS: We established two animal models of cholestasis: 3,5-diethoxycarbonyl-1,4-dihydrocollidine feeding for 2, 4 and 6 weeks and bile duct ligation for 14 days. Using these two models, we identified differentially expressed genes (DEGs) by RNA-Seq analysis and used the newly-found knowledge of DEGs in comprehensive bioinformatic analyses to investigate key molecular events. Sequencing results were confirmed by experimental verification. RESULTS: Our study detected overlapping DEGs in the two models, of these 568 genes were upregulated and 117 genes were downregulated. Gene Ontology analysis demonstrated that the upregulated genes were associated with the biological processes of cell adhesion, cell migration and cell motility, while the metabolic processes of various substances were enriched for the downregulated genes. Kyoto Encyclopedia of Genes and Genomes pathway analysis showed that the upregulated pathways were mainly distributed in focal adhesion, ECM-receptor interaction and amoebiasis, while downregulated pathways focused on peroxisome proliferator-activated receptor signaling pathway, metabolic pathways and primary bile acid biosynthesis. These findings were further confirmed by protein-protein interaction network modeling. Hub genes Src, Pdgfb, Col15a1, Mmp9, Egfr were selected using centralities analyses and verified by qRT-PCR. CONCLUSION: We profiled a global mRNA landscape in CLD to promote a complete understanding of transcriptomic events of this disease, offering candidate biomarkers and therapeutic targets for the clinic.


Assuntos
Ductos Biliares/lesões , Colestase Intra-Hepática/genética , Perfilação da Expressão Gênica/métodos , Redes Reguladoras de Genes , Piridinas/efeitos adversos , Animais , Colestase Intra-Hepática/etiologia , Modelos Animais de Doenças , Regulação da Expressão Gênica , Ontologia Genética , Humanos , Camundongos , Mapas de Interação de Proteínas , Análise de Sequência de RNA
14.
Medicine (Baltimore) ; 98(15): e15127, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30985676

RESUMO

RATIONALE: Bile duct injury (BDI), a major complication of cholecystectomy, usually needs hepaticojejunostomy or primary repair over T-tube in severe cases. There were few cases about retained fragments of T-tube. Whereas, intact T-tube retained in common bile duct (CBD) for years after BDI was very rare. PATIENT CONCERNS: A 55-year-old female complaining of a retained T-tube in the right upper quadrant for 10 years with bilious exudation for 3 months. DIAGNOSIS: Based on the medical history of reoperation after the initial laparoscopic cholecystectomy (LC), the retained T-tube, the bilious exudation, and the feature of image modalities, she was diagnosed with retained biliary T-tube, biliary leak, hepatolithiasis, and BDI. INTERVENTIONS: After nonsurgical management at local hospitals, the patient had her indwelling T-tube removal during laparotomy in our center finally. During this procedure, bile duct exploration, hilar bile ducts reconstruction, and primary Roux-en-Y hepaticojejunostomy were performed. OUTCOMES: Unfortunately, bile leakage occurred postoperatively. After drainage of the peritoneal bilious fluid, the patient recovered gradually without further complication. LESSONS: T-tube in CBD could act as nidus for stone formation after long-time placement. As a result of gradual stone formation on T-tube, severe hepatic ducts dilatation may occur without the presence of jaundice. Timely follow-up and proper surgical intervention should be suggested for patients with T-tube placement or iatrogenic BDI to avoid further impacts.


Assuntos
Ductos Biliares/lesões , Ductos Biliares/cirurgia , Complicações Pós-Operatórias/cirurgia , Ductos Biliares/diagnóstico por imagem , Colecistectomia , Remoção de Dispositivo , Diagnóstico Diferencial , Feminino , Humanos , Doença Iatrogênica , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem
16.
J Hepatobiliary Pancreat Sci ; 26(4): 123-127, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30828991

RESUMO

Bile duct injuries are the most common serious complication of cholecystectomy. Avoidance of bile duct injury is a key aim of biliary surgery. The purpose of this paper is to describe laparoscopic cholecystectomy from the viewpoint of three conceptual goals. Three conceptual goals of cholecystectomy are: (1) getting secure anatomical identification of key structures; (2) making the right decision not to perform a total cholecystectomy when conditions are too dangerous to get secure identification - the "inflection point"; and (3) finishing the operation safely when secure anatomical identification of cystic structures is not possible. The Critical View of Safety (CVS) has been shown to be a good way of getting secure anatomical identification. Conceptually, CVS is a method of target identification, the targets being the two cystic structures. Sometimes, anatomic identification is not possible because the risk of biliary injury is judged to be too great. Then a decision is made to abandon the attempt to do a complete cholecystectomy - and instead to "bail-out". This "inflection point" is defined as the moment at which the decision is made to halt the attempt to perform a total cholecystectomy laparoscopically and to finish the operation by a different method. Currently the best bail-out procedure seems to be subtotal fenestrating cholecystectomy. Application of conceptual goals of cholecystectomy can help the surgeon to avoid biliary injury.


Assuntos
Ductos Biliares/lesões , Colecistectomia Laparoscópica/métodos , Colecistectomia Laparoscópica/efeitos adversos , Humanos
17.
Surg Clin North Am ; 99(2): 283-299, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30846035

RESUMO

Common bile duct injury is a feared complication of cholecystectomy, with an incidence of 0.1% to 0.6%. A majority of injuries go unnoticed at index operation, and postoperative diagnosis can be difficult. Patient presentation can vary from vague abdominal pain to uncontrolled sepsis and peritonitis. Diagnostic evaluation typically begins with ultrasound or CT scan in the acute setting, and source control is paramount at time of presentation. In a stable patient, hepatobiliary iminodiacetic acid scan can be useful in identifying an ongoing bile leak, which requires intervention. A variety of diagnostic techniques define biliary anatomy. Treatment often requires a multidisciplinary approach.


Assuntos
Ductos Biliares/lesões , Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Complicações Intraoperatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Humanos , Doença Iatrogênica , Complicações Intraoperatórias/classificação , Complicações Intraoperatórias/terapia , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/terapia
18.
J Surg Res ; 239: 166-172, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30836298

RESUMO

BACKGROUND: To study the feasibility of laparo-endoscopic single-site (LESS) cholecystectomy through a 10-mm incision using a miniature magnetically anchored and controlled laparoscopy system and a grasper system. METHODS: The miniature magnetically anchored and controlled laparoscopy system consisted of a miniature magnetically anchored camera (MMAC), an external magnetic anchoring unit, and a vision output device. The camera weighed 9.8 g and measured Φ10 mm × 50 mm. The magnetically anchored and controlled grasper system consisted of a magnetically anchored grasper (MAG), an external magnetic anchoring unit, and a push-pull device. The MAG had a titanium alloy clip head and a magnetic tail. The laparoscopy system and grasper system were used simultaneously to perform LESS cholecystectomy through a single 10-mm incision in model canines. RESULTS: LESS cholecystectomy through a 10-mm incision using the MMAC and MAG was attempted in six dogs. The mean operative time was 85.75 ± 7.14 min. The operation was completed successfully in four cases, with failure occurring in one case due to gallbladder rupture and in another due to bile duct injury. The MMAC provided clear imaging, and the MAG provided sufficient exposure to perform the cholecystectomy. The use of multiple magnetically anchored and controlled instruments did not result in notable collisions. CONCLUSIONS: The designed MMAC and MAG system could be easily maneuvered. LESS cholecystectomy may be feasible through a single 10-mm incision with the simultaneous use of multiple magnetically anchored and controlled instruments.


Assuntos
Colecistectomia Laparoscópica/instrumentação , Doenças da Vesícula Biliar/cirurgia , Imãs , Cirurgia Vídeoassistida/instrumentação , Animais , Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Cães , Desenho de Equipamento , Estudos de Viabilidade , Vesícula Biliar/lesões , Vesícula Biliar/cirurgia , Humanos , Modelos Animais , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Ruptura/etiologia , Cirurgia Vídeoassistida/efeitos adversos , Cirurgia Vídeoassistida/métodos
20.
Minerva Chir ; 74(3): 203-206, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29795065

RESUMO

BACKGROUND: Acute calculous cholecystitis is a leading cause for hospital admission especially in developed countries. As older age population increases, medical research should consider the efficacy of all therapeutic options, including early surgical procedure in an emergency context, for the treatment of acute cholecystitis in elderly high-risk patients. METHODS: From 01/01/2012 to 31/12/2016, 245 patients were admitted to our Institution with diagnosis of acute cholecystitis and managed with cholecystectomy within the same hospitalization. The study population was divided into 2 subgroups: group A (patients aged more than 80 years) and group B (patients within the limit of 80 years of age); the objective of the study was to evaluate and compare the surgical outcomes of the 2 groups in terms of conversion rate, mortality rate, overall morbidity and procedure-related complication rates. RESULTS: Statistical analysis did not show significant differences between ultra octogenarian and younger patients in terms of conversion to open procedure, iatrogenic bile duct lesions, postoperative peritoneal bleeding, bile leakage and peritoneal collection; no differences in terms of hospital stay have been demonstrated. Mortality and overall morbidity rates, even if similar to what observed in Literature and within acceptable values, were significantly higher in elderly patients, due to the presence of severe comorbidities leading to potentially fatal postoperative events. CONCLUSIONS: Minimally invasive approach in an emergency setting for acute cholecystitis seems to be a feasible and adequate therapeutic approach for extremely aged high-risk patients.


Assuntos
Colecistectomia , Colecistite Aguda/cirurgia , Tempo para o Tratamento , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Ductos Biliares/lesões , Colecistectomia/efeitos adversos , Colecistectomia/métodos , Colecistectomia/mortalidade , Colecistite Aguda/mortalidade , Coledocolitíase/complicações , Coledocolitíase/cirurgia , Comorbidade , Conversão para Cirurgia Aberta/estatística & dados numéricos , Feminino , Humanos , Doença Iatrogênica , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
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