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1.
BMC Surg ; 21(1): 71, 2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33530973

RESUMO

BACKGROUND: Hemobilia due to rupture of hepatic artery pseudoaneurysm and recurrent hemorrhage caused by hepatic artery collateral circulation are both rare complications after liver trauma. There have been a number of separate reports of both complications, but no cases have been reported in which the two events occurred in the same patient. Here we report a recurrent hemorrhage in the bile duct due to hepatic artery pseudoaneurysm secondary to collateral circulation formation after hepatic artery ligation in a patient with liver trauma. CASE PRESENTATION: A 52-year-old male patient was admitted to our hospital for liver trauma (Grade IV according to the American Association for the Surgery of Trauma (AAST) grading system) with active bleeding after a traffic accident. Hepatic artery ligation was performed for hemostasis. Three months after the surgery, the patient was readmitted for melena and subsequent hematemesis. Selective angiography examination revealed the formation of collateral circulation between the superior mesenteric artery and right hepatic artery. Moreover, a ruptured hepatic artery pseudoaneurysm was observed and transcatheter arterial embolization (TAE) was performed for hemostasis at the same time. After the treatment, the patient recovered very well and had an uneventful prognosis until the last follow-up. CONCLUSION: For patients with hepatic trauma, the selection of the site of hepatic artery ligation and the diagnosis and treatment methods of postoperative biliary hemorrhage are crucial for the prognosis of the disease.


Assuntos
Falso Aneurisma , Aneurisma Roto , Hemobilia , Artéria Hepática , Ligadura/efeitos adversos , Fígado , Traumatismos Abdominais/complicações , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Aneurisma Roto/etiologia , Aneurisma Roto/terapia , Angiografia/métodos , Ductos Biliares/diagnóstico por imagem , Ductos Biliares/lesões , Circulação Colateral , Embolização Terapêutica , Hematemese/etiologia , Hematemese/terapia , Hemobilia/etiologia , Hemobilia/terapia , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/lesões , Artéria Hepática/cirurgia , Humanos , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Fígado/lesões , Masculino , Melena/etiologia , Melena/terapia , Pessoa de Meia-Idade , Recidiva , Circulação Esplâncnica
2.
J Surg Res ; 257: 349-355, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32892130

RESUMO

BACKGROUND: Bile duct injury (BDI) during cholecystectomy requiring biliary enteric reconstruction (BER) is associated with increased risk of postoperative mortality and substantive increases in costs of care. The impact of the timing of repair on overall costs of care is poorly understood. MATERIALS AND METHODS: The Healthcare Cost and Utilization Project Florida State databases (2006-2015) were queried to identify patients undergoing BER within 1-y of cholecystectomy performed for benign biliary disease. Patients were then categorized by the time interval between cholecystectomy to BER: early (≤3 d), intermediate (4 d to 6 wk), or delayed (>6 wk). By repair timing strategy, 1-y outcomes were aggregated, including charges, inpatient costs, aggregate length of stay, and inpatient mortality. RESULTS: Of 563,887 patients undergoing cholecystectomy, 1168 required a BER (0.21%) within 1-y of cholecystectomy. Early BER was performed in 560 patients (47.9%), intermediate BER in 439 patients (37.6%), and delayed BER in 169 (14.5%) patients. On multivariable analysis adjusting for patient, procedure, and facility factors, intermediate BER demonstrated an increased risk of mortality (odds ratio 2.04, 95% confidence interval [CI]: 1.16-3.56) and increased aggregate inpatient cost (+$12,472; 95% CI: $6421-$18,524) relative to early BER. There was no notable difference in adjusted risk of inpatient mortality between the early and delayed BER cohorts (odds ratio 0.90; 95% CI: 0.32-1.25), but delayed BER was associated with increased aggregate inpatient costs (+$45,111; 95% CI: $36,813-$53,409). CONCLUSIONS: When compared with delayed BER, early repair was associated with shorter aggregate inpatient hospitalization without increased postoperative mortality. Intermediate timing of repair is associated with increased costs and risk of mortality.


Assuntos
Ductos Biliares/lesões , Ductos Biliares/cirurgia , Colecistectomia/efeitos adversos , Tempo para o Tratamento/economia , Idoso , Colecistectomia/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
3.
J Vasc Interv Radiol ; 31(10): 1587-1591, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32951970

RESUMO

Intraductal cooling via a percutaneous transhepatic biliary drainage tube holds great promise in facilitating thermal ablation of liver tumors adjacent to the central bile ducts. However, the difficulties and complications associated with puncturing nondilated bile ducts are greater than those associated with puncturing dilated bile ducts. As reported here, percutaneous transcholecystic contrast-enhanced ultrasound was performed in 7 patients to visualize the nondilated bile ducts and guide percutaneous transhepatic biliary drainage, thus facilitating the intraductal cooling-assisted thermal ablation process. The procedures were technically successful in all 7 patients, and no major complications were recorded during the follow-up period.


Assuntos
Traumatismos Abdominais/prevenção & controle , Ductos Biliares/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Drenagem , Neoplasias Hepáticas/cirurgia , Fosfolipídeos/administração & dosagem , Ablação por Radiofrequência , Hexafluoreto de Enxofre/administração & dosagem , Ultrassonografia de Intervenção , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/etiologia , Idoso , Ductos Biliares/lesões , Meios de Contraste/efeitos adversos , Drenagem/efeitos adversos , Drenagem/instrumentação , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Microbolhas , Pessoa de Meia-Idade , Fosfolipídeos/efeitos adversos , Ablação por Radiofrequência/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Hexafluoreto de Enxofre/efeitos adversos , Resultado do Tratamento , Ultrassonografia de Intervenção/efeitos adversos
4.
Am J Pathol ; 190(11): 2251-2266, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32712019

RESUMO

Activation of the substance P (SP)/neurokinin 1 receptor (NK1R) axis triggers biliary damage/senescence and liver fibrosis in bile duct ligated and Mdr2-/- (alias Abcb4-/-) mice through enhanced transforming growth factor-ß1 (TGF-ß1) biliary secretion. Recent evidence indicates a role for miR-31 (MIR31) in TGF-ß1-induced liver fibrosis. We aimed to define the role of the SP/NK1R/TGF-ß1/miR-31 axis in regulating biliary proliferation and liver fibrosis during cholestasis. Thus, we generated a novel model with double knockout of Mdr2-/- and NK1R-/ (alias Tacr1-/-) to further address the role of the SP/NK1R axis during chronic cholestasis. In vivo studies were performed in the following 12-week-old male mice: (i) NK1R-/-; (ii) Mdr2-/-; and (iii) NK1R-/-/Mdr2-/- (Tacr1-/-/Abcb4-/-) and their corresponding wild-type controls. Liver tissues and cholangiocytes were collected, and liver damage, changes in biliary mass/senescence, and inflammation as well as liver fibrosis were evaluated by both immunohistochemistry in liver sections and real-time PCR. miR-31 expression was measured by real-time PCR in isolated cholangiocytes. Decreased ductular reaction, liver fibrosis, biliary senescence, and biliary inflammation were observed in NK1R-/-/Mdr2-/- mice compared with Mdr2-/- mice. Elevated expression of miR-31 was observed in Mdr2-/- mice, which was reduced in NK1R-/-/Mdr2-/- mice. Targeting the SP/NK1R and/or miR-31 may be a potential approach in treating human cholangiopathies, including primary sclerosing cholangitis.


Assuntos
Subfamília B de Transportador de Cassetes de Ligação de ATP/deficiência , Ductos Biliares , Colangite Esclerosante , Cirrose Hepática , Receptores da Neurocinina-1/deficiência , Subfamília B de Transportador de Cassetes de Ligação de ATP/metabolismo , Animais , Ductos Biliares/lesões , Ductos Biliares/metabolismo , Ductos Biliares/patologia , Colangite Esclerosante/genética , Colangite Esclerosante/metabolismo , Colangite Esclerosante/patologia , Modelos Animais de Doenças , Técnicas de Silenciamento de Genes , Cirrose Hepática/genética , Cirrose Hepática/metabolismo , Cirrose Hepática/patologia , Camundongos Knockout , Receptores da Neurocinina-1/metabolismo
5.
Magy Seb ; 73(2): 49-56, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32609630

RESUMO

Biliary injury is a rare but a very serious complication of laparoscopic cholecystectomy (LC). Our aim was to analyse the incidence of the biliary injuries and its therapeutic outcome on patients who underwent LC or converted LC. Our research was conducted at the 1st Department of Surgery, Semmelweis University, Budapest between 2006 and 2016, retrospectively. We analysed the LCs and converted LCs performed at our Department and as well as cases where the primary operations were conducted at other institutions but they were unable to provide the adequate therapy for the injury, thus the patients were transferred to our institution. At the 1st Department of Surgery complications occurred in 0,66% (30/4885) of all LCs. 327 converted LCs were done, complications occurred in 26 (7.95%) times. 22 patients were transferred to the 1st Department of Surgery from other institutions. Bilio-vascular injuries occurred in 61% (41/78). ERCP was performed in 25 cases with a 92% success rate. Reoperation was needed in 41% (28/41). Biliary reconstruction during the reoperation was performed via hepaticojejunostomy in 82% of all reoperations. The therapeutic solutions of LC's complications are complex. Therefore, the treatment is recommended only in institutions with appropriate experience.


Assuntos
Ductos Biliares/lesões , Sistema Biliar/lesões , Colecistectomia Laparoscópica/efeitos adversos , Colelitíase/cirurgia , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Adulto , Colecistectomia Laparoscópica/estatística & dados numéricos , Colelitíase/epidemiologia , Feminino , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
6.
JSLS ; 24(2)2020.
Artigo em Inglês | MEDLINE | ID: mdl-32518480

RESUMO

Background and Objectives: Single-incision laparoscopic cholecystectomy (SILC) has become increasingly popular. Regarding the difficulties of SILC in acute cholecystitis, additional port insertion is sometimes required. However, appropriate locations for additional port insertion have not been well studied. In the present study, the safety and effectiveness of the first additional port insertion in the epigastric region during SILC was assessed. Methods: Additional port insertions were needed in 52 of 113 patients who underwent SILC for acute cholecystitis. The first port was inserted in the epigastric region and the second (if required) was inserted in the right lateral subcostal area. A drainage catheter was positioned through the epigastric port. Results: One additional port was inserted in 43 patients and two additional ports were inserted in 9 patients. Mean operation time was 45.0 minutes in the Pure SILC group and 83.3 minutes in Additional Port group. Mean hospital stay was 3.7 days in the Pure SILC group and 5.9 days in Additional Port group. There was no open conversion. Intra-operative (n = 5) and postoperative bile leakages (n = 2) were identified in six patients. Timing of operation after onset of symptoms was significantly greater in the group with bile duct injury than in those without bile duct injury in patients who required additional ports. Conclusions: The first additional port in the epigastric area during SILC for acute cholecystitis helps to complete the operation without open conversion. However, the procedure can be performed safely in selective patients with relatively short duration of symptoms.


Assuntos
Colecistectomia Laparoscópica/métodos , Colecistite Aguda/cirurgia , Adulto , Ductos Biliares/lesões , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Seleção de Pacientes , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
7.
Am J Gastroenterol ; 115(8): 1191-1198, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32483004

RESUMO

Every year approximately 750,000 cholecystectomies are performed in the United States, most of those are performed laparoscopically. Postcholecystectomy complications are not uncommon and lead to increased morbidity and financial burden. Some of the most commonly encountered complications with laparoscopic cholecystectomy include biliary injury (0.08%-0.5%), bile leak (0.42%-1.1%), retained common bile duct stones (0.8%-5.7%), postcholecystectomy syndrome (10%-15%), and postcholecystectomy diarrhea (5%-12%). Endoscopy has an important role in the diagnosis and management of biliary complications and in many cases can provide definitive management. There is no consensus on the best therapeutic approach for biliary complications. Therefore, biliary complications should be approached by an experienced multidisciplinary team. It is important for the gastroenterologist to be familiar with the management of such complications (Visual Abstract, Supplemental Digital content 1, http://links.lww.com/AJG/B544).


Assuntos
Doenças dos Ductos Biliares/prevenção & controle , Ductos Biliares/lesões , Colecistectomia Laparoscópica , Humanos , Complicações Pós-Operatórias/prevenção & controle
8.
Ann Surg ; 272(1): 3-23, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32404658

RESUMO

BACKGROUND: BDI is the most common serious complication of laparoscopic cholecystectomy. To address this problem, a multi-society consensus conference was held to develop evidenced-based recommendations for safe cholecystectomy and prevention of BDI. METHODS: Literature reviews were conducted for 18 key questions across 6 broad topics around cholecystectomy directed by a steering group and subject experts from 5 surgical societies (Society of Gastrointestinal and Endoscopic Surgeons, Americas Hepato-Pancreato-Biliary Association, International Hepato-Pancreato-Biliary Association, Society for Surgery of the Alimentary Tract, and European Association for Endoscopic Surgery). Evidence-based recommendations were formulated using the grading of recommendations assessment, development, and evaluation methodology. When evidence-based recommendations could not be made, expert opinion was documented. A number of recommendations for future research were also documented. Recommendations were presented at a consensus meeting in October 2018 and were voted on by an international panel of 25 experts with greater than 80% agreement considered consensus. RESULTS: Consensus was reached on 17 of 18 questions by the guideline development group and expert panel with high concordance from audience participation. Most recommendations were conditional due to low certainty of evidence. Strong recommendations were made for (1) use of intraoperative biliary imaging for uncertainty of anatomy or suspicion of biliary injury; and (2) referral of patients with confirmed or suspected BDI to an experienced surgeon/multispecialty hepatobiliary team. CONCLUSIONS: These consensus recommendations should provide guidance to surgeons, training programs, hospitals, and professional societies for strategies that have the potential to reduce BDIs and positively impact patient outcomes. Development of clinical and educational research initiatives based on these recommendations may drive further improvement in the quality of surgical care for patients undergoing cholecystectomy.


Assuntos
Ductos Biliares/lesões , Colecistectomia Laparoscópica/normas , Doença Iatrogênica/prevenção & controle , Complicações Intraoperatórias/prevenção & controle , Humanos , Fatores de Risco
9.
Surgery ; 167(6): 942-949, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32183995

RESUMO

BACKGROUND: Outcomes after Strasberg grade E bile duct injury have been widely reported. However, there are comparatively few reports of outcomes after Strasberg A to D bile duct injury. Therefore, the aim of this study was to comprehensively evaluate the long-term clinical and economic impact of Strasberg A to D bile duct injury. METHODS: Patients with Strasberg A to D bile duct injury were identified from a prospectively collected and maintained database. Long-term biliary complication rates, as well as treatment costs were then estimated, and compared across Strasberg injury grades. RESULTS: A total of N = 120 patients were identified, of whom N = 49, 13, 20, and 38 had Strasberg grade A, B, C, and D bile duct injury, respectively. Surgical repair was most commonly performed in Strasberg grade D injuries (74% vs 8%-20% in lower grades, P < .001). By 5 years post bile duct injury, the estimated long-term biliary complication rate was 40% in Strasberg grade D injuries, compared with 15% in Strasberg grade A (P = .022). A significant difference in total treatment and follow-up costs was also detected (P < .001), being highest in Strasberg grade D injuries (mean £11,048/US$14,252 per patient) followed by the Strasberg grade B group (mean £10,612/US$13,689 per patient). DISCUSSION: Strasberg grade A to D injuries lead to considerable long-term morbidity and cost. Strasberg grade D injuries are typically managed surgically and result in the highest complication rate and treatment costs. Strasberg grade B injuries lead to a similar complication rate and treatment cost but are often managed without surgery.


Assuntos
Ductos Biliares/lesões , Doença Iatrogênica/economia , Complicações Intraoperatórias/cirurgia , Anastomose em-Y de Roux/economia , Ductos Biliares/cirurgia , Colecistectomia Laparoscópica/efeitos adversos , Custos e Análise de Custo , Feminino , Seguimentos , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Estudos Retrospectivos , Reino Unido , Ferimentos e Lesões/classificação
11.
Updates Surg ; 72(1): 137-143, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32008215

RESUMO

Bile duct injury remains the most serious complication of laparoscopic cholecystectomy (LC), the main cause was misidentification of cystic duct (CD). The aim of this study was to evaluate the effectiveness and security of retrograde tracing along "cystic duct" (RTACD) method for the prevention of biliary misidentification injury in LC. The conception of RTACD method was first described and then illustrated by simulation dissection with extrahepatic biliary structure charts. A total of 840 patients undergoing LC were selected. After the "CD" was separated during operation, its authenticity was identified by RTACD method according to its course and origin. The "CD" can be clipped/divided only when it was identified to be true CD. Among 840 patients, the initially separated "CD" was identified as actual CD in 831 cases, common hepatic (bile) duct in six cases, accessory right posterior sectoral duct in two cases, and right haptic duct in one case. LCs were successfully finished in 837 patients, and converted to open cholecystectomy in three cases. The average operation time was 64.23 min (range 25-225 min), and the average blood loss was 8.07 ml (range 2-200 ml). No biliary misidentification injury was found. All patients recovered smoothly. No jaundice or abdominal pain was noted in the patients during 1-19 months follow-up. RTACD method is a safe and effective new technique of preventing biliary misidentification injury.


Assuntos
Ductos Biliares/lesões , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Ducto Cístico , Doença Iatrogênica/prevenção & controle , Humanos
13.
Ann Surg ; 271(3): 449-459, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32106173

RESUMO

OBJECTIVE: The aim of the study was to systematically review and meta-analyze the available evidence regarding the association between timing of repair or referral and clinical outcomes in bile duct injury (BDI). BACKGROUND: Surgical repair is recommended for patients with complex BDI following laparoscopic cholecystectomy. However, consensus on the timing of surgery or referral to a specialist is lacking. METHODS: We searched PubMed, Embase, Cochrane Library, and Scopus for eligible studies. The coprimary outcomes were repair failure in follow-up and postoperative complications. We pooled odds ratios (ORs) using random-effects models. RESULTS: We included 32 studies. The rate of repair failure was significantly higher for early versus delayed repair [OR 1.65, 95% confidence interval (CI) 1.14-2.37, P= 0.007], lower for early versus delayed referral (OR 0.28, 95% CI 0.17-0.45, P < 0.001), but did not differ substantially for on-table versus postcholecystectomy repair (OR 2.06, 95% CI 0.89-4.73, P = 0.09). Regarding postoperative complications, early referral outperformed delayed referral (OR 0.24, 95% CI 0.09-0.68, P= 0.007); however, we found no significant differences between early and delayed repair (OR 1.34, 95% CI 0.96-1.87, P= 0.08), or between on-table and postcholecystectomy repair (OR 1.13, 95% CI 0.42-3.07, P= 0.81). At the cutoff time point of 6 weeks, early repair was associated with increased rates of repair failure (OR 4.03; P < 0.001), postoperative complications (OR 2.18; P < 0.001), and biliary stricture (OR 6.23; P < 0.001). CONCLUSIONS: Among patients with BDI, early referral and delayed repair appear to confer favorable outcomes.


Assuntos
Ductos Biliares/lesões , Ductos Biliares/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar , Colecistectomia Laparoscópica , Complicações Pós-Operatórias/cirurgia , Tempo para o Tratamento , Humanos , Doença Iatrogênica , Encaminhamento e Consulta , Falha de Tratamento
15.
J Med Case Rep ; 14(1): 16, 2020 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-31969183

RESUMO

BACKGROUND: Benign biliary stricture is an infrequent condition and the majority occur following cholecystectomy. This case report highlights the occurrence of such a stricture 11 years after cholecystectomy without development of biliary cirrhosis. CASE PRESENTATION: Our patient was a 55-year-old Nepalese woman who presented to our hospital with cholangitis of 1-month duration and a history of cholecystectomy 11 years ago. A diagnosis of benign biliary stricture without features of biliary cirrhosis was made, and the patient was successfully managed with a multidisciplinary approach. CONCLUSION: Benign biliary stricture can present even decades after cholecystectomy. Roux-en-Y hepaticojejunostomy is the treatment of choice, and a long-term favorable outcome can be expected.


Assuntos
Ductos Biliares/lesões , Ductos Biliares/cirurgia , Colecistectomia/efeitos adversos , Constrição Patológica/complicações , Anastomose em-Y de Roux/reabilitação , Feminino , Humanos , Jejunostomia/reabilitação , Efeitos Adversos de Longa Duração , Pessoa de Meia-Idade , Nepal/epidemiologia
16.
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


No disponible


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
17.
Dig Surg ; 37(1): 10-21, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30654363

RESUMO

BACKGROUND: Bile duct injury (BDI) is a devastating complication following cholecystectomy. After initial management of BDI, patients stay at risk for late complications including anastomotic strictures, recurrent cholangitis, and secondary biliary cirrhosis. METHODS: We provide a comprehensive overview of current literature on the long-term outcome of BDI. Considering the availability of only limited data regarding treatment of anastomotic strictures in literature, we also retrospectively analyzed patients with anastomotic strictures following a hepaticojejunostomy (HJ) from a prospectively maintained database of 836 BDI patients. RESULTS: Although clinical outcomes of endoscopic, radiologic, and surgical treatment of BDI are good with success rates of around 90%, quality of life (QoL) may be impaired even after "clinically successful" treatment. Following surgical treatment, the incidence of anastomotic strictures varies from 5 to 69%, with most studies reporting incidences around 10-20%. The median time to stricture formation varies between 11 and 30 months. Long-term BDI-related mortality varies between 1.8 and 4.6%. Of 91 patients treated in our center for anastomotic strictures after HJ, 81 (89%) were treated by percutaneous balloon dilatation, with a long-term success rate of 77%. Twenty-four patients primarily or secondarily underwent surgical revision, with recurrent strictures occurring in 21%. CONCLUSIONS: The long-term impact of BDI is considerable, both in terms of clinical outcomes and QoL. Treatment should be performed in tertiary expert centers to optimize outcomes. Patients require a long-term follow-up to detect anastomotic strictures. Strictures should initially be managed by percutaneous dilatation, with surgical revision as a next step in treatment.


Assuntos
Ductos Biliares/lesões , Ductos Biliares/cirurgia , Colecistectomia/efeitos adversos , Doença Iatrogênica , Anastomose em-Y de Roux/efeitos adversos , Colangite/etiologia , Colecistectomia/métodos , Constrição Patológica/etiologia , Dilatação/instrumentação , Humanos , Jejuno/cirurgia , Cirrose Hepática Biliar/etiologia , Prognóstico , Qualidade de Vida , Recidiva , Reoperação , Estudos Retrospectivos
18.
J Gastroenterol Hepatol ; 35(3): 492-498, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31418477

RESUMO

BACKGROUND AND AIM: Fully covered self-expandable metallic stent (FCSEMS) may be an effective modality for managing anastomotic biliary stricture (ABS) after liver transplantation. However, stent migration and stent-induced ductal injury are the main limitations. The objective of this study was to evaluate the usefulness of an unflared, intraductal FCSEMS that was designed to minimize migration and ductal injury for refractory ABS after living donor liver transplantation (LDLT). METHODS: A total of 32 consecutive patients with symptomatic ABS after LDLT unresolved by plastic stents with or without balloon dilation at four tertiary medical centers were prospectively enrolled. A short (3 or 5 cm) FCSEMS having long lasso (10 cm) used in this study had unflared convex ends to minimize tissue hyperplasia and smaller center portion to prevent migration. The FCSEMS was placed above the papilla and removed at 3-4 months after stenting. RESULTS: Technical and clinical success rates of intraductal placement with FCSEMS were 100% (32/32) and 81.2% (26/32), respectively. Early stent migration was observed in five (15.6%) patients. However, three patients with early stent migration had stricture resolution without needing additional intervention. Intended stent removal was successful in 27 (100%) patients (median, 101 days; range, 23-118 days). No stent-induced ductal change was observed in all patients. Stricture recurrence was observed in 11.5% (3/26) of patients during 639 days of median duration of follow-up (range, 366-2079 days). CONCLUSIONS: Intraductal placement of an unflared short FCSEMS may be a promising option for refractory ABS after LDLT with minimal stent-induced ductal injury and stent migration.


Assuntos
Colestase/cirurgia , Transplante de Fígado , Doadores Vivos , Metais , Complicações Pós-Operatórias/cirurgia , Stents , Idoso , Ductos Biliares/lesões , Feminino , Seguimentos , Migração de Corpo Estranho/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Stents/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
20.
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
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