scholarly journals Clinical Study on Causative Factors and Recurrence of Choledocholithiasis

1996 ◽  
Vol 3 (2) ◽  
pp. 81-91 ◽  
Author(s):  
Hajime Hoshi ◽  
Yoshihiro Sakai
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Biliary Tract ◽  
Cystic Duct ◽  
Multivariate Analyses ◽  
Hepatic Duct ◽  
Calcium Bilirubinate ◽  
Gallbladder Stones ◽  
Duct Diameter ◽  
Increased Risk

To identify factors involved in choledocholithiasis, clinical characteristics were studied using univariate and multivariate analyses. Factors involved in recurrence were also investigated. The subjects consisted of 51 patients with calcium bilirubinate stones (B group) and 52 patients with cholesterol stones (C group). All patients had choledocholithiasis and underwent lithotripsy by endoscopic sphincterotomy (EST) during the past 9 years. Twenty variables, including clinical symptoms and endoscopic retrograde cholangiopancreatography (ERCP) findings, were analyzed using a Statistical Analysis System (SAS) software package. Univariate analysis were done using Student's t-test and the chi-square test. Multivariate analyses were done by stepwise logistic regression analysis. In univariate analyses, there were significant differences between the B group and C group in nine variables: age, common bile duct diameter, common hepatic duct diameter, common bile duct stone diameter, cystic duct diameter, and the presence of gallbladder stones, atypical arrangement of the hepatic duct, parapapillary diverticulum, and large parapapillary diverticulum. In multivariate analysis, the four variables of no gallbladder stone, large parapapillary diverticulum, cystic duct less than 8 mm, and atypical arrangement of the hepatic duct were significant independent factors for the development of stones in the B group, with relative risks of 37.75, 16.73, 5.56, and 5.49, respectively. The results indicated that calcium bilirubinate stones were frequently associated with parapapillary diverticulum and abnormal arrangement of the bile duct. The formation of these stones was attributed to chronic biliary stasis caused by dysfunction of the biliary tract, including the papilla. In contrast, most cholesterol stones found in the common bile duct had apparently descended from the gallbladder. Common bile duct stones recurred after EST in 9 patients, all of whom had calcium bilirubinate stones. On ERCP, recurrence was found to be frequently associated with gallbladder stones, large parapapillary diverticula, and atypical arrangement of the hepatic duct. Patients with these characteristics on initial ERCP should therefore receive appropriate treatment and undergo strict follow-up observations owing to the increased risk of recurrence caused by dysfunction of the biliary tract.

scholarly journals P-BN27 Novel technique for safe and efficient cannulation of the cystic and common bile duct

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Khurram Khan ◽  
Morag McLellan ◽  
Sajid Mahmud
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Cystic Duct ◽  
Gallstone Disease ◽  
Common Bile Duct Exploration ◽  
Conversion To Open Surgery ◽  
Critical View Of Safety ◽  
Novel Technique ◽  
Increased Risk ◽  
Time Required

Abstract Background Concomitant stones in the common bile duct (CBD) at the time of laparoscopic cholecystectomy (LC) are present in up to 15% of patients.  In conjunction with intra-operative cholangiogram (IOC), transcystic common bile duct exploration (TCBDE) enables diagnosis and management of ductal stones in a single stage procedure.  However, cannulation of the cystic duct (CD) and CBD can be challenging.  With repeated attempts at cannulation, there is increased risk of iatrogenic injury by creating a false passage or perforating the duct.  We propose a novel technique for the safe cannulation of the CD and CBD. Methods Once critical view of safety is achieved, a clip is placed distally in the CD and opened with scissors.  A flexible tip 80cm guidewire is then preloaded into 5-French ureteric catheter. The complex is then passed into the introducer through the lateral port. A grasper placed at Hartmann’s pouch is used to retract the gallbladder and straighting the CD. Only the guidewire is advanced out of the catheter, traversing the CD and CBD. Once safely advanced, the catheter can then be slid over the guidewire and the guidewire can be removed. IOC and TCBDE can then be performed if indicated. Results This technique was performed on 18 patients who failed CD cannulation during elective and emergency LC for symptomatic gallstone disease in a single center performed by the same surgical team.  Median age was 46 years and there was 15 females.  A total of 34 cannulations were attempted (in 18 patients) which 100% success rate.  There was no added time required for the technique.  In majority of cases it decreased the operative time due to quick intubation of CBD.  None of the cases required conversion to open surgery. Conclusions The novel technique described for cannulation of the cystic duct uses a Seldinger ‘like’ approach. This is a safe an effective strategy for cannulation of the CD, making the skills more accessible and more time efficient. This should encourage more surgeons to perform IOC and TCBDE where indicated. 

scholarly journals Strategies for Management of Bile Duct Injury During Laparoscopic Cholecystectomy

2001 ◽  
Vol 7 (2) ◽  
pp. 55-61 ◽  
Author(s):  
Tatsuya Aoki ◽  
Akihiko Tsuchida ◽  
Hitoshi Saito ◽  
Yuichi Nagakawa ◽  
Keiichi Kitamura ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Duct Injury ◽  
Cystic Duct ◽  
Hepatic Duct ◽  
Common Hepatic Duct ◽  
Tube Drainage ◽  
T Tube ◽  
Aberrant Bile Duct

We encountered 10 patients with bile duct injuries during laparoscopic cholecystectomy. Their causes were electrocautery in 2 patients, misjudgment in 2, mechanical injury in 3, aberrant bile duct in 2, and weakness of the bile duct wall in one. The sites of injury were cystic duct in 4 patients, common bile duct in 2, aberrant bile duct in 2, common hepatic duct in one, and common bile duct plus right hepatic duct in one. Treatments for the injuries discovered intraoperatively consisted of T-tube drainage above in 2 patients, re-ligation of the cystic duct in one, ligation of an aberrant bile duct in one, simple suture and T-tube in one, and choledochojejunostomy in one. In the remaining 4 patients discovered postoperatively, 2 were conservatively treated by endoscopic retrograde biliary drainage. The duration of hospitalization was 9–12 days in the 4 patients with simple suture or ligation, 10–21 days in 2 cases of bile drainage, and 34–43 days in 3 with T-tube drainage. The patient with choledochojejunostomy suffered repeated cholangitis, resulting in hepatic abscess with hospitalization for 6 months. Since laparoscopic surgery should be minimally invasive, meticulous attention is necessary before and during surgery to avoid bile duct injury.

Functional gradients in muscle cells isolated from gallbladder, cystic duct, and common bile duct

1988 ◽  
Vol 255 (5) ◽  
pp. G647-G652 ◽  
Author(s):  
C. Severi ◽  
J. R. Grider ◽  
G. M. Makhlouf
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Biliary Tract ◽  
Cystic Duct ◽  
Single Cells ◽  
Muscle Cells ◽  
Relative Sensitivity ◽  
Gallbladder Emptying ◽  
Duct Cells ◽  
Low Concentrations

The existence of a gradient inherent to muscle cells of the biliary tract was examined in muscle cells isolated separately from the fundus of the gallbladder, cystic duct, and common bile duct of the dog. Muscle cells, measured in suspension or as single perfused cells, exhibited a proximal-to-distal gradient expressed by the magnitude of response and the sensitivity to hormonal cholecystokinin octapeptide and neural (acetylcholine and methionine-enkephalin) contractile agonists. Measurements in suspensions showed that cells from the fundus 1) were 7-40 times more sensitive to contractile agonists than cells from the cystic duct and 13-200 times more sensitive than cells from the common bile duct and 2) generated greater maximal contraction. The latter was expressed by the ratio of maximal responses (fundus: cystic duct cells, 1.90 +/- 0.12, P less than 0.001; fundus: common bile duct cells, 1.50 +/- 0.07 P less than 0.001), which was independent of sensitivity to agonists. Similar results were obtained in measurements on single cells with respect to relative sensitivity and to ratio of maximal responses (fundus: cystic duct cells, 1.80 +/- 0.08, P less than 0.001; fundus: common bile duct cells, 1.49 +/- 0.06, P less than 0.001). The ratio of responses to low concentrations of agonists was even higher (three- to fourfold), reflecting both the greater sensitivity and the greater contraction of muscle cells of the fundus. We conclude that a proximal-to-distal biliary gradient exists that is an inherent property of muscle cells from various regions of the biliary tract; the gradient would act to facilitate gallbladder emptying in response to hormonal and neural stimulation.

Causes, diagnosis, and treatment of postoperative obstructive jaundice

2021 ◽  
Vol 29 (2) ◽  
pp. 257-266
Author(s):  
Makhmadsho K. Gulov ◽  
Kakhramon R. Ruziboyzoda
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Obstructive Jaundice ◽  
Minimally Invasive ◽  
Biliary Tract ◽  
Hepatic Duct ◽  
Abdominal Cavity ◽  
Surgical Interventions ◽  
Laparoscopic Operation ◽  
The Common

AIM: This study aimed to analyze the causes, diagnosis, and clinical treatment of postoperative obstructive jaundice (POOJ) in routine surgical practice. MATERIALS AND METHODS: Twenty-four patients with POOJ that developed in the organs of the hepatobiliary system after surgical interventions were included in this study. The patients were subjected to the following procedures to diagnose the causes of POOJ and choose the treatment methods: general clinical examination, biochemical blood tests, dynamic postoperative ultrasound examination of the abdominal organs, video laparoscopy, computed tomography, magnetic resonance imaging, fistulocholangiography, endoscopic retrograde cholagiopancreatography, and percutaneous transhepatic cholangiostomy. RESULTS: POOJ occurred in 18 cases after they had different variants of surgical interventions on the biliary tract after traditional (n = 6) and video laparoscopic cholecystectomy (n = 12). POOJ also developed in 6 cases after they underwent surgery on the liver: atypical (n = 2) and anatomical (n = 2) resection of the liver. This condition manifested after the opening and draining of liver abscesses under US control (n = 2). POOJ was treated with different methods to alleviate the developed complications. After surgical interventions on the liver and biliary tract in 6 cases, relaparotomy, sequestrectomy with sanation, drainage of the abdominal cavity (n = 4), and right-sided hemihepatectomy (n = 2) were performed. In 6 other cases, on days 34 of the development of POOJ after laparoscopic operation (n = 2), relaparotomy was performed, clips and ligature were removed from the choledoch with the formation of Roux-en-Y hepaticojejunostomy. Minimally invasive methods of POOJ correction were applied to 12 cases. Of the 12 cases, 5, 2, and 1 were subjected to endoscopic papillosphincterotomy with lithoextraction, endoscopic papillosphincterotomy with lithoextraction coupled with nasobiliary drainage, and relaparoscopy and redrainage of the common bile duct, respectively. In 4 cases, percutaneous transhepatic cholangiostomy was performed at the first stage. At the second stage, after POOJ resolution, the following procedures were implemented: redrainage of the common bile duct (n = 2) and dilatation of the orifice of the right hepatic duct with reconstruction of hepaticojejunostomy on the hidden transhepatic drainage. CONCLUSION: POOJ is still encountered in clinical practice in a sufficient number of cases. Treatment results largely depend on the time of diagnosis and the choice of optimal surgical strategies. The main causes of POOJ are tactical and technical diagnostic and treatment errors. POOJ is diagnosed on the basis of the data of modern radiation and laboratory and instrumental examination methods. Surgical tactics for POOJ are individually active and dependent on the severity, time, and causes of development. They also depend on the general condition of patients. Along with minimally invasive interventions for POOJ, early relaparotomy is less dangerous than passive expectation tactics.

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