Background Bile duct injuries (BDI) can occur after a cholecystectomy procedure performed by any surgeons. These ensured a poor experience for patients and surgeons and marred the minimally invasive surgery approach, which should have promised rapid recovery. This study aimed to evaluate the management of BDI following cholecystectomy procedure in Cipto Mangunkusumo Hospital, Jakarta, as a tertiary hospital. Method Descriptive retrospective cross-sectional design was used on open and laparoscopic cholecystectomy performed between January 2008 and December 2018. This study is reported in line with STROCSS 2019 Criteria. Result A total of 24 patients with BDI were included, with female preponderance (62,5%) with a median age 45 (21–58) years. Sixteen post-laparoscopy cases were classified according to Strasberg classification; 6 cases were type E3, 2 cases each of type E1 and E2, and one case each of Strasberg C and D. The remaining 4 were Strasberg A. Eight post-open cases were classified based on Bismuth criteria: 4 cases of Bismuth I, 1 case of Bismuth II, and 3 cases of Bismuth III. Five cases were presented with massive biloma, 7 with jaundice, and 10 cases with biliary-pancreatic fluid production through the surgical drain. The average time of problem recognition to patient's admission was 19 (7–152) days and admission to surgery was 14 days. Roux-en-Y hepaticojejunostomy was performed in 18 cases, choledocho-duodenostomy in 2 cases, and primary ligation cystic duct in 4 cases. Post-operative follow-up showed 2 patients had recurrent cholangitis, 2 superficial surgical site infection, and 2 relaparotomy due to bile anastomosis leakage and burst abdomen. The median length of hospital stay was 38 (14–53) days with zero hospital mortality. No stricture detected in long term follow-up. Conclusion Common bile duct was the most frequent site of BDI, and Roux-en-Y hepaticojejunostomy reconstruction performed by HPB surgeons on high volume center results in a good outcome.
Agenesis vena porta adalah kelainan yang jarang ditemukan dimana aliran darah vena dari limpa dan usus tidak melalui hepar tetapi mengalir ke aliran sistemik melalui berbagai pintasan. Dilaporkan satu kasus pasien wanita berusia 32 tahun dengan kelainan ini dimana pasien mengalami hematemesis dan melena berulang dan didapati adanya splenomegali dan hipersplenisme. Pada angiografi tidak ditemukan adanya vena porta. Dilakukan tindakan splenektomi untuk menurunkan tekanan pada vena-vena sekitar gaster dan mengkoreksi hipersplenisme. Enam bulan pasca operasi dilakukan endoskopi dengan hasil varises pada esofagus sudah menghilang sedangkan varises pada gaster sudah mengecil.
Further goal is treatment of underlying cause of biliary leak. Minimally invasive procedures are procedures of choice.
atleast 2 months to 36 months. Readmission and recurrences were evaluated Results: Cystobiliary communication could be identified pre operatively in 9 out of the 22 patients whereas in the rest it was made intraoperatively.Cyst evacuation with omentoplasty and partial pericystectomy were considered as conservative surgeries whereas total cystopericystectomy and right or left hemi hepatectomies were considered as radical procedures. 2 patients who were offered conservative surgical treatment underwent post op ERCP.CBD exploration and T tube placement was necessitated in 7 patients. Conclusion: Treatment options are multiple. While conservative approaches carried a small but significantly high incidence of recurrence, radical surgery has its own disadvantages in terms of prolonged operating time, higher blood loss and in its need for a HPB surgeon. The need for CBD exploration and T tube drainage was comparable in both approaches. Larger studies are needed to formulate a protocol.
Overall survival curve of the study groups Introduction: Portal vein thrombosis (PVT) is a common complication for patients with end-stage liver disease. The presence of PVT used to be a contraindication to LDLT. This is related to technical difficulties of PV reconstruction, increased blood loss, and the risk for postoperative PV complications. Methods: We reviewed the data of LDLT patients at Liver Transplantation Unit, Mansoura University, Egypt during the period between May 2004 till March 2017. Patients were divided into three groups. Group I: patients without PVT, Group II: attenuated PV patients (PV diameter <8 mm), and Group III PVT patients. Results: During the study period, 500 cases underwent LDLT. Group I included 446 patients (89.2%), Group II included 26 patients (5.2%), and Group III included 28 patients (5.6%). Higher incidence of hematemesis and encephalopathy was detected in Group III. Longer anhepatic phase duration was found in Group III. There were no significant differences regarding operation time, blood loss, and transfusion requirements. Higher incidence of postoperative vascular complications was found in Group III. The median OS was 33 months (4-169). The 1-, 3-, and 5years OS survival rates of Group I were 80.5%, 77.7%, and 75%, while for Group II were 84.6%, 79.6%, and 73.5%, and for Group III were 88.3%, 64.4%, and 64.4% respectively. There was no significant difference between the groups regarding OS rates (Log-Rank: 0.793). Conclusion: Preoperative PVT increases the complexity of LDLT operation and the operative trauma to the patient, but it does not reduce the OS rates.
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