Altered Consciousness Associated with Chronic Liver Disease

Ghavidel, Ali

doi:10.15171/mejdd.2018.129

Cited by 4 publications

(9 citation statements)

References 6 publications

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“…Subsequent inflammation surrounding the area can lead to erosion of the cystic stump and CBD wall, allowing surgical clips to migrate into the CBD. The clips then act as a nidus for bile aggregation, leading to stone formation and bile duct obstruction [ 4 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Existing literature suggests that the majority of PCCM cases can be successfully managed through endoscopic retrograde cholangiopancreatography (ERCP), a minimally invasive procedure aimed at removing the migrated clip and resolving associated biliary obstruction. However, approximately 20% of cases may necessitate alternative therapeutic approaches beyond ERCP, underscoring the importance of recognizing and promptly addressing this complication to optimize patient outcomes [ 3 , 4 ]. As such, this case report aims to contribute to the existing body of knowledge surrounding PCCM by presenting a clinical case of clip migration into the CBD following cholecystectomy.…”

Section: Introductionmentioning

confidence: 99%

“…Post-cholecystectomy clip migration represents a rare yet noteworthy complication, occurring when surgical clips utilized to seal the cystic duct migrate into the common bile duct (CBD). Although infrequent, this complication warrants attention due to its potential to lead to obstructive jaundice, biliary colic, or even more serious consequences if left untreated [3][4][5]. Existing literature suggests that the majority of PCCM cases can be successfully managed through endoscopic retrograde cholangiopancreatography (ERCP), a minimally invasive procedure aimed at removing the migrated clip and resolving associated biliary obstruction.…”

Section: Introductionmentioning

confidence: 99%

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Post-cholecystectomy Clip Migration: A Case Report

Singh,

Arumugam,

Mathur

et al. 2024

Cureus

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Surgical clip migration into the common bile duct (CBD) with subsequent stone formation is an exceedingly rare complication following both laparoscopic and open cholecystectomy, with fewer than 100 cases reported in the literature. Herein, we present the case of a 78-year-old female who presented with abdominal pain and dark urine six years after an open cholecystectomy. Her abdominal ultrasonography revealed no abnormalities, with only mild derangements noted in liver function tests. However, computed tomography of the abdomen unveiled a single metallic surgical clip lodged within the CBD, surrounded by a bile stone, alongside another clip at the gallbladder fossa. The patient underwent endoscopic retrograde cholangiopancreatography (ERCP), during which the clip was successfully removed. The procedure has utilized SpyGlass cholangioscopy. While clip migration into the CBD remains a rare phenomenon, it should be considered in the differential diagnosis of patients presenting with obstructive jaundice or biliary colic post-cholecystectomy. Minimally invasive management by ERCP is the procedure of choice for migrated clips-related complications but surgical common bile duct exploration may be necessary. This case highlights the importance of vigilance and prompt intervention in managing post-cholecystectomy clip migration (PCCM) but potentially serious postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Post-cholecystectomy Clip Migration: A Case Report

Singh,

Arumugam,

Mathur

et al. 2024

Cureus

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“…Despite relatively prolonged intraoperative time, extracorporeal knotting eliminates the drawbacks of clipping as: Clip migration, slippage ,internalization and cat eye stones. Ghavidel,22 stated that cat eye stones due to clip migration can occur mostly after a median period of two years post cholecystectomy. Rawal, 23 noted the migration of two clips into the common bile duct resulting in stone formation.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Clipless Laparoscopic Cholecystectomy with the Aid of Extracorporeal Mishra’s Knot

Seifalyazal

Sameh

Elnabil-Mortada

2023

Ain Shams Journal of Surgery

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Introduction: Routinely in laparoscopic cholecystectomy, titanium clips were utilized to secure cystic duct and artery. Lately, there are lot of advances in sealing cystic duct and artery as Harmonic Scalpel, Plasma Kinetic sealer, intracorporeal and extracorporeal suturing. Although some of these methods are effective, they are expensive with low availability. Aim of the study:To evaluate the use of extracorporeal Mishra's knot in securing cystic duct and artery in laparoscopic cholecystectomy regarding operative time, cost effectiveness and post operative complications. Patients and methods:This prospective hospital-based study was conducted between October 2017 and November 2019 at Al-Jedaani hospitals, KSA. Thirty patients who underwent laparoscopic cholecystectomy were included. Cystic duct and artery were secured with extracorporeal Mishra's knot. Results:The mean operative time was 61.81 minutes ±3.31. Postoperative bile leak and superficial surgical site infection were reported in 3.3% and 6.7% respectively. The cost of used suture material was (10-14 $). Conclusion:Using extracorporeal Mishra's knot to secure cystic duct and artery is feasible, economic and safe.

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“…Unlike ligation with sutures during open surgery, the clips used during laparoscopic surgery are likely to slip, displace, migrate, and perforate the viscera with major bleeding, and rarely embolism. It may also cause cystic duct necrosis, bile leakage, and gallstone formation [9][10][11][12][13]. Routinely, the cystic duct and cystic artery are ligated separately during laparoscopic surgery for acute cholecystitis.…”

Section: Introductionmentioning

confidence: 99%

Concurrent ligation of cystic duct and cystic artery versus separate ligation during laparoscopic cholecystectomy in patients with acute cholecystitis

Rahmani¹,

Bonyadi²,

Sohrab³

et al. 2020

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Introduction: Laparoscopic cholecystectomy as a gold standard for treatment of patients with acute cholecystitis is associated with complications. Some complications are dependent on the methods of surgery and applying clips. Aim of the research:To compare complications following concurrent and separate ligation of cystic duct and artery and evaluate the costs of each procedure. Material and methods:The study was designed as a prospective cohort. Patients with acute cholecystitis due to gallstones were included. They were assigned into two groups: 1) separate ligation group and 2) concurrent ligation group. Routine laparoscopic surgery was performed. For the first group, the hilum was dissected and the cystic duct and artery were ligated separately. For the concurrent group, the cystic duct and artery were ligated together. Intra-operative and post-operative data were measured. Results: A total of 122 patients were enrolled in this study. The median lengths of symptoms to surgery were 3.23 days for the concurrent group versus 3.67 days for the separate group (p = 0.004). There was no statistically significant difference in post-operative complications. One patient in the concurrent group had biliary colic and cholestasis due to a stone in common bile duct managed by endoscopic retrograde cholangiopancreatography. Twice as many clips were used in the separate group than in the concurrent group (six clips vs. three clips, p ≤ 0.001). Further analyses revealed that operation time and costs were significantly higher in the separate ligation group. Conclusions: The mean duration of surgery and number of clips applied for ligation were higher in the separate ligation group. Concurrent ligation seems to be associated with similar complications and therapeutic outcomes compared to separate ligation and is cost effective for replacement of the routine procedure in the future. StreszczenieWprowadzenie: Cholecystektomia laparoskopowa -złoty standard w leczeniu pacjentów z ostrym zapaleniem pęcherzyka żółciowego -wiąże się z występowaniem określonych powikłań. Niektóre z nich zależą od stosowanej metody operacyjnej i zakładania klipsów. Cel pracy: Porównanie powikłań po jednoczesnym i oddzielnym podwiązaniu przewodu pęcherzykowego i tętnicy pęcherzykowej oraz ocena kosztów związanych z tymi procedurami. Materiał i metody: Badanie przeprowadzono z wykorzystaniem prospektywnej kohorty pacjentów. Do analizy włączono chorych z ostrym zapaleniem pęcherzyka żółciowego wywołanym kamicą żółciową. Uczestników podzielono na dwie grupy w zależności od rodzaju podwiązania: 1) oddzielne podwiązanie i 2) jednoczesne podwiązanie. Wykonano rutynową operację laparoskopową. W pierwszej grupie wypreparowano wnękę oraz oddzielnie podwiązano przewód pęcherzykowy i tętnicę pęcherzykową. W drugiej grupie przeprowadzono jednoczesne podwiązanie przewodu pęcherzykowego i tętnicy pęcherzykowej. Zebrano odpowiednie dane śród-i pooperacyjne.Concurrent ligation of cystic duct and cystic artery versus separate ligation during laparoscopic cholecystectomy ...

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Altered Consciousness Associated with Chronic Liver Disease

Cited by 4 publications

References 6 publications

Post-cholecystectomy Clip Migration: A Case Report

Post-cholecystectomy Clip Migration: A Case Report

Evaluation of Clipless Laparoscopic Cholecystectomy with the Aid of Extracorporeal Mishra’s Knot

Concurrent ligation of cystic duct and cystic artery versus separate ligation during laparoscopic cholecystectomy in patients with acute cholecystitis

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