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Applied Surgical Anatomy
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Vishal G Shelat, Andrew Clayton Lee, Julian Wong, Karen Randhawa, CJ Shukla, Choon Sheong Seow, Tjun Tang
If a bile duct injury is suspected during surgery – what would you do?Call HPB surgical colleagueArrange for intra-operative cholangiogramPlace a drain and bailout and refer to specialist HPB unit
Biliary obstruction and leaks
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
Factors associated with bile duct injury most commonly include a failure correctly to identify anatomical structures before clips, ligatures or cautery are applied. The reasons for such failure may include: misidentification of the common duct for the cystic duct when anatomy is normal; failure to appreciate aberrant anatomy [15]; difficulty in adequate visualization due to patient obesity, hepatomegaly or previous surgery resulting in adhesions; damage occurring during attempts to acquire urgent haemostasis; and distortion and limitation of the operating field when using laparoscopic instruments.
Liver, Gallbladder, and Exocrine Pancreas
Published in Pritam S. Sahota, James A. Popp, Jerry F. Hardisty, Chirukandath Gopinath, Page R. Bouchard, Toxicologic Pathology, 2018
Russell C. Cattley, James A. Popp, Steven L. Vonderfecht
It is suspected that the mechanism of bile duct injury involves exposure of the biliary epithelium to reactive metabolites that either are excreted into the bile or may form in the bile via breakdown of conjugated metabolite(s) that are excreted in the bile. In the rare instance, precipitated drug or drug metabolite may be found within the lumen of the ducts containing damaged bile duct epithelial cells. It is uncertain whether this event is rare or whether it is recognized and underreported in the course of screening for new drug candidates, as deselection is routinely decided.
Open hepatic artery flow with portal vein clamping protects against bile duct injury compared to pringles maneuver
Published in Scandinavian Journal of Gastroenterology, 2023
Siliang Zhang, Pingli Cao, Pinduan Bi, Fu Yang, Ming Wu, Ding Luo, Bin Yang
Liver tissues were fixed with 10% formalin for 24 h at room temperature, then embedded in paraffin. Sections were cut into 4 μm thickness and prepared for hematoxylin&eosin, immunohistochemistry and immunofluorescence staining. The detailed procedure was carried out as previously described [14]. Briefly, the sections were dewaxed and hydrated by xylene and alcohol (70%, 90%, 100%, v/v) at room temperature. The sections were then stained with hematoxylin for 5 min and then eosin for 1 min (Beyotime, China) at room temperature. The hematoxylin-eosin (H&E)-stained paraffin-embedded liver sections were observed in light microscopy (DM6000B, Leica, Germany). The bile duct was histologically assessed by employing the method of bile duct injury severity score (BDISS) that was introduced by Genken et al. [15]. Two independent expert pathologists who were unaware of group assignments performed the scoring.
Echinococcosis in a non-endemic country – 20-years’ surgical experience from a Norwegian tertiary referral Centre
Published in Scandinavian Journal of Gastroenterology, 2022
Sheraz Yaqub, Mogens Jensenius, Ole Einar Heieren, Anders Drolsum, Frank O. Pettersen, Knut Jørgen Labori
For the 51 patients who underwent surgical treatment, the median hospital stay was eight days (range, 3-75). Clavien Dindo grade ≥3 complications occurred in 30% (Table 3). There was one postoperative death (2%) within 90-days due to a myocardial infarction. Bile leakage occurred in seven patients and was treated successfully in all patients with endoscopic retrograde cholangiopancreatography (ERCP) and biliary stent placement. A minor bile duct injury detected intraoperatively occurred in one patient and was treated with primary suture, and postoperatively ERCP with biliary stent. One patient developed severe acute hypernatremia, detected immediately postoperatively, caused by intraoperative peritoneal lavage with 20% hypertonic saline due to cystic fluid spillage. Clavien-Dindo grade ≥3 complication occurred in 18.8%, 33.3%, and 83.3% in patients treated with radical surgery, conservative surgery, and combined surgery, respectively (Table 3). Follow-up was for most patients performed at their primary hospitals elsewhere in Norway. To the best of our knowledge, no cases were readmitted with relapse after surgical treatment.
Microwave ablation for peribiliary hepatocellular carcinoma: propensity score analyses of long-term outcomes
Published in International Journal of Hyperthermia, 2021
Hao Hu, Jia Chang Chi, Rong Liu, Bo Zhai
Most intrahepatic small bile duct injury has been considered as minor complication without any effects on clinical outcomes [15]. These bile duct changes after ablation are easily ignored in patients without either clinical or laboratory abnormalities [16]. However, intrahepatic central bile duct injury may cause different degree of biliary complications and indirectly influences prognosis of patients. Severe bile duct dilatation after ablation has been significantly associated with survival and recurrence rate in patients [17,18]. Presently, no study has compared the therapeutic outcomes of peribiliary and non-peribiliary HCC. Only a few studies [17–19] have addressed the efficacy and safety of ablation methods for peribiliary HCC. These studies, however, yielded conflicting results in terms of local and distant tumor progression and therapeutic outcomes. These controversies have not been addressed in a large, comparative study with long-term follow-up. Furthermore, no guidelines on the use of ablation for the treatment of peribiliary HCC have been proposed.