Congenital hyperinsulinism
Prem Puri in Newborn Surgery, 2017
Each of the medical treatments of CHI can have its side effects.7 Long-term use of diazoxide is associated with hypertrichosis (excessive growth of hair in areas where hair does not normally grow), and this can limit its long-term use. Octreotide is associated with a wide range of side effects including gastrointestinal upset (abdominal pain, nausea, bloating, and diarrhea), and suppression of growth hormone (GH), thyroid-stimulating hormone (TSH), and adrenocorticotropic hormone (ACTH). Recurrent hypoglycemia can occur as a result of insufficient surgical resection of the diffuse form of the disease, or due to failed localization in the focal form, and should be evident within the first 72 hours after the operation. Persistent hypoglycemia may require further surgical resection. Other surgical complications include postoperative infection, bleeding, and operative trauma to the bile duct.22 If the latter is diagnosed preoperatively, then primary repair and drainage is performed. Delayed diagnosis of bile duct injury can be treated operatively or conservatively depending on the degree of damage and the timing of presentation.
Complications of Biliary Tract Surgery and Trauma
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
Stewart and Way40 reported that several factors are associated with the successful repair of common duct injuries after biliary surgery. These factors are preoperative cholangiography, the choice of surgical repair, the details of the surgical repair, and the experience of the surgeon performing the repair. These authors demonstrated that 96% of repair procedures for bile duct injury were unsuccessful without preoperative cholangiography. When complete cholangiography was performed preoperatively, 84% of the initial repair procedures were successful. Primary end-to-end anastomosis led to unsuccessful outcomes in all cases, whereas Roux-en-Y hepaticojejunostomy led to success in 63% of cases. The success rate was 94% if the first repair was performed by a tertiary care biliary surgeon, but only 17% if the initial repair was performed by the primary surgeon.
Liver, Gallbladder, and Exocrine Pancreas
Pritam S. Sahota, James A. Popp, Jerry F. Hardisty, Chirukandath Gopinath, Page R. Bouchard in Toxicologic Pathology, 2018
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.
Comparison of procedure-related complications between percutaneous cryoablation and radiofrequency ablation for treating periductal hepatocellular carcinoma
Published in International Journal of Hyperthermia, 2020
Seong Eun Ko, Min Woo Lee, Hyunchul Rhim, Tae Wook Kang, Kyoung Doo Song, Dong Ik Cha, Hyo Keun Lim
Tumor location should be considered for the successful and safe local ablation of HCCs. The management of periductal HCCs by RFA is challenging because thermal injury to the bile duct can result in biliary complications such as bile duct stricture and hepatic biloma [11–13]. In addition, central bile duct injury can severely impair liver function and lead to poor prognosis [14]. Given that CA is safer than RFA for tumors close to critical structures [8,15], tumors near the bile duct can be treated with CA without serious biliary complications. Studies comparing CA and RFA have not found significant differences in the overall safety between the two ablative techniques for HCC; however, tumor location relative to the bile duct was not determined in these studies [5,6]. Therefore, this study aimed to evaluate the incidence and severity of biliary complications after treating HCCs abutting the bile duct using CA or RFA and assess independent risk factors for biliary complications after these procedures.
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.
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.
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