RESUMO
BACKGROUND: Antibiotics have been reported as an efficient and safe treatment option for uncomplicated acute appendicitis without an appendicolith diagnosed using computed tomography (CT). The aim of this study was to assess the association of a CT-diagnosed appendicolith and its characteristics with appendicitis severity. METHODS: A large prospective patient cohort with suspected acute appendicitis enrolled between April 2017 and November 2018 was retrospectively reviewed. The initial analysis evaluated the association of a CT-diagnosed appendicolith with complicated acute appendicitis; then, based on the availability of CT images, a subset of patients was analysed for the correlation of appendicolith characteristics with appendicitis severity. The final appendicitis assessment (uncomplicated or complicated-including perforation, gangrene, an abscess, or a tumour) was determined for all patients. RESULTS: Out of 3512 eligible patients, 3085 patients with appendicitis were selected and 380 patients with an appendicolith and with a CT image available for reassessment were included. Out of the 3085 patients with CT-diagnosed acute appendicitis, 1101 (35.7%) patients presented with both acute appendicitis and an appendicolith and, out of these, 519 (47.1%) had complicated acute appendicitis. In the patients without an appendicolith (1984 patients), 426 (21.5%) had complicated appendicitis (P < 0.001). Re-evaluation of CT images for 380 patients showed that a larger appendicolith diameter (OR = 1.15 (95% c.i. 1.06 to 1.25); P < 0.001), appendicolith location at the base of the appendix (55.1% versus 44.9%; P = 0.008), and heterogeneous appendiceal wall enhancement around the appendicolith (68.4% versus 31.6%; P < 0.001) were associated with an increased risk of complicated acute appendicitis. CONCLUSION: The presence of an appendicolith in patients with acute appendicitis is correlated with the risk of complicated appendicitis. This risk is further increased by a larger appendicolith diameter or appendicolith location at the base of the appendix.
Assuntos
Apendicite , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Humanos , Apendicite/diagnóstico por imagem , Apendicite/complicações , Masculino , Feminino , Adulto , Estudos Retrospectivos , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Aguda , Adulto Jovem , Apêndice/diagnóstico por imagem , Apêndice/patologia , Litíase/diagnóstico por imagem , Litíase/complicações , Apendicectomia , Adolescente , IdosoRESUMO
BACKGROUND: Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide. Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional multisession percutaneous transhepatic cholangioscopic lithotripsy (PTCSL). AIM: To study one-step PTCSL using the percutaneous transhepatic one-step biliary fistulation (PTOBF) technique guided by three-dimensional (3D) visualization. METHODS: This was a retrospective, single-center study analyzing, 140 patients who, between October 2016 and October 2023, underwent one-step PTCSL for hepatolithiasis. The patients were divided into two groups: The 3D-PTOBF group and the PTOBF group. Stone clearance on choledochoscopy, complications, and long-term clearance and recurrence rates were assessed. RESULTS: Age, total bilirubin, direct bilirubin, Child-Pugh class, and stone location were similar between the 2 groups, but there was a significant difference in bile duct strictures, with biliary strictures more common in the 3D-PTOBF group (P = 0.001). The median follow-up time was 55.0 (55.0, 512.0) days. The immediate stone clearance ratio (88.6% vs 27.1%, P = 0.000) and stricture resolution ratio (97.1% vs 78.6%, P = 0.001) in the 3D-PTOBF group were significantly greater than those in the PTOBF group. Postoperative complication (8.6% vs 41.4%, P = 0.000) and stone recurrence rates (7.1% vs 38.6%, P = 0.000) were significantly lower in the 3D-PTOBF group. CONCLUSION: Three-dimensional visualization helps make one-step PTCSL a safe, effective, and promising treatment for patients with complicated primary hepatolithiasis. The perioperative and long-term outcomes are satisfactory for patients with complicated primary hepatolithiasis. This minimally invasive method has the potential to be used as a substitute for hepatobiliary surgery.
Assuntos
Imageamento Tridimensional , Litíase , Litotripsia , Hepatopatias , Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Litíase/diagnóstico por imagem , Litíase/terapia , Complicações Pós-Operatórias/epidemiologia , Recidiva , Resultado do Tratamento , Hepatopatias/diagnóstico por imagem , Hepatopatias/terapia , Endoscopia do Sistema Digestório/métodosRESUMO
A 6-year-old intact female domestic dwarf rabbit (Oryctolagus cuniculus) was referred because of a chronic obstructive rhinitis not resolving despite antibiotic treatments. Computed tomography examination revealed 2 sub-obstructive structures of mineral density in the right nasal cavity and nasopharynx. Neoplasia and rhinolithiasis were the main differential diagnoses. A dorsal rhinostomy was performed and 1 mineralized lesion was removed. Infrared spectrophotometric and histological examinations of the lesion and nasal mucosa were consistent with a 100% calcium carbonate rhinolith with bacterial colonization and chronic lymphocytic rhinitis. Clinical signs improved during the first 4 wk following surgery. However, despite inhaled anti-inflammatory treatment, the rabbit's condition deteriorated when the rhinostomy site closed, and she died 7 wk after surgery. Rhinolith and lymphocytic rhinitis should be considered as differential diagnoses for upper respiratory tract signs in rabbits resistant to antimicrobial treatment. Key clinical message: Rhinolithiasis and chronic lymphocytic rhinitis should be included in the differential diagnoses of rabbits presenting with chronic obstructive upper respiratory tract signs characterized by purulent nasal discharge and failure of treatment despite adequate antimicrobial therapy, especially with unilateral signs. Computed tomography and rhinoscopy with biopsies are suggested to explore those possibilities.
Rhinolithiase au carbonate de calcium associée à une rhinite lymphoïde chronique chez un lapin de compagnie (Oryctolagus cuniculus)Une lapine naine domestique (Oryctolagus cuniculus) intacte, âgée de 6 ans, a été référée en raison d'une rhinite obstructive chronique non résolue malgré des traitement antibiotiques. L'examen tomodensitométrique a révélé 2 structures sous-obstructives de densité minérale dans la cavité nasale droite et le nasopharynx. La néoplasie et la rhinolithiase étaient les principaux diagnostics différentiels. Une rhinostomie dorsale a été réalisée et 1 lésion minéralisée a été retirée. Les examens par spectrophotométrie infrarouge et histologiques de la lésion et de la muqueuse nasale étaient compatibles avec un rhinolithe à 100 % en carbonate de calcium avec colonisation bactérienne et rhinite lymphocytaire chronique. Les signes cliniques se sont améliorés au cours des 4 premières semaines suivant l'intervention chirurgicale. Cependant, malgré un traitement anti-inflammatoire inhalé, l'état de la lapine s'est détérioré lors de la fermeture du site de rhinostomie et elle est décédée 7 semaines après l'opération. Le rhinolithe et la rhinite lymphocytaire doivent être envisagés comme diagnostic différentiel des signes des voies respiratoires supérieures chez les lapins résistants au traitement antimicrobien.Message clinique clé :La rhinolithiase et la rhinite lymphocytaire chronique doivent être incluses dans les diagnostics différentiels des lapins présentant des signes obstructifs chroniques des voies respiratoires supérieures caractérisés par un écoulement nasal purulent et un échec du traitement malgré un traitement antimicrobien adéquat, en particulier avec des signes unilatéraux. La tomodensitométrie et la rhinoscopie avec biopsies sont suggérées pour explorer ces possibilités.(Traduit par Dr Serge Messier).
Assuntos
Carbonato de Cálcio , Litíase , Rinite , Animais , Coelhos , Feminino , Rinite/veterinária , Rinite/tratamento farmacológico , Rinite/patologia , Carbonato de Cálcio/uso terapêutico , Litíase/veterinária , Litíase/patologia , Doenças Nasais/veterinária , Doenças Nasais/patologia , Doenças Nasais/tratamento farmacológico , Diagnóstico Diferencial , Evolução FatalRESUMO
A 12-year-old female spayed Domestic Shorthair cat presented with a 4-day history of lethargy, inappetence and vomiting. Physical findings included a grade 2/6 heart murmur and cranial abdominal pain on palpation. Serum biochemistry revealed elevated total bilirubin and liver enzymes activities. Abdominal ultrasound revealed multiple pancreatoliths, cholelithiasis and dilation of the pancreatic duct. During exploratory laparotomy, catheterisation of the pancreatic duct with retrograde and orthograde flushing to remove the pancreatoliths was performed via a distal enterotomy and proximal left apical partial pancreatectomy respectively. Catheterisation and flushing of the common bile duct were performed to confirm patency prior to cholecystectomy. Bacterial culture of pancreatoliths, pancreatic tissue and bile grew a heavy, pure growth of Providencia rettgeri. Fluorescent immunostaining histopathology revealed clusters of rod-shaped bacteria within the pancreatic parenchyma and gall bladder mucosa. The cat received pradofloxacin for two weeks. She made a complete recovery and remained well at a six-month follow-up.
Assuntos
Antibacterianos , Doenças do Gato , Infecções por Enterobacteriaceae , Providencia , Animais , Gatos , Feminino , Doenças do Gato/cirurgia , Doenças do Gato/microbiologia , Providencia/isolamento & purificação , Infecções por Enterobacteriaceae/veterinária , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/cirurgia , Antibacterianos/uso terapêutico , Pancreatopatias/veterinária , Pancreatopatias/cirurgia , Resultado do Tratamento , Litíase/veterinária , Litíase/cirurgiaRESUMO
The presence of calculi inside the uterine cavity is an uncommon finding, with few cases described in the literature. Here, we present a clinical case of a 30-year-old patient with uterine lithiasis. The patient presented with 3 months of evolution, characterized by abdominal pain in the hypogastrium, with a report of transvaginal ultrasound of hematometra with suggestive images of endometrial polyps. For this reason, she was scheduled for hysteroscopy, where three lesions of hard consistency were found, with the largest 1.5 cm. Currently, due to the few cases of uterine lithiasis described, there is no explanation of how the stones are formed in the uterine cavity. The age of the patient in this case report and the absence of predisposing factors for uterine calcifications reported in the literature is striking, which leads us to propose a hypothesis of the origin of uterine lithiasis, which is related to the history of cesarean section and the presence of hematometra, such hematic retention could have predisposed to the development of calculi in this patient. Uterine lithiasis is an extremely rare entity with few published cases; therefore, further studies are necessary.
Assuntos
Histeroscopia , Litíase , Doenças Uterinas , Humanos , Feminino , Histeroscopia/métodos , Adulto , Litíase/diagnóstico por imagem , Litíase/diagnóstico , Doenças Uterinas/diagnóstico , Doenças Uterinas/diagnóstico por imagem , Dor Abdominal/etiologia , Cesárea/efeitos adversos , Ultrassonografia , Hematometra/etiologiaRESUMO
BACKGROUND/AIM: Severity of microlithiasis- and sludge-induced pancreatitis in comparison to gallstone-induced pancreatitis has never been studied for a lack of definition. MATERIALS AND METHODS: In this retrospective cohort study, 263 patients with acute biliary pancreatitis treated at a tertiary care center from 2005 to 2021 were stratified according to the recent consensus definition for microlithiasis and sludge. The gallstone-pancreatitis cohort was compared to microlithiasis, sludge, and suspected stone passage pancreatitis cohorts in terms of pancreatitis outcome, liver function, and endosonography/endoscopic retrograde cholangiopancreatography results using one-way analysis of variance and χ 2 test. Multinomial logistic regression analysis was performed to correct for bias. RESULTS: Microlithiasis- and sludge-induced pancreatitis, classified according to the revised Atlanta classification, did not present with a milder course than gallstone-induced pancreatitis ( P = 0.62). Microlithiasis and sludge showed an increase in bilirubin on the day of admission to hospital, which was not significantly different from gallstone-induced pancreatitis ( P = 0.36). The likelihood of detecting biliary disease on endosonography resulting in bile duct clearance was highest on the day of admission and day 1, respectively. CONCLUSIONS: Microlithiasis and sludge induce gallstone-equivalent impaired liver function tests and induce pancreatitis with similar severity compared with gallstone-induced acute biliary pancreatitis.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Cálculos Biliares , Pancreatite , Índice de Gravidade de Doença , Humanos , Estudos Retrospectivos , Cálculos Biliares/complicações , Cálculos Biliares/diagnóstico por imagem , Pancreatite/etiologia , Pancreatite/complicações , Pancreatite/diagnóstico , Masculino , Pessoa de Meia-Idade , Feminino , Idoso , Adulto , Endossonografia/métodos , Litíase/complicaçõesAssuntos
Neoplasias dos Ductos Biliares , Colangiocarcinoma , Veias Hepáticas , Veia Porta , Humanos , Colangiocarcinoma/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/cirurgia , Neoplasias dos Ductos Biliares/complicações , Veias Hepáticas/diagnóstico por imagem , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/cirurgia , Litíase/cirurgia , Litíase/diagnóstico por imagem , Litíase/complicações , Masculino , Pessoa de Meia-Idade , Hepatopatias/diagnóstico por imagem , Hepatopatias/diagnóstico , Hepatopatias/etiologia , Diagnóstico Diferencial , Feminino , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: It is unclear whether laparoscopic hepatectomy (LH) for hepatolithiasis confers better clinical benefit and lower hospital costs than open hepatectomy (OH). This study aim to evaluate the clinical and economic value of LH versus OH. METHODS: Patients undergoing OH or LH for primary hepatolithiasis at Yijishan Hospital of Wannan Medical College between 2015 and 2022 were divided into OH group and LH group. Propensity score matching (PSM) was used to balance the baseline data. Deviation-based cost modelling and weighted average median cost (WAMC) were used to assess and compare the economic value. RESULTS: A total of 853 patients were identified. After exclusions, 403 patients with primary hepatolithiasis underwent anatomical hepatectomy (OH n=143; LH n=260). PSM resulted in 2 groups of 100 patients each. Although LH required a longer median operation duration compared with OH (285.0 versus 240.0 min, respectively, P<0.001), LH patients had fewer wound infections, fewer pre-discharge overall complications (26 versus 43%, respectively, P=0.009), and shorter median postoperative hospital stays (8.0 versus 12.0 days, respectively, P<0.001). No differences were found in blood loss, major complications, stone clearance, and mortality between the two matched groups. However, the median overall hospital cost of LH was significantly higher than that of OH (CNY¥52,196.1 versus 45,349.5, respectively, P=0.007). Although LH patients had shorter median postoperative hospital stays and fewer complications than OH patients, the WAMC was still higher for the LH group than for the OH group with an increase of CNY¥9,755.2 per patient undergoing LH. CONCLUSION: The overall clinical benefit of LH for hepatolithiasis is comparable or even superior to that of OH, but with an economic disadvantage. There is a need to effectively reduce the hospital costs of LH and the gap between costs and diagnosis-related group reimbursement to promote its adoption.
Assuntos
Hepatectomia , Laparoscopia , Pontuação de Propensão , Humanos , Hepatectomia/economia , Hepatectomia/métodos , Feminino , Masculino , Laparoscopia/economia , Laparoscopia/métodos , Pessoa de Meia-Idade , Adulto , Estudos Retrospectivos , Hepatopatias/cirurgia , Hepatopatias/economia , Estudos de Coortes , Idoso , Litíase/cirurgia , Litíase/economia , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias/economia , Resultado do TratamentoRESUMO
BACKGROUND: This study investigated the clinical application of the indocyanine green (ICG) fluorescence navigation technique in bile duct identification during laparoscopic common bile duct exploration (LCBDE) for complex hepatolithiasis. METHODS: Eighty patients with complex hepatolithiasis were admitted to our department between January 2022 and June 2023 and randomly divided into control and observation groups. The control group underwent conventional LCBDE, while the observation group underwent LCBDE guided by ICG fluorescence. RESULTS: Intraoperatively, the observation group had shorter operation and search times for the common bile duct (CBD), as well as reduced intraoperative blood loss and fewer complications, such as conversion to laparotomy and various injuries (gastroduodenal, colon, pancreatic, and vascular) than the control group, with statistical significance (P < 0.05). Postoperatively, the observation group had lower rates of postoperative bile leakage, abdominal infection, postoperative hemorrhage, and residual stone than the control group. Additionally, the observation group demonstrated significantly shorter times for resuming flatus, removal of the abdominal drainage tube, and hospitalization than the control group, with statistical significance (P < 0.05). CONCLUSION: ICG fluorescence navigation technology effectively visualizes the bile duct, improves its identification rate, shortens the operation time, prevents biliary tract injury, and reduces the occurrence of complications.
Assuntos
Coledocolitíase , Laparoscopia , Litíase , Hepatopatias , Humanos , Coledocolitíase/cirurgia , Ducto Colédoco/cirurgia , Verde de Indocianina , Laparoscopia/métodos , Tempo de Internação , Litíase/cirurgia , Hepatopatias/cirurgia , Estudos RetrospectivosRESUMO
BACKGROUND: This study aimed to reveal the early and late postoperative complications and outcomes after surgery for congenital biliary dilatation (CBD) by reviewing cases over the past 40 years. METHODS: We retrospectively evaluated 59 patients with CBD who underwent radical surgery for complications and outcomes, based on medical records. Early complications were defined as those requiring treatment within 5 years of the initial operation. Late complications were defined as those treated more than 5 years later. RESULTS: The median age at the first surgery was 37 months. Regarding biliary reconstruction, 54 of the 59 patients (91.5%) underwent hepaticojejunostomy. Although three patients underwent cholecystoduodenostomy and one patient underwent hepaticoduodenostomy, all were converted to hepaticojejunostomy after a median of 12.5 years. One patient developed synchronous biliary carcinoma and underwent pancreaticoduodenectomy. Early complications occurred in seven patients with 10 events (surgical site infection, n = 3 bile leakage, n = 3; ileus, n = 3; bile duct obstruction, n = 1 and intussusception, n = 1). Late complications occurred in nine patients with 12 events (ileus, n = 3; anastomotic stricture, n = 3; hepatolithiasis, n = 3; asynchronous biliary carcinoma, n = 2; pancreatolithiasis, n = 1). Two of the three patients with hepatolithiasis underwent hepatectomy refractory to the endoscopic approach. Two patients developed asynchronous biliary carcinoma at 34 and 13 years after last operation; both ultimately died of the carcinoma. Only 35 patients (61.4%) underwent a follow-up examination. A total of 11 female patients (45.8%) eventually married, and all successfully gave birth. CONCLUSION: Although the long-term prognosis is excellent with complete cyst excision and hepaticojejunostomy, we emphasize the importance of long-term follow-up.
Assuntos
Carcinoma , Cisto do Colédoco , Íleus , Litíase , Hepatopatias , Criança , Humanos , Feminino , Pré-Escolar , Estudos Retrospectivos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgiaRESUMO
The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts, above the hilar confluence of the hepatic ducts. The disease is more prevalent in Asia, mainly owing to socioeconomic and dietary factors, as well as the prevalence of biliary parasites. In the last century, owing to migration, its global incidence has increased. The main pathophysiological mechanisms involve cholangitis, bile infection and biliary strictures, creating a self-sustaining cycle that perpetuates the disease, frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of "recurrent pyogenic cholangitis". Furthermore, long-standing hepatolithiasis is a known risk factor for development of intrahepatic cholangiocarcinoma. Various classifications have aimed at providing useful insight of clinically relevant aspects and guidance for treatment. The management of symptomatic patients and those with complications can be complex, and relies upon a multidisciplinary team of hepatologists, endoscopists, interventional radiologists and hepatobiliary surgeons, with the main goal being to offer relief from the clinical presentations and prevent the development of more serious complications. This comprehensive review provides insight on various aspects of hepatolithiasis, with a focus on epidemiology, new evidence on pathophysiology, most important clinical aspects, different classification systems and contemporary management.
Assuntos
Ductos Biliares Intra-Hepáticos , Humanos , Fatores de Risco , Ductos Biliares Intra-Hepáticos/patologia , Litíase/epidemiologia , Litíase/terapia , Litíase/diagnóstico , Prevalência , Resultado do Tratamento , Hepatopatias/epidemiologia , Hepatopatias/terapia , Hepatopatias/diagnóstico , Incidência , Colangite/epidemiologia , Colangite/terapia , Colangite/diagnósticoRESUMO
A 91-year-old man had a history of cholecystectomy and choledochostomy for cholecystolithiasis and choledocholithiasis. Eleven years earlier, intrahepatic stones were found in the posterior bile duct, and he did not wish to undergo treatment. Over time, worsening of the intrahepatic stones and dilation of the intrahepatic bile duct were observed. At 91 years old, enhanced abdominal CT revealed wall thickening of the hilar bile duct, and MRCP showed stenosis of the hilar bile duct. Endoscopic retrograde cholangiography showed no contrast in the right intrahepatic bile duct and marked dilation of the left intrahepatic bile duct. Brush cytology confirmed adenocarcinoma, leading to a diagnosis of hilar cholangiocarcinoma. He underwent open right and caudal lobectomy with biliary reconstruction. Histopathological examination revealed a hilar cholangiocarcinoma, T3N1M0, Stage â ¢c, mainly located at the confluence of the right and left hepatic ducts. This case suggests a potential association between hepatolithiasis and hilar cholangiocarcinoma, emphasizing the importance of regular imaging examinations for timely surgical resection. Early intervention, including liver resection, is recommended for the management of hepatolithiasis.
Assuntos
Neoplasias dos Ductos Biliares , Colangiocarcinoma , Humanos , Masculino , Neoplasias dos Ductos Biliares/cirurgia , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Idoso de 80 Anos ou mais , Colangiocarcinoma/cirurgia , Fatores de Tempo , Litíase/cirurgia , Ductos Biliares Intra-Hepáticos/cirurgia , Ductos Biliares Intra-Hepáticos/patologia , Hepatectomia , Seguimentos , Hepatopatias/cirurgia , Tumor de Klatskin/cirurgia , Tumor de Klatskin/patologiaRESUMO
PURPOSE: Percutaneous transhepatic one-step biliary fistulation (PTOBF) is used to treat choledocholithiasis and biliary stricture. This study aimed to evaluate the safety and efficacy of ultrasound-guided PTOBF combined with rigid choledochoscopy in the treatment of recurrent hepatolithiasis. MATERIALS AND METHODS: The clinical data of 37 consecutive patients who underwent PTOBF combined with rigid choledochoscopy for RHL from March 2020 to March 2022 at our hospital were retrospectively analyzed. RESULTS: A total of 68 percutaneous transhepatic punctures were performed in 37 patients, with a puncture success rate of 85.29% (58/68) and a dilatation success rate of 100.00% (58/58). The mean blood loss of operation was 9.84 ± 18.10 mL, the mean operation time was 82.05 ± 31.92 min, and the mean length of postoperative hospital stay was 5.59 ± 3.26 days. The initial stone clearance rate was 40.54% (15/37) and the final stone clearance rate was 100% (37/37). The incidence of postoperative complications was 10.81% (4/37), including 2 cases of pleural effusion, 1 case of hemorrhage, and 1 case of cholangitis, which recovered after treatment. During a mean follow-up period of 23 months (range 12 to 36 months), only 1 patient experienced stone recurrence. CONCLUSION: Ultrasound-guided PTOBF combined with rigid choledochoscopy in the treatment of RHL based on skilful manipulation seems to be a safe, effective and minimally invasive method with clinical application value. Further comparative studies with large sample sizes are needed in the future to confirm the reliability of its therapeutic results.
Assuntos
Cálculos , Litíase , Hepatopatias , Humanos , Hepatopatias/cirurgia , Litíase/cirurgia , Estudos Retrospectivos , Reprodutibilidade dos Testes , Ultrassonografia de Intervenção , Resultado do TratamentoRESUMO
BACKGROUND AND AIM: Balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) is an emerging procedure for pancreatobiliary diseases in patients with surgically altered anatomy. However, data on BE-ERCP for hepatolithiasis after hepaticojejunostomy (HJS) are still limited. METHODS: Stone removal success, adverse events and recurrence were retrospectively studied in consecutive patients who underwent BE-ERCP for hepatolithiasis after HJS between January 2011 and October 2022. Subgroup analysis was performed to compare clinical outcomes between patients who had undergone HJS over 10 years before (past HJS group) and within 10 years (recent HJS group). RESULTS: A total of 131 patients were included; 39% had undergone HJS for malignancy and 32% for congenital biliary dilation. Scope insertion and complete stone removal were successful in 89% and 73%, respectively. Early adverse events were observed in 9.9%. Four patients (3.1%) developed gastrointestinal perforation but could be managed conservatively. Hepatolithiasis recurrence rate was 17%, 20% and 31% in 1-year, 3-year, and 5-year after complete stone removal. The past HJS group was the only risk factor for failed stone removal (odds ratio 10.4, 95% confidence interval 2.99-36.5) in the multivariable analysis. Failed scope insertion (20%) and failed guidewire or device insertion to the bile duct (22%) were two major reasons for failed stone removal in the past HJS group. CONCLUSIONS: BE-ERCP for hepatolithiasis was effective and safe in cases with HJS but the complete stone removal rate was low in the past HJS group. Recurrent hepatolithiasis was common and careful follow up study is needed even after complete stone removal.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Litíase , Hepatopatias , Humanos , Masculino , Feminino , Estudos Retrospectivos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Pessoa de Meia-Idade , Idoso , Hepatopatias/cirurgia , Litíase/cirurgia , Adulto , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Recidiva , Jejunostomia/métodos , Idoso de 80 Anos ou mais , Resultado do TratamentoRESUMO
BACKGROUND: Bladder lithiasis comprises 5% of urological lithiasis. Large bladder stones associated with vesicovaginal fistulas are rare, and the risk factors are not an isolated process. There are metabolic comorbidities associated with this pathology, including diabetes mellitus. CASE PRESENTATION: A 70-year-old Mestizo patient is presented, reporting dysuria, pollakiuria, and abdominal pain of 4 months of evolution, located in the hypogastric region, also with a sensation of a foreign body in the vaginal introitus. In her pathological history, she presented type 2 diabetes mellitus. A computed tomography scan of the abdomen and pelvis was performed, reporting a tumor lesion in the abdominal wall. Therefore, surgical intervention was performed by cystolithotomy, obtaining a giant stone adhered to the vaginal wall with a size of 10 cm × 12 cm. CONCLUSION: Early detection of this pathology should be exhaustive in patients with characteristics and comorbidities associated with stone development to avoid possible complications, such as vesicovaginal fistulas.
Assuntos
Parede Abdominal , Cálculos , Diabetes Mellitus Tipo 2 , Litíase , Fístula Vesicovaginal , Humanos , Feminino , Idoso , Fístula Vesicovaginal/diagnóstico por imagem , Fístula Vesicovaginal/cirurgia , Litíase/complicações , Diabetes Mellitus Tipo 2/complicações , Cálculos/complicações , Cálculos/cirurgiaRESUMO
BACKGROUND: The advantages of laparoscopic left-sided hepatectomy (LLH) for treating hepatolithiasis in terms of the time to postoperative length of hospital stay (LOS), morbidity, long-term abdominal wall hernias, hospital costs, residual stone rate, and recurrence of calculus have not been confirmed by a randomized controlled trial. The aim of this trial is to compare the safety and effectiveness of LLH with open left-sided hepatectomy (OLH) for the treatment of hepatolithiasis. METHODS: Patients with hepatolithiasis eligible for left-sided hepatectomy will be recruited. The experimental design will produce two randomized arms (laparoscopic and open hepatectomy) at a 1:1 ratio and a prospective registry. All patients will undergo surgery in the setting of an enhanced recovery after surgery (ERAS) programme. The prospective registry will be based on patients who cannot be randomized because of the explicit treatment preference of the patient or surgeon or because of ineligibility (not meeting the inclusion and exclusion criteria) for randomization in this trial. The primary outcome is the LOS. The secondary outcomes are percentage readmission, morbidity, mortality, hospital costs, long-term incidence of incisional hernias, residual stone rate, and recurrence of calculus. It will be assumed that, in patients undergoing LLH, the length of hospital stay will be reduced by 1 day. A sample size of 86 patients in each randomization arm has been calculated as sufficient to detect a 1-day reduction in LOS [90% power and α = 0.05 (two-tailed)]. The trial is a randomized controlled trial that will provide evidence for the merits of laparoscopic surgery in patients undergoing liver resection within an ERAS programme. CONCLUSIONS: Although the outcomes of LLH have been proven to be comparable to those of OLH in retrospective studies, the use of LLH remains restricted, partly due to the lack of short- and long-term informative RCTs pertaining to patients with hepatolithiasis in ERAS programmes. To evaluate the surgical and long-term outcomes of LLH, we will perform a prospective RCT to compare LLH with OLH for hepatolithiasis within an ERAS programme. TRIAL REGISTRATION: ClinicalTrials.gov NCT03958825. Registered on 21 May 2019.
Assuntos
Cálculos , Laparoscopia , Litíase , Hepatopatias , Humanos , Hepatectomia/efeitos adversos , Hepatectomia/métodos , Hepatopatias/diagnóstico , Hepatopatias/cirurgia , Litíase/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: To compare the efficacy of Three-scope combined (laparoscopic, rigid choledochoscopy and electronic choledochoscopy, TS) with laparoscopic hepatectomy (LH) for patients with hepatolithiasis (HL). METHODS: Between January 2019 and January 2020, 118 consecutive patients with HL treated with TS (TS group, n = 57) or LH (LH group, n = 61) were analyzed in this study. Perioperative and long-term outcomes, including operative time, intraoperative blood loss, blood transfusion, postoperative bowel function recovery time, postoperative hospital stay, complication rate, stone removal rate, and stone recurrence rate, were compared and analyzed between the two groups. RESULTS: Compared with the LH group, the TS group had significantly lower intraoperative blood loss and transfusions, significantly shorter operative time and hospital stay, and fewer complications (P < 0.05 for all). There was no significant difference in the final stone removal rate, stone recurrence rate and postoperative bowel function recovery time (P > 0.05 for all). CONCLUSION: TS is a safe and effective treatment for HL and is superior to LH in terms of overall treatment outcome and complications.
Assuntos
Laparoscopia , Litíase , Litotripsia , Hepatopatias , Humanos , Hepatectomia/efeitos adversos , Hepatopatias/cirurgia , Litíase/cirurgia , Perda Sanguínea Cirúrgica , Complicações Pós-Operatórias/etiologia , Ductos Biliares , Laparoscopia/efeitos adversos , Resultado do Tratamento , Tempo de Internação , Estudos RetrospectivosRESUMO
Background: Because of lack of an appropriate surgical approach, laparoscopic surgery in patients with left/right Glisson pedicle involvement is still rarely conducted. This study aimed to discusses the methods of intrahepatic Glisson intrathecal dissection via a hepatic parenchymal transection-first approach for laparoscopic hemihepatectomy in patients with left/right Glisson pedicle involvement. Materials and Methods: We retrospectively analyzed the clinical data of 21 patients who underwent laparoscopic hepatectomy in the Second Affiliated Hospital, Third Military Medical University (Army Medical University) from March 2021 to May 2022. Results: The mean age of the patients was 53.1 ± 11.6 years; mean operation time, 191.9 ± 22.3 minutes; median intraoperative blood loss, 205 mL (160-300 mL); and median length of hospital stay, 8 days (7-9 days). None of the patients underwent conversion to open procedure. Thirteen patients had pathologically confirmed hepatocellular carcinoma (HCC) with portal tumor thrombi (PVTT), and 8 was confirmed hepatolithiasis. Intraoperative frozen pathology and final pathology showed tumor free surgical margins in HCC with PVTT patients. After conservative treatment, all the complications such as postoperative liver section effusion, pleural effusion, pneumonia, intra-abdomen bleeding, and bile leak were cured. During outpatient follow-up examination, no other abnormality was detected. All HCC with PVTT patients were treated with a tyrosine kinase inhibitor after the operation and survived tumor-free. Conclusions: Proposed here is a more safe and feasible method of laparoscopic hemihepatectomy in patients with left/right Glisson pedicle involvement, but many problems still needs further exploration.