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Bo Wang - One of the best experts on this subject based on the ideXlab platform.
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application of a new type of sutureless magnetic biliary enteric anastomosis stent for one stage reconstruction of the biliary enteric continuity after acute Bile Duct Injury an experimental study
Journal of Surgical Research, 2008Co-Authors: Zhiyong Zhang, Chang Liu, Yuan Shi, Bo WangAbstract:Background The Bile Duct cannot be repaired or reconstructed in one stage after 24 h of Bile Duct Injury due to significant inflammation. Even if the Bile Duct can be repaired, anastomosis is difficult because of the extremely technical nature of the procedure. The traditional method of anastomosis utilizes screw thread. This would increase the inflammatory response, delay anastomotic healing, and lead to the increase in the failure rate. To reconstruct the biliary-enteric continuity under the circumstance of severe inflammation after Bile Duct Injury, we invented a new type of anastomotic apparatus (sutureless magnetic stent) for cholangiojejunostomy. The objective of this study was to evaluate the effect of a new type of sutureless magnetic biliary-enteric anastomosis stent, which was used to reconstruct the biliary-enteric continuity in one stage. The reconstruction was conDucted under the circumstance of severe inflammation after acute Bile Duct Injury in dogs. Methods We used a model of acute Bile Duct Injury and Bile peritonitis in dogs. The sutureless magnetic biliary-enteric anastomosis stents was used to reconstruct the biliary-enteric continuity in one stage under the circumstance of a Bile Duct with severe inflammation. The effect of stents was observed. Cholangiography and anastomotic histology were examined at 1 mo and compared with traditional manual anastomosis. Results Anastomotic stents were used to reconstruct the biliary-enteric continuity in one stage in dogs. No anastomotic leak or infection occurred. Cholangiography showed that the anastomosis was unobstructed. Histological examinations showed that the anastomosis healed well, the inflammatory reaction was small, and collagen fibers lined up in order. There was high incidence of Bile leakage in the conventional suture group. Cholangiography showed that anastomotic stenosis was high. Histological examination showed that there was more extensive inflammation around the anastomosis and the collagen fibers were disorganized. Conclusion It was safe and feasible to use the new type of anastomosis stent to reconstruct the biliary-enteric continuity in one stage under the circumstance of severe Bile Duct inflammation after Bile Duct Injury in dogs.
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application of a new type sutureless anastomosis stent to the primary reconstruction of the bilioenteric continuity after acute Bile Duct Injury in dogs
Journal of Nanjing Medical University, 2007Co-Authors: Zhiyong Zhang, Chang Liu, Yuan Shi, Bo WangAbstract:Abstract Objective To evaluate the effect of a new-type sutureless magnetic bilioenteric anastomosis stent that was used to reconstruct the bilioenteric continuity (primarily under the circumstances of severe inflammation after acute Bile Duct Injury in dogs) Methods Establishing an animal model of acute Bile Duct Injury with severe inflammation and Bile peritonitis in dogs. The new-type sutureless magnetic bilioenteric anastomosis stent was used to reconstruct the bilioenteric continuity primarily. Results The experiment group anastomosis healed well with a mild local inflammation reaction, and the collagen lined up in order without the occurrence of observable Bile leakage and infection. Conclusion It was safe and feasible to use the new-type anastomosis stent to reconstruct the bilioenteric continuity primarily under the circumstances of severe inflammation after acute Bile Duct Injury in dogs.
Julia F Kohn - One of the best experts on this subject based on the ideXlab platform.
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characterization of common Bile Duct Injury after laparoscopic cholecystectomy in a high volume hospital system
Surgical Endoscopy and Other Interventional Techniques, 2018Co-Authors: Julia F Kohn, Alexander Trenk, Kristine Kuchta, Brittany Lapin, Woody Denham, John G Linn, Stephen P Haggerty, Ray Joehl, Michael B UjikiAbstract:Background Despite the popularity of laparoscopic cholecystectomy, rates of common Bile Duct Injury remain higher than previously observed in open cholecystectomy. This retrospective chart review sought to determine the prevalence of, and risk factors for, biliary Injury during laparoscopic cholecystectomy within a high-volume healthcare system.
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characterization of common Bile Duct Injury after laparoscopic cholecystectomy in a high volume hospital system
Surgical Endoscopy and Other Interventional Techniques, 2018Co-Authors: Julia F Kohn, Alexander Trenk, Kristine Kuchta, Brittany Lapin, Woody Denham, John G Linn, Stephen P Haggerty, Ray Joehl, Michael B UjikiAbstract:Despite the popularity of laparoscopic cholecystectomy, rates of common Bile Duct Injury remain higher than previously observed in open cholecystectomy. This retrospective chart review sought to determine the prevalence of, and risk factors for, biliary Injury during laparoscopic cholecystectomy within a high-volume healthcare system. 800 of approximately 3000 cases between 2009 and 2015 were randomly selected and retrospectively reviewed. A single reviewer examined all operative notes, thereby including all cases of BDI regardless of ICD code or need for a second procedure. Biliary injuries were classified per Strasberg et al. (J Am Coll Surg 180:101–125, 1995). Logistic regression models were utilized to identify univariable and multivariable predictors of biliary injuries. 31.0% of charts stated that the Critical View of Safety was obtained, and 12.4% of charts correctly described the critical view in detail. Three patients (0.4%) had a cystic Duct leak, and 4 (0.5%) had a common Bile Duct Injury. Of the four CBDI, three patients had a partial transection of the CBD and one had a partial stricture. Patients who suffered BDI were more likely to have had lower hemoglobin, urgent surgery, choledocholithiasis, or acutely inflamed gallbladder. Multivariable analysis of BDI risk factors showed higher preoperative hemoglobin to be independently protective against CBDI. Acutely inflamed gallbladder and choledocholithiasis were independently predictive of CBDI. The rate of CBDI in this study was 0.5%. Acutely inflamed conditions were risk factors for biliary Injury. Multivariable analysis suggests a protective effect of higher preoperative hemoglobin. There was no correlation of CVS with prevention of biliary Injury, although only 12.4% of charts could be verified as following the technique correctly. Better implementation of CVS, and increased caution in patients with perioperative inflammatory signs, may be important for preventing Bile Duct Injury. Additionally, counseling patients with acute inflammation on increased risk is important.
Michael B Ujiki - One of the best experts on this subject based on the ideXlab platform.
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characterization of common Bile Duct Injury after laparoscopic cholecystectomy in a high volume hospital system
Surgical Endoscopy and Other Interventional Techniques, 2018Co-Authors: Julia F Kohn, Alexander Trenk, Kristine Kuchta, Brittany Lapin, Woody Denham, John G Linn, Stephen P Haggerty, Ray Joehl, Michael B UjikiAbstract:Background Despite the popularity of laparoscopic cholecystectomy, rates of common Bile Duct Injury remain higher than previously observed in open cholecystectomy. This retrospective chart review sought to determine the prevalence of, and risk factors for, biliary Injury during laparoscopic cholecystectomy within a high-volume healthcare system.
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characterization of common Bile Duct Injury after laparoscopic cholecystectomy in a high volume hospital system
Surgical Endoscopy and Other Interventional Techniques, 2018Co-Authors: Julia F Kohn, Alexander Trenk, Kristine Kuchta, Brittany Lapin, Woody Denham, John G Linn, Stephen P Haggerty, Ray Joehl, Michael B UjikiAbstract:Despite the popularity of laparoscopic cholecystectomy, rates of common Bile Duct Injury remain higher than previously observed in open cholecystectomy. This retrospective chart review sought to determine the prevalence of, and risk factors for, biliary Injury during laparoscopic cholecystectomy within a high-volume healthcare system. 800 of approximately 3000 cases between 2009 and 2015 were randomly selected and retrospectively reviewed. A single reviewer examined all operative notes, thereby including all cases of BDI regardless of ICD code or need for a second procedure. Biliary injuries were classified per Strasberg et al. (J Am Coll Surg 180:101–125, 1995). Logistic regression models were utilized to identify univariable and multivariable predictors of biliary injuries. 31.0% of charts stated that the Critical View of Safety was obtained, and 12.4% of charts correctly described the critical view in detail. Three patients (0.4%) had a cystic Duct leak, and 4 (0.5%) had a common Bile Duct Injury. Of the four CBDI, three patients had a partial transection of the CBD and one had a partial stricture. Patients who suffered BDI were more likely to have had lower hemoglobin, urgent surgery, choledocholithiasis, or acutely inflamed gallbladder. Multivariable analysis of BDI risk factors showed higher preoperative hemoglobin to be independently protective against CBDI. Acutely inflamed gallbladder and choledocholithiasis were independently predictive of CBDI. The rate of CBDI in this study was 0.5%. Acutely inflamed conditions were risk factors for biliary Injury. Multivariable analysis suggests a protective effect of higher preoperative hemoglobin. There was no correlation of CVS with prevention of biliary Injury, although only 12.4% of charts could be verified as following the technique correctly. Better implementation of CVS, and increased caution in patients with perioperative inflammatory signs, may be important for preventing Bile Duct Injury. Additionally, counseling patients with acute inflammation on increased risk is important.
D. J. Gouma - One of the best experts on this subject based on the ideXlab platform.
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long term impact of Bile Duct Injury on morbidity mortality quality of life and work related limitations
Annals of Surgery, 2017Co-Authors: Klaske A C Booij, Thomas M Van Gulik, Philip R De Reuver, Erik A J Rauws, Olivier R Busch, Otto M Van Delden, Susan Van Dieren, D. J. GoumaAbstract:Assessment of long-term comprehensive outcome of multimodality treatment of Bile Duct Injury (BDI) in terms of morbidity, mortality, quality of life (QoL), survival, and work related limitations. The impact of BDI on work ability is scarcely investigated. BDI patients referred to a tertiary center after BDI were included (n = 800). QoL and work related limitations (HLQ) were compared with 175 control patients after uncomplicated laparoscopic cholecystectomy. The mean survival after BDI was 17.6 years (95% confidence interval, CI, 17.2-18.0 years). BDI related mortality was 3.5% (28/800). Corrected for sex, ASA classification, treatment and type of Injury, survival is worse in male patients (hazard ratio, HR 1.50, 95% CI 1.01-2.33) and progressively worse with higher ASA classification (ASA2: 5.25 (2.94-9.37), ASA3: 18.1 (9.79-33.3). Patients treated surgically had a significantly better survival (HR: 0.45 (95% CI: 0.25-0.80). BDI patients reported a significantly worse physical QoL compared with the control group and worse disease specific QoL. Loss of proDuctivity of work was significantly higher among BDI patients. There also was a significant hindrance in unpaid work. A higher number of Bile Duct Injury patients were receiving disability benefits after long-term follow-up (34.9% vs 19.6%, P = 0.004). Reconstructive surgery in BDI patients is associated with improved survival. Although the clinical outcome of multidisciplinary treatment of Bile Duct Injury is good, it is associated with a significant decrease in QoL, loss of proDuctivity in both paid and unpaid work and high rates of disability benefits use
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morbidity and mortality after minor Bile Duct Injury following laparoscopic cholecystectomy
Endoscopy, 2014Co-Authors: Klaske A C Booij, Philip R De Reuver, Erik A J Rauws, Otto M Van Delden, Susan Van Dieren, Kenneth Yap, D. J. GoumaAbstract:Background and study aims: Cystic Duct and Luschka Duct leakage after laparoscopic cholecystectomy are often classified as minor injuries because the outcome of endoscopic stenting and percutaneous drainage is generally reported to be good. However, the potential associated early mortality and risk factors for mortality are scarcely reported. The aim of this study was to describe the outcome, mortality, and risk factors for poor survival of patients with type A Bile Duct Injury (BDI) referred to a tertiary center. Patients and methods: Between January 1990 and January 2012, 800 patients were referred for BDI treatment and included in a prospective database. Results: Type A BDI, according to the Amsterdam and Strasberg classifications, was diagnosed in 216 patients. Treatment after referral was mainly endoscopic (n = 192 [88.9 %]) and radiologic (n = 14 [6.5 %]). Complications related to endoscopic retrograde cholangiopancreatography (ERCP) occurred in 14 patients (6.5 %). Other complications were sepsis (n = 34 [15.7 %]), cardiopulmonary (n = 22 [10.2 %]), and abscess formation (n = 15 [6.9 %]). BDI-related mortality was 4.2 % (9/216). Multivariate analysis showed age (hazard ratio [HR] = 1.04, 95 % confidence interval [CI] 1.00 – 1.07) and American Society of Anesthesiologists class 3 or 4 (HR = 5.64, 95 %CI 2.31 – 13.77) to be independent factors significantly associated with mortality. Conclusions: Type A “minor” BDI after laparoscopic cholecystectomy is associated with considerable short-term mortality related to the patient’s condition at referral. Older patients and patients with ASA 3 or 4 have a significantly higher risk of mortality.
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Long-term Results of a Primary End-to-end Anastomosis in Peroperative Detected Bile Duct Injury
Journal of Gastrointestinal Surgery, 2007Co-Authors: P. R. Reuver, O. R. C. Busch, E. A. Rauws, J. S. Lameris, Th. M. Gulik, D. J. GoumaAbstract:The management of a Bile Duct Injury detected during laparoscopic cholecystectomy is still under discussion. An end-to-end anastomosis (with or without T-tube drainage) in peroperative detected Bile Duct Injury has been reported to be associated with stricture formation of the anastomosis area and recurrent jaundice. Between 1991 and 2005, 56 of a total of 500 Bile Duct Injury patients were referred for treating complications after a primary end-to-end anastomosis. After referral, 43 (77%) patients were initially treated endoscopically or by percutaneous transhepatic stent placement ( n = 3; 5%). After a mean follow-up of 7 ± 3.3 years, 37 patients (66%) were successfully treated with dilatation and endoscopically placed stents. One patient died due to a treatment-related complication. A total of 18 patients (32%) underwent a hepaticojejunostomy. Postoperative complications occurred in three patients (5%) without hospital mortality. These data confirm that end-to-end anastomosis might be considered as a primary treatment for peroperative detected transection of the Bile Duct without extensive tissue loss. Complications (stricture or leakage) can be adequately managed by endoscopic or percutaneous drainage the majority of patients (66%) and reconstructive surgery after complicated end-to-end anastomosis is a procedure with relative low morbidity and no mortality.
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endoscopic and surgical management of Bile Duct Injury after laparoscopic cholecystectomy
Best Practice & Research in Clinical Gastroenterology, 2004Co-Authors: Erik A J Rauws, D. J. GoumaAbstract:Laparoscopic cholecystectomy has become the first choice of management for symptomatic cholecystolithiasis. While it is associated with decreased postoperative morbidity and mortality, Bile Duct injuries are reported to be more severe and more common (0-2.7%), when compared to open cholecystectomy (0.2-0.5%) [New Engl. J. Med. 234 (1991) 1073; Am. J. Surg. 165 (1993) 9; Surg. Clin. N Am. 80 (2000) 1127]. These Bile Duct injuries include leaks, strictures, transection and removal of (part of) the Duct, with or without vascular damage. Bile Duct Injury might be due to misidentification of the biliary tract anatomy due to acute cholecystitis, large impacted stones, short cystic Duct, anatomical variations, but also due to technical errors leading to bleeding with subsequent clipping and coagulation trauma [Ann. Surg. 237 (2003) 460]. Early recognition and adequate multidisciplinary approach is the cornerstone for the optimal final outcome. Suboptimal management of injuries often leads to more extensive damage to the biliary tree and its vasculature with as consequences biliary peritonitis, sepsis, abscesses, multiple organ failure, a more difficult (proximal) reconstruction and in the long run, secondary biliary cirrhosis, and liver failure. Despite increasing experience in performing laparoscopic cholecystectomy, the frequency of Bile Duct injuries has not decreased [Ann. Surg. 234 (2001) 549]. Therapy encompasses endoscopic stenting, percutaneous transhepatic dilatation (PTCD) and surgical reconstruction.
Zhiyong Zhang - One of the best experts on this subject based on the ideXlab platform.
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application of a new type of sutureless magnetic biliary enteric anastomosis stent for one stage reconstruction of the biliary enteric continuity after acute Bile Duct Injury an experimental study
Journal of Surgical Research, 2008Co-Authors: Zhiyong Zhang, Chang Liu, Yuan Shi, Bo WangAbstract:Background The Bile Duct cannot be repaired or reconstructed in one stage after 24 h of Bile Duct Injury due to significant inflammation. Even if the Bile Duct can be repaired, anastomosis is difficult because of the extremely technical nature of the procedure. The traditional method of anastomosis utilizes screw thread. This would increase the inflammatory response, delay anastomotic healing, and lead to the increase in the failure rate. To reconstruct the biliary-enteric continuity under the circumstance of severe inflammation after Bile Duct Injury, we invented a new type of anastomotic apparatus (sutureless magnetic stent) for cholangiojejunostomy. The objective of this study was to evaluate the effect of a new type of sutureless magnetic biliary-enteric anastomosis stent, which was used to reconstruct the biliary-enteric continuity in one stage. The reconstruction was conDucted under the circumstance of severe inflammation after acute Bile Duct Injury in dogs. Methods We used a model of acute Bile Duct Injury and Bile peritonitis in dogs. The sutureless magnetic biliary-enteric anastomosis stents was used to reconstruct the biliary-enteric continuity in one stage under the circumstance of a Bile Duct with severe inflammation. The effect of stents was observed. Cholangiography and anastomotic histology were examined at 1 mo and compared with traditional manual anastomosis. Results Anastomotic stents were used to reconstruct the biliary-enteric continuity in one stage in dogs. No anastomotic leak or infection occurred. Cholangiography showed that the anastomosis was unobstructed. Histological examinations showed that the anastomosis healed well, the inflammatory reaction was small, and collagen fibers lined up in order. There was high incidence of Bile leakage in the conventional suture group. Cholangiography showed that anastomotic stenosis was high. Histological examination showed that there was more extensive inflammation around the anastomosis and the collagen fibers were disorganized. Conclusion It was safe and feasible to use the new type of anastomosis stent to reconstruct the biliary-enteric continuity in one stage under the circumstance of severe Bile Duct inflammation after Bile Duct Injury in dogs.
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application of a new type sutureless anastomosis stent to the primary reconstruction of the bilioenteric continuity after acute Bile Duct Injury in dogs
Journal of Nanjing Medical University, 2007Co-Authors: Zhiyong Zhang, Chang Liu, Yuan Shi, Bo WangAbstract:Abstract Objective To evaluate the effect of a new-type sutureless magnetic bilioenteric anastomosis stent that was used to reconstruct the bilioenteric continuity (primarily under the circumstances of severe inflammation after acute Bile Duct Injury in dogs) Methods Establishing an animal model of acute Bile Duct Injury with severe inflammation and Bile peritonitis in dogs. The new-type sutureless magnetic bilioenteric anastomosis stent was used to reconstruct the bilioenteric continuity primarily. Results The experiment group anastomosis healed well with a mild local inflammation reaction, and the collagen lined up in order without the occurrence of observable Bile leakage and infection. Conclusion It was safe and feasible to use the new-type anastomosis stent to reconstruct the bilioenteric continuity primarily under the circumstances of severe inflammation after acute Bile Duct Injury in dogs.