The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform

Yi Miao - One of the best experts on this subject based on the ideXlab platform.

  • primary closure following laparoscopic common bile duct exploration combined with intraoperative cholangiography and choledochoscopy
    World Journal of Surgery, 2012
    Co-Authors: Huihua Cai, Donglin Sun, Yueming Sun, Jianfeng Bai, Hanlin Zhao, Yi Miao
    Abstract:

    Laparoscopic common bile duct exploration (LCBDE) has become one of the main options for treating choledocholithiasis associated with cholelithiasis. Our objective was to assess the short-term outcomes of patients undergoing laparoscopic primary closure of the common bile duct (CBD) compared with laparoscopic choledochotomy plus T-tube drainage. We retrospectively studied 137 patients undergoing primary closure following LCBDE (group A) compared with 102 cases with laparoscopic choledochotomy plus T-tube drainage (group B) between January 2007 and January 2010. Intraoperative cholangiography (IOC) and choledochoscopy were performed in all patients. Three patients in group A (2.2%) were converted to open surgery and two (2.0%) in group B because of serious adherence. According to routine IOC, unexpected CBD stones were found in 16 cases (6.8%). The duration of the operation in group A was shorter than in group B (92.4 ± 15.2 vs. 125.7± 32.6 min, P < 0.05), as was length of postoperative stay (3.1± 2.4 vs. 5.7± 4.3 days, P < 0.05). Postoperative bile leakage occurred in six patients (4.5%) in group A and four cases (4.0%) in group B; all of the patients recovered after simple drainage without reoperation. Bile peritonitis was seen in one case after T-tube removal. The median follow-up was 26 months. There were no recurrences. Laparoscopic primary closure of the CBD is safe and successful for the management of CBD stones. Application of IOC and choledochoscopy to ensure clearance of the CBD and careful suturing are essential for primary closure.

  • primary closure following laparoscopic common bile duct exploration combined with intraoperative cholangiography and choledochoscopy
    World Journal of Surgery, 2012
    Co-Authors: Huihua Cai, Donglin Sun, Yueming Sun, Jianfeng Bai, Hanlin Zhao, Yi Miao
    Abstract:

    Background Laparoscopic common bile duct exploration (LCBDE) has become one of the main options for treating choledocholithiasis associated with cholelithiasis. Our objective was to assess the short-term outcomes of patients undergoing laparoscopic primary closure of the common bile duct (CBD) compared with laparoscopic choledochotomy plus T-tube drainage.

Huihua Cai - One of the best experts on this subject based on the ideXlab platform.

  • primary closure following laparoscopic common bile duct exploration combined with intraoperative cholangiography and choledochoscopy
    World Journal of Surgery, 2012
    Co-Authors: Huihua Cai, Donglin Sun, Yueming Sun, Jianfeng Bai, Hanlin Zhao, Yi Miao
    Abstract:

    Laparoscopic common bile duct exploration (LCBDE) has become one of the main options for treating choledocholithiasis associated with cholelithiasis. Our objective was to assess the short-term outcomes of patients undergoing laparoscopic primary closure of the common bile duct (CBD) compared with laparoscopic choledochotomy plus T-tube drainage. We retrospectively studied 137 patients undergoing primary closure following LCBDE (group A) compared with 102 cases with laparoscopic choledochotomy plus T-tube drainage (group B) between January 2007 and January 2010. Intraoperative cholangiography (IOC) and choledochoscopy were performed in all patients. Three patients in group A (2.2%) were converted to open surgery and two (2.0%) in group B because of serious adherence. According to routine IOC, unexpected CBD stones were found in 16 cases (6.8%). The duration of the operation in group A was shorter than in group B (92.4 ± 15.2 vs. 125.7± 32.6 min, P < 0.05), as was length of postoperative stay (3.1± 2.4 vs. 5.7± 4.3 days, P < 0.05). Postoperative bile leakage occurred in six patients (4.5%) in group A and four cases (4.0%) in group B; all of the patients recovered after simple drainage without reoperation. Bile peritonitis was seen in one case after T-tube removal. The median follow-up was 26 months. There were no recurrences. Laparoscopic primary closure of the CBD is safe and successful for the management of CBD stones. Application of IOC and choledochoscopy to ensure clearance of the CBD and careful suturing are essential for primary closure.

  • primary closure following laparoscopic common bile duct exploration combined with intraoperative cholangiography and choledochoscopy
    World Journal of Surgery, 2012
    Co-Authors: Huihua Cai, Donglin Sun, Yueming Sun, Jianfeng Bai, Hanlin Zhao, Yi Miao
    Abstract:

    Background Laparoscopic common bile duct exploration (LCBDE) has become one of the main options for treating choledocholithiasis associated with cholelithiasis. Our objective was to assess the short-term outcomes of patients undergoing laparoscopic primary closure of the common bile duct (CBD) compared with laparoscopic choledochotomy plus T-tube drainage.

Bryan G Sauer - One of the best experts on this subject based on the ideXlab platform.

  • interobserver agreement for evaluation of imaging with single operator choledochoscopy what are we looking at
    Digestive and Liver Disease, 2014
    Co-Authors: Amrita Sethi, Monica Gaidhane, Jessica L Widmer, Neeral L Shah, Douglas K Pleskow, Steven A Edmundowicz, Divyesh V Sejpal, Frank G Gress, George H Pop, Bryan G Sauer
    Abstract:

    a b s t r a c t Background: Single operator choledochoscopy is a platform used to assist in the confirmation of diagnosis of biliary lesions. However, there are little data regarding the interobserver agreement of imaging inter- pretation. Our objective was to assess the interobserver agreement in single operator choledochoscopy interpretation. Methods: 38 De-identified SPY Choledochoscopy video clips were sent to 7 interventional endoscopists. They were asked to score the videos on presence of four criteria selected by the investigators: growth, stricture, hyperplasia, and ulceration. Observers also chose a final diagnosis from the categories of cancer, hyperplasia, inflammation, or normal. Kappa scores were calculated for the scoring of the four criteria and for the selection of the final diagnosis. Results: The overall interobserver agreement was fair in scoring for the presence of a growth (K = 0.28, SE 0.035) and stricture (K = 0.32, SE 0.035). Scoring for ulceration was slight to fair (K = 0.17, SE 0.035). There was only slight agreement for the presence of hyperplasia (K = 0.11, SE 0.035); and presumed final diagnosis based on imaging (K = 0.18, SE 0.022). Conclusion: The results of this study support the need for an effort to identify and validate cholangioscopy imaging criteria for biliary pathology. This may assist in improving the reliability of the diagnostic value of cholangioscopy as its use becomes more widespread.

  • safety and efficacy of laser lithotripsy for complicated biliary stones using direct choledochoscopy
    Digestive Diseases and Sciences, 2013
    Co-Authors: Bryan G Sauer, Mark Cerefice, Douglas C Swartz, Monica Gaidhane, Animesh Jain, Shahzad Haider, Michel Kahaleh
    Abstract:

    Background The first-line therapy for choledocholithiasis is endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction, which is successful in over 90 % of cases. However, large biliary stones often require extracorporeal shockwave lithotripsy, electrohydraulic lithotripsy (EHL), or laser lithotripsy. The objective of our study was to assess the safety and efficacy of laser lithotripsy with choledochoscopy guidance.

Ahmad H M Nassar - One of the best experts on this subject based on the ideXlab platform.

  • intrahepatic choledochoscopy during trans cystic common bile duct exploration technique feasibility and value
    Surgical Endoscopy and Other Interventional Techniques, 2012
    Co-Authors: Vivienne Gough, Nathan Stephens, Zubir Ahmed, Ahmad H M Nassar
    Abstract:

    Transcystic laparoscopic common bile duct exploration (TC-LCBDE) is advantageous for exploring the bile duct. Choledochoscopy, however, may be quite challenging to perform transcystically because the cystic duct is usually narrow, duct anatomy may be unfavorable, and not all stones are amenable to transcystic extraction. Convention suggests that it is technically very difficult to visualize the intrahepatic bile ducts with transcystic choledochoscopy, due to the angle of insertion of the cystic into the common bile duct (CBD). However, we have performed intrahepatic choledochoscopy successfully, moving the Choledochoscope from the CBD into the common hepatic duct by using what we have termed a “wiper blade maneuver”. The purpose of this study was to confirm how often this was possible. A search of a prospectively collected database of patients undergoing routine intraoperative cholangiography (IOC) and laparoscopic CBD exploration under the care of a single consultant surgeon was performed. A total of 592 LCBDEs were performed between September 1992 and January 2011; 325 were transcystic explorations. Of these, 72.5 % were female and 56 % were admitted acutely. Exploration and duct clearance was performed by blind Dormia basket trawling in 63 %. The Choledochoscope was utilized in 120 cases (37 %). The 3-mm Choledochoscope was used in 66 (55 %) and the 5-mm scope in 54 (45 %). Intrahepatic choledochoscopy was performed in 49 patients (40.8 %). Length of surgery was 40–350 min (median 90 min; standard deviation 49 min). It is technically challenging to perform intrahepatic choledochoscopy with a 3-mm Choledochoscope due to its narrow gauge. The more rigid 5-mm scope is thus preferred, but is limited in TCE because its effective use depends on the presence of a dilated cystic duct. Despite the technical limitations of both caliber scopes, we have demonstrated that intrahepatic choledochoscopy during TCE is possible, with each, in 40 % of cases.

Sandro Zonta - One of the best experts on this subject based on the ideXlab platform.