The Experts below are selected from a list of 156 Experts worldwide ranked by ideXlab platform
A. Mosca - One of the best experts on this subject based on the ideXlab platform.
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Detection of Mirizzi syndrome with magnetic resonance cholangiopancreatography: laparoscopic or open approach?
Surgical Endoscopy And Other Interventional Techniques, 2002Co-Authors: L. Presta, A. Ragozzino, P. Perrotti, C. Antropoli, D. Molino, R. De Ritis, A. MoscaAbstract:Imaging of the gallbladder and biliary tract has changed dramatically in the past 20 years. Magnetic resonancecholangiopancreatography provides a noninvasive alternative to endoscopic retrograde cholangiopancreatography and percutaneous transhepatic Cholangiography in the diagnosis of Mirizzi syndrome. In this laparoscopic era, when diagnosis is certain, surgeons must choose between a laparoscopic and a traditional open approach. The authors review their cases of hepatobiliary surgery during the period 1993–2000. Three cases of Mirizzi syndrome (0.4%) were observed among 712 surgical hepatobiliary patients (two type 1 cases and one type 2 case). The authors suggest that with Mirizzi syndrome type 1, laparoscopy together with Peroperative Cholangiography should be used to resolve anatomic doubts. If clipping of the cystic duct is possible and certain, then laparoscopy may be continued and finished. In the case of cholecystocholedochal fistula (Mirizzi syndrome type 2), when the diagnosis is determined before surgery, the authors believe that laparoscopy is dangerous. Adhesions, inflammation, and anatomy changes may cause injuries to the main bile duct, so an open traditional approach is suggested.
Rene Baumann - One of the best experts on this subject based on the ideXlab platform.
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Management of common bile duct stones in a single operation combining laparoscopic cholecystectomy and Peroperative endoscopic sphincterotomy
Journal of Hepato-Biliary-Pancreatic Surgery, 2002Co-Authors: Christian Meyer, Jacques Vo Huu Le, Serge Rohr, Bernard Duclos, Jean-marie Reimund, Rene BaumannAbstract:The diagnosis and treatment strategy to apply to common bile duct stones (CBDS) is always a controversial subject. The aim of this study was to evaluate the treatment of CBDS in a “one-stage” operation by laparoscopic cholecystectomy (LC) and Peroperative endoscopic sphincterotomy (ES). Between January 1994 and April 2000, 60 patients, 24 men and 36 women (sex ratio, 1.5), with a median age of 57 years (range, 26 to 84 years), were treated for suspected or confirmed CBDS. The CBDS were uncomplicated in 53 patients (88%) and associated with a complication in 7 patients (12%); namely, cholangitis (in 3 patients) and acute pancreatitis (in 4 patients). The Peroperative ES was performed immediately after the LC during the same operative time, with Peroperative Cholangiography being systematically performed. The mean operative time for LC was 60 min (range, 40–90 min). The general anesthesia was prolonged by 40 min in order to perform an ES (range, 30–60 min), including the time required for endoscopic equipment installation. The Peroperative ES was unsuccessful in 2 patients (3%) due to the impossibility of catheterizing the papilla. In the first patient, postoperative ES was successful. In the second patient, the small CBDS was left to pass spontaneously. In 1 patient, because of multiple calculi in the CBD, open surgery was performed immediately after the ES. In 2 patients, a residual stone was found by Cholangiography on the sixth postoperative day, and spontaneous evacuation occurred 2 weeks later. Final ductal clearance was achieved in 100% of the patients. There was no mortality and the incidence of postoperative minor complications was 3% (2 patients). The duration of postoperative hospitalization was 4.6 days (range, 3–11 days). The one-stage treatment procedure is, to us, an alternative to the minimally invasive treatment of CBDS. This method is rapid, reliable, and safe. It now needs to be evaluated in larger studies, keeping in mind that the limiting characteristic is the proximity and the availability of the endoscopic team.
L. Presta - One of the best experts on this subject based on the ideXlab platform.
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Detection of Mirizzi syndrome with magnetic resonance cholangiopancreatography: laparoscopic or open approach?
Surgical Endoscopy And Other Interventional Techniques, 2002Co-Authors: L. Presta, A. Ragozzino, P. Perrotti, C. Antropoli, D. Molino, R. De Ritis, A. MoscaAbstract:Imaging of the gallbladder and biliary tract has changed dramatically in the past 20 years. Magnetic resonancecholangiopancreatography provides a noninvasive alternative to endoscopic retrograde cholangiopancreatography and percutaneous transhepatic Cholangiography in the diagnosis of Mirizzi syndrome. In this laparoscopic era, when diagnosis is certain, surgeons must choose between a laparoscopic and a traditional open approach. The authors review their cases of hepatobiliary surgery during the period 1993–2000. Three cases of Mirizzi syndrome (0.4%) were observed among 712 surgical hepatobiliary patients (two type 1 cases and one type 2 case). The authors suggest that with Mirizzi syndrome type 1, laparoscopy together with Peroperative Cholangiography should be used to resolve anatomic doubts. If clipping of the cystic duct is possible and certain, then laparoscopy may be continued and finished. In the case of cholecystocholedochal fistula (Mirizzi syndrome type 2), when the diagnosis is determined before surgery, the authors believe that laparoscopy is dangerous. Adhesions, inflammation, and anatomy changes may cause injuries to the main bile duct, so an open traditional approach is suggested.
Alessandro Settimi - One of the best experts on this subject based on the ideXlab platform.
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Lessons Learned from the First 109 Laparoscopic Cholecystectomies Performed in a Single Pediatric Surgery Center
World Journal of Surgery, 2009Co-Authors: Ciro Esposito, Francesca Alicchio, Ida Giurin, Flavio Perricone, Giuseppe Ascione, Alessandro SettimiAbstract:Background Laparoscopic cholecystectomy (LC) is a frequent operation in adults but is seldom performed in children. A retrospective review of 109 consecutive patients who underwent LC over an 11-year period was performed to see what lessons were learned from this experience. Methods From January 1996 to January 2007, a total of 109 patients were referred to our unit to undergo LC. Nine adult patients were excluded from the analysis. The remaining 100 pediatric patients form the basis of this report. Isolated cholecystectomies were performed using a four-trocar technique, with a fifth trocar added for cases in which splenectomy was required. One patient with main bile duct dilatation at preoperative echography underwent Peroperative Cholangiography. Results We recorded three anatomic anomalies (3%), two involving the bile duct and one the cystic artery. We recorded four minor problems during surgery: In one case there was failure of the tip of reusable scissors, and in three cases there was a small perforation of the gallbladder during the dissection step. We recorded four (4%) postoperative complications, which required redo surgery: one patient with bleeding from the cystic artery; one case of dislocation of clips positioned on the cystic duct; and two patients with lesions of the main bile duct that had not been detected during surgery. The treatment consisted in choledojejunostomy on postoperative day 7 in one case and suture of the choledocus on a stent positioned using endoscopic retrograde cholangiopancreatography on postoperative day 5 in the second case. Both biliary complications occurred in patients more than 14 years of age. We also recorded one umbilical granuloma. Conclusions LC is an effective procedure in children . On the basis of our experience, it seems that major complications can occur even with experienced surgeons, and they are more frequent in teenagers. Biliary or vascular anomalies of the gallbladder are encountered in about 3% of patients.
L Krusina - One of the best experts on this subject based on the ideXlab platform.
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indications for Peroperative Cholangiography in cholecystectomy
Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti, 1990Co-Authors: J Vetyska, L KrusinaAbstract:: In a group of 466 cholecystectomies with Peroperative Cholangiography the authors revealed sensitivity of the examination for cholangiolithiasis (255 before operation) in 95.3%, for diagnosis of all benign diseases of the bile ducts (288 operations) in 95.8%. They established six indication criterias for Peroperative Cholangiography during cholecystectomy: 1. jaundice or elevated serum bilirubin before operation, 2. pancreatitis or elevated amylase values in blood or urine before operation, 3. elevated alkaline phosphatase (ALP) or gamma-glutamyl transpeptidase (GMT) serum values before operation, 4. small (under 3 mm) or multiple (more than 10) gallstones, 5. a choledochus wider than 10 mm, 6 a cystic duct wider than 3 mm. As indication suffices positivity of one of the criteria. By introducing these indications it was possible to reduce Peroperative Cholangiography during cholecystectomies by cca 40% with a 0.1% risk of diagnostic errors in the diagnosis of benign diseases of the bile ducts.