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Yoo D. Laparoscopic choledocholithotomy and transductal T-tube insertion with indocyanine green fluorescence imaging and laparoscopic ultrasound: A case report. World J Clin Cases 2023; 11:7193-7199. [PMID: 37946768 PMCID: PMC10631426 DOI: 10.12998/wjcc.v11.i29.7193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/28/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Laparoscopic choledocholithotomy for a large impacted common bile duct (CBD) stone is a challenging procedure because of the technical difficulty and the possibility of postoperative complications, even in this era of minimally invasive surgery. Herein, we present a case of large impacted CBD stones. CASE SUMMARY A 71-year-old man showed a distal CBD stone (45 mm × 20 mm) and a middle CBD stone (20 mm × 15 mm) on computed tomography. Endoscopic retrograde cholangiopancreatography failed due to the large size of the impacted stone and the presence of a large duodenal diverticulum. Laparoscopic choledocholithotomy was decided, and we used a near-infrared indocyanine green fluorescence scope to detect and expose the supraduodenal CBD more accurately. Then, the location, size, and shape of the stones were detected using a laparoscopic intraoperative ultrasound. The CBD was opened with a 2-cm-sized vertical incision. After irrigating several times, two CBD stones were removed with the Endo BabcockTM. T-tube insertion was done for postoperative cholangiography and delayed the removal of remnant sludge. The patient had no postoperative complications. CONCLUSION Laparoscopic choledocholithotomy by transcholedochal approach and transductal T-tube insertion is a safe and feasible option for large-sized impacted CBD stones.
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Affiliation(s)
- Daegwang Yoo
- Department of Surgery, Seoul Soonchunhyang University Hospital, Seoul 04401, South Korea
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2
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Friberg M, Woeller K, Iberi V, Mancheno PP, Riedeman J, Bohman L, Davis CC. Development of in vitro methods to model the impact of vaginal lactobacilli on Staphylococcus aureus biofilm formation on menstrual cups as well as validation of recommended cleaning directions. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1162746. [PMID: 37671283 PMCID: PMC10475951 DOI: 10.3389/frph.2023.1162746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/25/2023] [Indexed: 09/07/2023] Open
Abstract
Introduction Menstrual cups (MC) are a reusable feminine hygiene product. A recent publication suggested that Staphylococcus aureus (S. aureus) biofilms can form on MCs which may lead to increased risk of menstrual Toxic Shock Syndrome (mTSS). Additionally, there is concern that buildup of residual menses may contribute to microbial growth and biofilm formation further increasing mTSS risk. Quantitative and qualitative analysis of in vitro tests were utilized to determine if S. aureus biofilm could form on MC in the presence of the keystone species Lactobacillus after 12 h of incubation. The methodology was based on a modification of an anaerobic in vitro method that harnesses the keystone species hypothesis by including a representative of vaginal lactic acid bacteria. Methods MCs were incubated anaerobically for 12 h in Vaginal Defined Media (VDM) with the two morphologically distinct bacteria, Lactobacillus gasseri (L. gasseri) and S. aureus. Colony Forming Units (CFU) for each organism from the VDM broth and sonicated MC were estimated. In addition, a separate experiment was conducted where S. aureus was grown for 12 h in the absence of L. gasseri. Qualitative analysis for biofilm formation utilized micro-CT (µ-CT) and cryogenic scanning electron microscopy (Cryo-SEM). Results Samples collected from the media control had expected growth of both organisms after 12 h of incubation. Samples collected from VDM broth were similar to media control at the end of the 12-h study. Total S. aureus cell density on MC following sonication/rinsing was minimal. Results when using a monoculture of S. aureus demonstrated that there was a significant growth of the organism in the media control and broth as well as the sonicated cups indicating that the presence of L. gasseri was important for controlling growth and adherence of S. aureus. Few rod-shaped bacteria (L. gasseri) and cocci (S. aureus) could be identified on the MCs when grown in a dual species culture inoculum and no biofilm was noted via µ-CT and cryo-SEM. Additionally, efforts to model and understand the validity of the current labeled recommendations for MC cleaning in-between uses are supported. Discussion The data support continued safe use of the Tampax® cup when used and maintained as recommended.
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Affiliation(s)
- Maria Friberg
- Baby, Feminine and Family Care Microbiology, The Procter & Gamble Company, Mason, OH, United States
| | - Kara Woeller
- Baby, Feminine and Family Care, Global Product Stewardship, The Procter & Gamble Company, Cincinnati, OH, United States
| | - Vighter Iberi
- Corporate Functions Analytical, The Procter & Gamble Company, Mason, OH, United States
| | | | - James Riedeman
- Baby, Family and Feminine Care Analytical Chemistry, The Procter & Gamble Company, Cincinnati, OH, United States
| | - Lisa Bohman
- Data Modeling and Sciences, The Procter & Gamble Company, Mason, OH, United States
| | - Catherine C. Davis
- Department of Medical Microbiology and Immunology, School of Medicine, Creighton University, Omaha, NE, United States
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Klabukov ID, Baranovskii DS, Shegay PV, Kaprin AD. Pitfalls and promises of bile duct alternatives: There is plenty of room in the regenerative surgery. World J Gastroenterol 2023; 29:4701-4705. [PMID: 37662863 PMCID: PMC10472900 DOI: 10.3748/wjg.v29.i30.4701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/11/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023] Open
Abstract
Current abdominal surgery has several approaches for biliary reconstruction. However, the creation of functional and clinically applicable bile duct substitutes still represents an unmet need. In the paper by Miyazawa and colleagues, approaches to the creation of bile duct alternatives were summarized, and the reasons for the lack of development in this area were explained. The history of bile duct surgery since the nineteenth century was also traced, leading to the conclusion that the use of bioabsorbable materials holds promise for the creation of bile duct substitutes in the future. We suggest three ideas that may stimulate progress in the field of bile duct substitute creation. First, a systematic analysis of the causative factors leading to failure or success in the creation of bile duct substitutes may help to develop more effective approaches. Second, the regeneration of a bile duct is delicately balanced between epithelialization and subsequent submucosal maturation within limited time frames, which may be more apparent when using quantitative models to estimate outcomes. Third, the utilization of the organism's endogenous regeneration abilities may enhance the creation of bile duct substitutes. We are convinced that an interdisciplinary approach, including quantitative methods, machine learning, and deep retrospective analysis of the causes that led to success and failure in studies on the creation of bile duct substitutes, holds great value. Additionally, more attention should be directed towards the balance of epithelialization and submucosal maturation rates, as well as induced angiogenesis. These ideas deserve further investigation to pave the way for bile duct restoration with physiologically relevant outcomes.
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Affiliation(s)
- Ilya D Klabukov
- Department of Regenerative Medicine, National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Obninsk 249036, Russia
| | - Denis S Baranovskii
- Department of Regenerative Medicine, National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Obninsk 249036, Russia
| | - Peter V Shegay
- Center for Innovative Radiological and Regenerative Technologies, National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Obninsk 249036, Russia
| | - Andrey D Kaprin
- Center for Innovative Radiological and Regenerative Technologies, National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Obninsk 249036, Russia
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4
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D'Haese JG, Uhl W, Schnitzbauer AA, Hoffmann K, Stavrou GA. [Potential risk to patient safety by discontinuation of production of classical T-drains? : Nationwide survey in Germany and statement of the surgical working group for liver, gall bladder and pancreatic diseases (CALGP) of the German Society for General and Visceral Surgery (DGAV)]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:419-423. [PMID: 37072621 DOI: 10.1007/s00104-023-01851-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 04/20/2023]
Abstract
The revision of the medical device regulation (MDR) legislation by the European Union and supplementations by the member states has been implemented for good reasons but causes dramatic side effects. It is no longer allowed to produce some rarely used medical devices by various manufacturers that have been successfully used for decades. Before production, a new application to the MDR would be necessary, which is not a realistic business case for companies producing rarely used devices. This problem currently relates to the Kehr T‑drain made from soft rubber or latex that has been in use since the late nineteenth century. A surgically placed T‑drain, although rarely necessary nowadays, is still in use worldwide for special indications in an attempt to avoid severe complications. These special indications include complex hepato-pancreato-biliary (HPB) procedures and perforations of the upper gastrointestinal (GI) tract where T‑drains may be used to secure the hepatojejunostomy or to create a stable fistula. The HPB working group (CALGP) of the German Society of General and Visceral Surgery (DGAV) provides a statement from a surgical perspective on this matter after a survey of all its members. Politics should be very careful not to generalize when implementing useful new regulations at a European and national level. Established and comprehensible treatment concepts should not be restricted and exemption permits should be quickly granted in these cases because the discontinuation of these niche products may lead to potential patient safety issues and even fatalities.
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Affiliation(s)
- Jan G D'Haese
- Klinik für Allgemein- und Viszeralchirurgie, Katholisches Klinikum Bochum, Universitätsklinikum der Ruhr-Universität Bochum, Standort St. Josef Hospital, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - Waldemar Uhl
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Bochum, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Andreas A Schnitzbauer
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt, Deutschland
| | - Katrin Hoffmann
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland
| | - Gregor A Stavrou
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Chirurgische Onkologie, Klinikum Saarbrücken, Saarbrücken, Deutschland
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Klabukov I, Tenchurin T, Shepelev A, Baranovskii D, Mamagulashvili V, Dyuzheva T, Krasilnikova O, Balyasin M, Lyundup A, Krasheninnikov M, Sulina Y, Gomzyak V, Krasheninnikov S, Buzin A, Zayratyants G, Yakimova A, Demchenko A, Ivanov S, Shegay P, Kaprin A, Chvalun S. Biomechanical Behaviors and Degradation Properties of Multilayered Polymer Scaffolds: The Phase Space Method for Bile Duct Design and Bioengineering. Biomedicines 2023; 11:745. [PMID: 36979723 PMCID: PMC10044742 DOI: 10.3390/biomedicines11030745] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
This article reports the electrospinning technique for the manufacturing of multilayered scaffolds for bile duct tissue engineering based on an inner layer of polycaprolactone (PCL) and an outer layer either of a copolymer of D,L-lactide and glycolide (PLGA) or a copolymer of L-lactide and ε-caprolactone (PLCL). A study of the degradation properties of separate polymers showed that flat PCL samples exhibited the highest resistance to hydrolysis in comparison with PLGA and PLCL. Irrespective of the liquid-phase nature, no significant mass loss of PCL samples was found in 140 days of incubation. The PLCL- and PLGA-based flat samples were more prone to hydrolysis within the same period of time, which was confirmed by the increased loss of mass and a significant reduction of weight-average molecular mass. The study of the mechanical properties of developed multi-layered tubular scaffolds revealed that their strength in the longitudinal and transverse directions was comparable with the values measured for a decellularized bile duct. The strength of three-layered scaffolds declined significantly because of the active degradation of the outer layer made of PLGA. The strength of scaffolds with the PLCL outer layer deteriorated much less with time, both in the axial (p-value = 0.0016) and radial (p-value = 0.0022) directions. A novel method for assessment of the physiological relevance of synthetic scaffolds was developed and named the phase space approach for assessment of physiological relevance. Two-dimensional phase space (elongation modulus and tensile strength) was used for the assessment and visualization of the physiological relevance of scaffolds for bile duct bioengineering. In conclusion, the design of scaffolds for the creation of physiologically relevant tissue-engineered bile ducts should be based not only on biodegradation properties but also on the biomechanical time-related behavior of various compositions of polymers and copolymers.
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Affiliation(s)
- Ilya Klabukov
- Department of Regenerative Medicine, National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 249031 Obninsk, Russia
- Department of Urology and Operative Nephrology, Peoples Friendship University of Russia (RUDN University), 117198 Moscow, Russia
- Obninsk Institute for Nuclear Power Engineering, National Research Nuclear University MEPhI, 115409 Obninsk, Russia
| | - Timur Tenchurin
- National Research Centre “Kurchatov Institute”, 1, Akademika Kurchatova pl., 123182 Moscow, Russia
| | - Alexey Shepelev
- National Research Centre “Kurchatov Institute”, 1, Akademika Kurchatova pl., 123182 Moscow, Russia
| | - Denis Baranovskii
- Department of Regenerative Medicine, National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 249031 Obninsk, Russia
- Department of Urology and Operative Nephrology, Peoples Friendship University of Russia (RUDN University), 117198 Moscow, Russia
| | - Vissarion Mamagulashvili
- National Research Centre “Kurchatov Institute”, 1, Akademika Kurchatova pl., 123182 Moscow, Russia
| | - Tatiana Dyuzheva
- Department of Hospital Surgery, Sklifosovsky Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Olga Krasilnikova
- Department of Regenerative Medicine, National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 249031 Obninsk, Russia
| | - Maksim Balyasin
- Research and Educational Resource Center for Cellular Technologies, Peoples Friendship University of Russia (RUDN University), 117198 Moscow, Russia
| | - Alexey Lyundup
- Research and Educational Resource Center for Cellular Technologies, Peoples Friendship University of Russia (RUDN University), 117198 Moscow, Russia
- N.P. Bochkov Research Centre for Medical Genetics, 115478 Moscow, Russia
| | - Mikhail Krasheninnikov
- Research and Educational Resource Center for Cellular Technologies, Peoples Friendship University of Russia (RUDN University), 117198 Moscow, Russia
- Lomonosov Institute of Fine Chemical Technologies, Russian Technological University MIREA, 119454 Moscow, Russia
| | - Yana Sulina
- Department of Obstetrics and Gynecology, Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Vitaly Gomzyak
- National Research Centre “Kurchatov Institute”, 1, Akademika Kurchatova pl., 123182 Moscow, Russia
| | - Sergey Krasheninnikov
- National Research Centre “Kurchatov Institute”, 1, Akademika Kurchatova pl., 123182 Moscow, Russia
| | - Alexander Buzin
- National Research Centre “Kurchatov Institute”, 1, Akademika Kurchatova pl., 123182 Moscow, Russia
- Laboratory of the Structure of Polymer Materials, Enikolopov Institute of Synthetic Polymer Materials RAS, 117393 Moscow, Russia
| | - Georgiy Zayratyants
- Department of Pathology, Moscow State University of Medicine and Dentistry, Delegatskaya st., 20, p. 1, 127473 Moscow, Russia
| | - Anna Yakimova
- Department of Regenerative Medicine, National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 249031 Obninsk, Russia
| | - Anna Demchenko
- N.P. Bochkov Research Centre for Medical Genetics, 115478 Moscow, Russia
| | - Sergey Ivanov
- Department of Regenerative Medicine, National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 249031 Obninsk, Russia
| | - Peter Shegay
- Department of Regenerative Medicine, National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 249031 Obninsk, Russia
- Department of Urology and Operative Nephrology, Peoples Friendship University of Russia (RUDN University), 117198 Moscow, Russia
| | - Andrey Kaprin
- Department of Regenerative Medicine, National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 249031 Obninsk, Russia
- Department of Urology and Operative Nephrology, Peoples Friendship University of Russia (RUDN University), 117198 Moscow, Russia
| | - Sergei Chvalun
- National Research Centre “Kurchatov Institute”, 1, Akademika Kurchatova pl., 123182 Moscow, Russia
- Laboratory of the Structure of Polymer Materials, Enikolopov Institute of Synthetic Polymer Materials RAS, 117393 Moscow, Russia
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6
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Zhu T, Lin H, Sun J, Liu C, Zhang R. Primary duct closure versus T-tube drainage after laparoscopic common bile duct exploration: a meta-analysis. J Zhejiang Univ Sci B 2021; 22:985-1001. [PMID: 34904412 DOI: 10.1631/jzus.b2100523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS: Laparoscopic common bile duct exploration (LCBDE) is considered a safe and effective method for the removal of bile duct stones. However, the choice of primary duct closure (PDC) or T-tube drainage (TTD) technique after LCBDE is still controversial. This study aimed to compare the safety and effectiveness of PDC and TTD after LCBDE. METHODS: Studies published before May 1, 2021 in PubMed, Web of Science, and Cochrane Library databases were searched to screen out randomized controlled trials (RCTs) and cohort studies to compare PDC with TTD. Meta-analyses of fixed effect and random effect models were performed using RevMan 5.3. RESULTS: A total of 1865 patients were enrolled in six RCTs and ten cohort studies. Regarding RCTs, the PDC group was significantly better than the TTD group in terms of operation time, total postoperative complications, postoperative hospital stay, and hospitalization expenses (all P<0.05). Based on cohort studies of the subgroup, the PDC group had shorter operation time, shorter postoperative hospital stay, less intraoperative blood loss, and limited total postoperative complications. Statistically, there were no significant differences in bile leakage, retained stones, stone recurrence, bile duct stricture, postoperative pancreatitis, other complications, or postoperative exhaust time between the TTD and PDC groups. CONCLUSIONS: Based on the available evidence, compared with TTD, PDC is safe and effective, and can be used as the first choice after transductal LCBDE in patients with choledocholithiasis.
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Affiliation(s)
- Taifeng Zhu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Biliary-Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Haoming Lin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Biliary-Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Jian Sun
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Biliary-Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Chao Liu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Biliary-Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China. ,
| | - Rui Zhang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation and Department of Biliary-Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
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7
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Song S, Lu T, Yang W, Gong S, Lei C, Yang J, Feng L, Tian H, Yang K, Guo T. T-tube or no T-tube for biliary tract reconstruction in orthotopic liver transplantation: an updated systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2021; 15:1201-1213. [PMID: 33720798 DOI: 10.1080/17474124.2021.1903874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: Biliary tract reconstruction with or without T-tube is commonly used in orthotopic liver transplantation (OLT). However, the efficacy and safety of T-tube usage remain controversial. This meta-analysis was conducted to assess the latest evidence of clinical outcomes.Methods: Embase, Cochrane Library, PubMed, and Web of Science were systematically searched from inception to 20 January 2021 for eligible studies. The analyses were performed using Review Manager and Stata.Results: A total of 24 trials involving 3320 participants were included in the meta-analysis. Compared with the no T-tube group, there was a higher incidence of overall biliary complications (OR:1.54; 95%CI, 1.06-2.24; P = 0.02), bile leaks (OR:2.34; 95%CI,1.57-3.48; P < 0.0001), cholangitis (OR:2.78; 95%CI,1.19-6.51; P = 0.002), and longer cold ischemia time (MD:22.27; 95%CI,0.80-43.74; P = 0.04) in the T-tube group. Furthermore, the no T-tube group had significantly higher odds of biliary strictures than the T-tube group (OR:0.60; 95%CI, 0.47-0.78; P = 0.0001).Conclusion: T-tube is still not routinely recommended, but is a good choice for OLT patients at high risk of biliary strictures. Notably, the higher rate of biliary complications in the T-tube group did not translate into an increase in endoscopic or re-operative interventions.
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Affiliation(s)
- Shaoming Song
- Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Tingting Lu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, China
| | - Wenwen Yang
- Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Shiyi Gong
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Caining Lei
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Jia Yang
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Lufang Feng
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Hongwei Tian
- Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou, China
| | - Tiankang Guo
- Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of General Surgery, Gansu Provincial Hospital, Lanzhou, China
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8
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Hori T. Comprehensive and innovative techniques for laparoscopic choledocholithotomy: A surgical guide to successfully accomplish this advanced manipulation. World J Gastroenterol 2019; 25:1531-1549. [PMID: 30983814 PMCID: PMC6452235 DOI: 10.3748/wjg.v25.i13.1531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/05/2019] [Accepted: 03/11/2019] [Indexed: 02/06/2023] Open
Abstract
Surgeries for benign diseases of the extrahepatic bile duct (EHBD) are classified as lithotomy (i.e., choledocholithotomy) or diversion (i.e., choledochojejunostomy). Because of technical challenges, laparoscopic approaches for these surgeries have not gained worldwide popularity. The right upper quadrant of the abdomen is advantageous for laparoscopic procedures, and laparoscopic choledochojejunostomy is safe and feasible. Herein, we summarize tips and pitfalls in the actual procedures of choledocholithotomy. Laparoscopic choledocholithotomy with primary closure of the transductal incision and transcystic C-tube drainage has excellent clinical outcomes; however, emergent biliary drainage without endoscopic sphincterotomy and preoperative removal of anesthetic risk factors are required. Elastic suture should never be ligated directly on the cystic duct. Interrupted suture placement is the first choice for hemostasis near the EHBD. To prevent progressive laceration of the EHBD, full-layer interrupted sutures are placed at the upper and lower edges of the transductal incision. Cholangioscopy has only two-way operation; using dedicated forceps to atraumatically grasp the cholangioscope is important for smart maneuvering. The duration of intraoperative stone clearance accounts for most of the operative time. Moreover, dedicated forceps are an important instrument for atraumatic grasping of the cholangioscope. Damage to the cholangioscope requires expensive repair. Laparoscopic approach for choledocholithotomy involves technical difficulties. I hope this document with the visual explanation and literature review will be informative for skillful surgeons.
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Affiliation(s)
- Tomohide Hori
- Department of Hepato-Biliary-Pancreatic Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
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9
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Biliary Duct-to-Duct Reconstruction with a Tunneled Retroperitoneal T-Tube During Liver Transplantation: a Novel Approach to Decrease Biliary Leaks After T-Tube Removal. J Gastrointest Surg 2017; 21:723-730. [PMID: 27815760 DOI: 10.1007/s11605-016-3313-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 10/19/2016] [Indexed: 01/31/2023]
Abstract
The benefit of placing a T-tube for duct-to-duct biliary reconstruction during orthotopic liver transplantation (OLT) remains controversial because it could be associated with specific complications, especially at the time of T-tube removal. While the utility of T-tube during OLT represents an eternal debate, only a few technical refinements of T-tube placement have been described since the report of the original technique by Starzl and colleagues. Herein, we present a novel technique of T-tube placement for duct-to-duct biliary reconstruction during OLT, using a tunneled retroperitoneal route. On the basis of our experience of 305 patients who benefitted from the reported technique, the placement of a tunneled retroperitoneal biliary T-tube appears to be safe and results in a low rate of biliary complications, especially at the time of T-tube removal.
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10
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The Use of Latex Catheters to Close Enterocutaneous Fistulas: An Institutional Protocol and Retrospective Review. AJR Am J Roentgenol 2017; 208:1373-1377. [PMID: 28301212 DOI: 10.2214/ajr.16.17294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to retrospectively review an institutional protocol that uses latex catheters for the treatment of enterocutaneous fistulas (ECFs) that are resistant to simple drainage. MATERIALS AND METHODS Forty-six consecutive patients with ECFs that did not close with simple abscess drainage were treated with latex catheters. These patients' charts were retrospectively reviewed to determine treatment success rates and the relationship of treatment success to clinical characteristics. RESULTS ECFs in 26 of the 46 (56.5%) patients were treated successfully with latex catheters. On univariate analysis, the fistulas that originated from the stomach were statistically less likely to close (p = 0.03), whereas those originating from the small bowel were more likely to close (p = 0.01). The duration of treatment was significantly longer in patients for whom the treatment failed than in those who were successfully treated (p = 0.003). After a total treatment time of more than 116 days (odds ratio [OR], 9.8 [95% CI, 2.5-38.4]; p = 0.001) or latex catheter treatment time of more than 74 days (OR, 8.9 [95% CI, 2.2-35.0]; p = 0.002), the chance of ECF closure decreased significantly. CONCLUSION Treatment of ECFs that are resistant to simple abscess cavity drainage with a latex catheter is possible and decreases the need for surgery.
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T-tube or No T-tube in Cadaveric Orthotopic Liver Transplantation: The Type of Tube Really Matters. Ann Surg 2015; 261:e172. [PMID: 23799419 DOI: 10.1097/sla.0b013e31829d56c0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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12
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Abstract
T-tube placement into the common bile duct (CBD) is most commonly performed after CBD exploration for cholelithiasis or repair of an iatrogenic CBD injury. Bile peritonitis occurring after T-tube removal is generally considered an exceedingly rare complication, which on occurrence necessitates urgent intervention. No clear guidance exists on the timing of T-tube removal and its relationship to the development of bile peritonitis. This study aimed to determine the incidence of bile peritonitis after T-tube removal, its relationship to the timing of removal and how knowledge of this can help the general surgeon.
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Affiliation(s)
- M Ahmed
- Shrewsbury and Telford Hospital NHS Trust, UK, Princess Royal Hospital, Apley Castle, Telford TF1 6TF, UK.
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Soltani E, Mehrabi Bahar A, Dehghanian P, Afzal Aghaei M, Mozaffari S. Prevention of Biliary Leakage after Removal of T-tube in Immunocompromised Patients. Indian J Surg 2013; 77:645-9. [PMID: 26730080 DOI: 10.1007/s12262-013-0958-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 07/26/2013] [Indexed: 12/30/2022] Open
Abstract
Biliary leakage after T-tube removal is an important complication which can be lethal especially in patients who received immunosuppressant agents. The purpose of the study is to determine a method which can evaluate the completion of tract formation in high-risk patients. Participants include 46 patients who were candidates for open cholecystectomy and common bile duct (CBD) exploration and T-tube insertion. Twelve of patients received corticosteroids and were divided into two groups. In the first group, T-tube was removed conventionally, but in the other group, we performed a "fistulography" 1 month postoperative to evaluate maturity of tract between CBD and the skin. Biliary peritonitis was seen in half of patients who are managed conventionally, but no complication was detected in patients who underwent fistulography. Fistulography is suggested to be done before T-Tube removal in immunocompromised patients in order to detect tract formation, which is effective in reduction of postremoval complications.
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Affiliation(s)
- Ehsan Soltani
- Acute Care Surgery Research Center, Faculty of Medicine, Taleghani Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Mehrabi Bahar
- Surgical Oncology Research Center, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Ibne Sina Street, Mashhad, Iran
| | - Paria Dehghanian
- Acute Care Surgery Research Center, Faculty of Medicine, Taleghani Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Monavar Afzal Aghaei
- Surgical Oncology Research Center, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Ibne Sina Street, Mashhad, Iran
| | - Samira Mozaffari
- Acute Care Surgery Research Center, Faculty of Medicine, Taleghani Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Daldoul S, Moussi A, Zaouche A. T-tube drainage of the common bile duct choleperitoneum: etiology and management. J Visc Surg 2012; 149:e172-8. [PMID: 22537812 DOI: 10.1016/j.jviscsurg.2012.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
External drainage of the common bile duct by placement of a T-tube is a common practice after choledochotomy. This practice may result in the specific complication of bile peritonitis due to leakage after removal of the T-tube. This complication has multiple causes: some are patient-related (corticotherapy, chemotherapy, ascites), and others are due to technical factors (inappropriate suturing of the drain to the ductal wall, minimal inflammatory reaction related to some drain materials). The clinical presentation is quite variable depending on the amount and rapidity of intra-peritoneal spread of of bile leakage. Abdominal ultrasound (US), with US-guided needle aspiration and occasionally Technetium(99) scintigraphy are useful for diagnosis. Traditional therapy consists of surgical intervention including peritoneal lavage and re-intubation of the choledochal fistulous tract to allow for a further period of external drainage. When leakage is walled off and well-tolerated, a more nuanced and less invasive conservative therapy may combine percutaneous drainage with endoscopic placement of a trans-ampullary biliary drainage.
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Affiliation(s)
- S Daldoul
- Service de chirurgie générale A, hôpital Charles-Nicolle, boulevard 9-Avril-1938, 1006 Tunis, Tunisia.
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Fossum M, Zuhaili B, Hirsch T, Spielmann M, Reish RG, Mehta P, Eriksson E. Minced skin for tissue engineering of epithelialized subcutaneous tunnels. Tissue Eng Part A 2009; 15:2085-92. [PMID: 19292681 DOI: 10.1089/ten.tea.2008.0149] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We used minced, autologous skin for neoepithelialization of surgically created subcutaneous tunnels in a large animal model. Partial-thickness skin grafts were harvested from the back region of five 50-60 kg Yorkshire pigs. The skin was minced to 0.8 x 0.8 x 0.3 mm particles. Silicone-latex tubes were covered with fibrin, rolled in minced skin, and placed in subcutaneous tunnels created in the abdominal area. For comparison, single cell suspensions of keratinocytes and fibroblasts in fibrin or fibrin only were transplanted on tubes. Tunnels were extracted after 14, 21, and 28 days for microscopic evaluation. All tubes transplanted with minced skin particles showed neoepithelialization. The epithelium was stratified and differentiated after 2 weeks in vivo, and the stratum corneum was directed toward the implanted tube. No epithelium formed from tubes transplanted with single cell suspensions, and only sparse keratinocytes could be detected by serial sectioning and immunostaining on day 14, but not later. No epithelial lining was found in tunnels with fibrin-only-coated tubes. Epithelial cysts could be found the first 2 weeks after transplantation in the minced skin group but not later. In conclusion, a minced skin technique could serve as a potential source for tissue engineering of tubular conduits for reconstructive purposes of the urethra and for cutaneous stomas for bladder catheterization, or intestinal irrigations. The method would have the advantage of being simple and expeditious and not requiring in vitro culturing.
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Affiliation(s)
- Magdalena Fossum
- Division of Pediatric Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital , Stockholm, Sweden
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BRAY JONATHANP, DOYLE RONANS, BURTON CAROLYNA. Minimally Invasive Inguinal Approach for Tube Cystostomy. Vet Surg 2009; 38:411-6. [DOI: 10.1111/j.1532-950x.2009.00510.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nikolić M, Karthikesalingam A, Nachimuthu S, Tang TY, Harris AM. Biliary peritonitis caused by a leaking T-tube fistula disconnected at the point of contact with the anterior abdominal wall: a case report. J Med Case Rep 2008; 2:302. [PMID: 18796154 PMCID: PMC2557018 DOI: 10.1186/1752-1947-2-302] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Accepted: 09/16/2008] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Operations on the common bile duct may lead to potentially serious complications such as biliary peritonitis. T-tube insertion is performed to reduce the risk of this occurring postoperatively. Biliary leakage at the point of insertion into the common bile duct, or along the fistula, can sometimes occur after T-tube removal and this has been reported extensively in the literature. We report a case where the site at which the T-tube fistula leaked proved to be the point of contact between the fistula and the anterior abdominal wall, a previously unreported complication. CASE PRESENTATION A 36-year-old sub-Saharan African woman presented with gallstone-induced pancreatitis and, once her symptoms settled, laparoscopic cholecystectomy was performed, common bile duct stones were removed and a T-tube was inserted. Three weeks later, T-tube removal led to biliary peritonitis due to the disconnection of the T-tube fistula which was recannulated laparoscopically using a Latex drain. CONCLUSION This case highlights a previously unreported mechanism for bile leak following T-tube removal caused by detachment of a fistula tract at its contact point with the anterior abdominal wall. Hepatobiliary surgeons should be aware of this mechanism of biliary leakage and the use of laparoscopy to recannulate the fistula.
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Affiliation(s)
- Marko Nikolić
- Department of General Surgery, Hinchingbrooke Hospital NHS Trust, Hinchingbrooke Park, Huntingdon, UK.
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SONG EDDIEKUGJU, MANN F(TONY, WAGNER-MANN COLETTEC. Comparison of Different Tube Materials and Use of Chinese Finger Trap or Four Friction Suture Technique for Securing Gastrostomy, Jejunostomy, and Thoracostomy Tubes in Dogs. Vet Surg 2008; 37:212-21. [DOI: 10.1111/j.1532-950x.2008.00368.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yagil-Kelmer E, Wagner-Mann C, Mann FA. Postoperative complications associated with jejunostomy tube placement using the interlocking box technique compared with other jejunopexy methods in dogs and cats: 76 cases (1999-2003). J Vet Emerg Crit Care (San Antonio) 2006. [DOI: 10.1111/j.1476-4431.2005.00180.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Maghsoudi H, Garadaghi A, Jafary GA. Biliary peritonitis requiring reoperation after removal of T-tubes from the common bile duct. Am J Surg 2005; 190:430-433. [PMID: 16105531 DOI: 10.1016/j.amjsurg.2005.04.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Revised: 04/05/2005] [Accepted: 04/05/2005] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bile peritonitis can occur when a T-tube is electively removed from the common bile duct, but this is regarded as a rare complication. Plastic T-tubes are known to increase this risk and should not be used. Latex rubber T-tubes are preferred, but the peritonitis can still occur. METHODS Prospective data were collected on 1375 patients who underwent common bile duct exploration between March 20, 1994 and March 20, 2003. RESULTS Thirty-four (2.47%) patients experienced generalized bile peritonitis after T-tube removal from the common bile duct. Mean age was 63.65 years. In all cases, a soft silicon-coated latex rubber T-tube was placed into the bile duct. All T-tubes were removed 21 days after surgery. Thirty-four patients developed acute generalized biliary peritonitis immediately after T-tube removal and required urgent active intervention. The mortality rate was 5.9%, and the mean hospital stay was 14.6 days. CONCLUSIONS The most common causes of lack of formation of T-tube tract and operative procedure were unknown and T-tube reinsertion, respectively. T-tube removal can result in significant morbidity and mortality.
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Affiliation(s)
- Hemmat Maghsoudi
- Department of Surgery, Faculty of Medicine, University of Medical Sciences of Tabriz, Tabriz, East Azarbaijan, Iran.
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Abstract
BACKGROUND Traditional management of choledocholithiasis has been supraduodenal choledochotomy, duct exploration and insertion of a T-tube. This study reviews the complications associated with T-tube use and assesses whether laparoscopic procedures are associated with an increase in complications relating to T-tube use. METHODS Case records from two large public hospitals in New South Wales (Australia) were analysed retrospectively for a 10-year period using a standardized data collection form. Morbidity, mortality and potential factors influencing the complication rate after choledochotomy and T-tube insertion were recorded. All complications were reviewed by an experienced biliary surgeon. RESULTS T-tubes were inserted in 274 patients, with 42 patients (15.3%) experiencing a total of 60 complications relating to T-tube use. Morbidity occurring while the tube was in situ included fluid and electrolyte disturbance (five patients), sepsis (10 patients), premature dislodgement (three patients) and bile leakage (six patients). Complications resulting after planned tube removal included localized pain (13 patients), biliary peritonitis (seven patients), a prolonged biliary fistula (seven patients) and a late bile duct stricture (one patient). T-tube complications resulted in a prolonged hospital stay (19 days vs 13 days, P = 0.005), 10 additional abdominal operations and two deaths. Complications related to T-tubes were constant over the study period and were similar between laparoscopic and open cases (13.8% vs 15.5%, P = 0.81). CONCLUSIONS Although this retrospective review is likely to have underestimated the incidence of T-tube complications, it has demonstrated significant morbidity associated with T-tube use. The incidence of these complications has been constant and is unrelated to a laparoscopic approach.
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Affiliation(s)
- Vanessa L Wills
- John Hunter Hospital, Newcastle, New South Wales, Australia.
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Soria Aledo V, Carrasco Prats M, González Martínez P. [Duodenal erosion as a complication of a Kehr T tube]. GASTROENTEROLOGIA Y HEPATOLOGIA 2001; 24:220-1. [PMID: 11333665 DOI: 10.1016/s0210-5705(01)70156-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Koivusalo A, Eskelinen M, Wolff H, Talva M, Mäkisalo H. Development of T-tube tracts in piglets: effect of insertion method and material of T-tubes. RESEARCH IN EXPERIMENTAL MEDICINE. ZEITSCHRIFT FUR DIE GESAMTE EXPERIMENTELLE MEDIZIN EINSCHLIESSLICH EXPERIMENTELLER CHIRURGIE 1997; 197:53-61. [PMID: 9226763 DOI: 10.1007/s004330050055] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
T-tube-related bile leakage is a considerable problem in liver transplantation but rather rare in surgery of biliary lithiasis. To investigate the effect of T-tube insertion method and material on the intraperitoneal T-tube tract, we performed a choledochotomy and insertion of T-tube (four of silicone, seven of latex, four of silicone with a latex sheath around the long arm) for 2 weeks on 15 piglets (choledochotomy group), and sutured a transected bile duct over a T-tube stent in nine piglets (five silicone, four latex), inserted similarly as in liver transplantations, for 6 weeks. Sixteen patients underwent cholectochotomy and T-tube drainage with a latex T-tube (n = 8) and latex-sheathed silicone T-tube (n = 8) for a median 9 (7-21) days. Histological examination of T-tube tracts in piglets was made, and complications after T-tube removal in the latex T-tube group were compared with those in the latex-sheathed silicone T-tube group. In piglets, latex T-tubes induced better tracts than silicone T-tubes (P < 0.05). Piglets in the choledochotomy group had tracts superior to those in the anastomotic stent group (P < 0.05). There was one bile leakage in the latex T-tube group, and none in the latex-sheathed silicone T-tube group. We conclude that T-tube tract development is affected by both the material and the insertion method of T-tubes. A silicone T-tube with a latex sheath around the long arm may also be a good choice for T-tube material in liver transplantation.
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Affiliation(s)
- A Koivusalo
- Helsinki University Central Hospital, Fourth Department of Surgery, Finland
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Koivusalo A, Makisalo H, Talja M, Cormio L, Ruutu M, Wolff H, Hockerstedt K. Biocompatibility of latex and silicone T tubes in the porcine common bile duct: an experimental study. RESEARCH IN EXPERIMENTAL MEDICINE. ZEITSCHRIFT FUR DIE GESAMTE EXPERIMENTELLE MEDIZIN EINSCHLIESSLICH EXPERIMENTELLER CHIRURGIE 1996; 196:53-66. [PMID: 8833487 DOI: 10.1007/bf02576828] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Toxicity of materials used in indwelling drains or catheters has the potential to damage surrounding tissues. The biocompatibility of biliary T-tubes was investigated using in groups of piglets (total 30 animals). In group 1 (n=16) a choledochotomy was performed with insertion of a latex T-tube (n=6) or a silicone T-tube (n=8), or without a T-tube (n=2). In group 2 (n=14) the common bile duct (CBD) was 3/4-transected, and the lesion was sutured over a latex T-tube (n=4) or a silicone T-tube (n=5), or without a T-tube (n=5). The groups were reoperated upon after 2 and 6 weeks respectively, and the CBD was harvested for scanning electron microscopy and light microscopy. The T-tubes were examined for cell culture toxicity with a DNA synthesis inhibition test. According to the cell culture tests, latex T-tubes were toxic and silicone T-tubes nontoxic. T-tubes induced moderate to pronounced fibrosis and epithelial damage in the CBD wall, but did not induce excessive fibrosis or scarring at the site of CBD suture. In the 6-week study period, however, the grade of tissue reactions in the CBD did not correlate with the toxicity of the T-tube materials, but rather reflected a foreign body reaction and mechanical pressure. Although gross anatomical changes did not occur, neither material seemed to be completely harmless for porcine CBD wall.
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Affiliation(s)
- A Koivusalo
- Fourth Department of Surgery, Helsinki University Central Hospital, Finland
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Koivusalo A, Isoniemi H, Salmela K, Edgren J, von Numers H, Höckerstedt K. Biliary complications in one hundred adult liver transplantations. Scand J Gastroenterol 1996; 31:506-11. [PMID: 8734350 DOI: 10.3109/00365529609006773] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Biliary complications are a common problem in liver transplantation (LT). METHODS We reviewed 100 consecutive adult LTs, including 10 retransplantations. Ten patients who survived for less than 1 month or developed hepatic artery thrombosis were excluded. Biliobiliary anastomosis was performed with a T-tube (CCT) (n = 25) or without it (CC) (n = 59), or biliodigestive anastomosis (Rouxen-Y) (n = 6) was used. RESULTS Biliary complications (8 anastomotic strictures and 9 bile leakages) occurred in 15 LTs. Surgical treatment was needed for seven strictures and two leakages. Complications tended to be more frequent with CCT than with CC (24% versus 12%). Biliary complications were often accompanied by cytomegalovirus disease and bacterial infections. After a median follow-up time of 5.2 years, total patient survival was 71% for all 100 LTs and 81% for those with biliary complications. CONCLUSIONS Biliary complications are rather frequent after LTs; they are often preceded by infections but can be treated and do not cause excessive mortality. T-tubes are not to be recommended.
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Affiliation(s)
- A Koivusalo
- Fourth Dept. of Surgery, Helsinki University Central Hospital, Finland
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Affiliation(s)
- S H Dougherty
- Department of Surgery, Texas Tech University School of Medicine, El Paso
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Holt SD, Tiwari IB, Howell GP. Biliary peritonitis following the removal of a T-tube. J ROY ARMY MED CORPS 1987; 133:155. [PMID: 3681837 DOI: 10.1136/jramc-133-03-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- S D Holt
- Princess Mary's Royal Air Force Hospital, Halton, Aylesbury, Bucks
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Abstract
U tube placement was employed as an adjunct to complicated biliary procedures in 14 patients. We found the transhepatic tubes to be useful for stenting biliary anastomoses, maintaining biliary drainage, delivering localized irradiation, and acting as permanent external conduits. The tubes remained in placed an average of 15 months and as long as 40 months. The frequency of cholangitis was minimized by frequent tube exchange. The U-shaped configuration makes tube exchange easy and inexpensive to perform.
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Dellinger EP, Steer M, Weinstein M, Kirshenbaum G. Adverse reactions following T-tube removal. World J Surg 1982; 6:610-5. [PMID: 7135990 DOI: 10.1007/bf01657878] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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