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Anterograde cholecystectomy. A, Beginning of the dissection for the left cephalad wall. B, Progression of gallbladder removal with minilaparoscopic approach. C, Top-approach dissection. D, D, Dissection near the infundibulum. E, Infundibulum opening showing rear wall of the common bile duct.
Source publication
Introduction: Mirizzi syndrome (MS) is an uncommon complication of long-term chronic cholecystitis, characterized by extrinsic compression of the common hepatic duct or the presence of cholecystobiliary fistula. A case of type IV MS, with extensively damaged common hepatic duct (CHD) due to gallstone impaction and fistula, was effectively treated b...
Contexts in source publication
Context 1
... establishing the pneumoperitoneum, 4 new lowfriction atraumatic trocars of 3.5 mm were placed along the right costal border. The setting of the surgical team (Figure 4) and the positioning of the trocars ( Figure 5) were according to our standard for minilaparoscopic cholecystectomy. 4 The procedure started with the release of the gallbladder "fundus first" from the liver bed, followed by the isolation, sealing, and transection of the cystic artery by electrocautery. ...
Context 2
... there are some alternatives that may contribute to reducing the incidence of iatrogenic injuries: 1. Anterograde cholecystectomy ("dome-down"), as in the present case, is used when approaching the gallbladder by the infundibulum is impossible or unsafe. This approach allows safe identification of both the cystic artery and the cystic duct 4,14 -18 ( Figure 5). ...
Citations
... The utilization of HD for type IV Mirizzi's syndrome has also recently been reported. [4]. ...
The management strategy of common bile duct stone will depend on personal experience, equipment availability, time and the availability of other departmental expertise. For a distally impacted common bile duct (CBD) stone in a low resource setting, an open approach will entail either leaving the stone where it is and carry out a choledochoduodenostomy, or removing the stone through a transduodenal sphincteroplasty. The latter has a significant risk of causing an acute pancreatitis. A case report of a hepaticoduodenostomy performed on a 40-year-old black African man for a retained, impacted distal CBD stone in a low resource setting with a good outcome is presented. The impacted CBD stone had complicated an open cholecystectomy for acute cholecystitis by causing the dehiscence of the cystic duct stump as a result of distal biliary obstruction. A bypass procedure such as a hepaticoduodenostomy may be an alternative to the traditional choledochoduodenostomy in the management of the retained, impacted distal CBD stone especially in the presence of sepsis. . A wide side- to-side hepaticoduodenostomy (>3cm d) is a safe and definitive procedure for the decompression of lower CBD obstruction and has good long-term results with infrequent complications including reflux cholangitis, hepatic abscess, stone recurrence, pancreatitis and the ‘sump’ syndrome. This case demonstrates that a hepaticoduodenostomy is safe and effective in rescuing the adverse sequelae of an impacted distal CBD stone in a low resource setting.
... [1][2][3][4][5] The incidence of these bile duct injuries (0.3-0.7%) has almost doubled since the advent of laparoscopic cholecystectomy and more severe complications such as stenosis can be treated with percutaneous or endoscopic procedures. [6][7][8] Alternative techniques have been explored for the management of these injuries with a notable approach being use of biomaterials that allow improved healing of target tissues. 9 Biomaterials have been employed in animal models for repair of bile duct injuries although have not yet been evaluated in humans. ...
... Adverse events resulting from surgical trauma of the CBD may not become clinically apparent for up to 12 months, especially when vascular insult leads to progressive ischemic damage of the biliary tissues. 7,8,10,19,20 For this reason, different groups were studied at varying postoperative time points (up to 330 days). The BCF used for CBD repair has a compact nonporous structure that prevents leakage of bile. ...
Background/objective
The aim was to evaluate the use of bacterial cellulose film and bile duct autograft in repairing critical common bile duct injury in pigs.
Methods
A prospective experimental analytical study was carried out on 20 Sus Domesticus, Piau suidae swine, divided into a control group ( n = 10) and an experimental group ( n = 10) divided into two subgroups: bacterial cellulose film E1 and bacterial cellulose film E2 to which bacterial cellulose film was randomly allocated. The control group underwent two complete critical common bile duct sections 10 mm apart, while the experimental group with a single critical common bile duct defect underwent a 10 mm section of the longitudinal shaft with edge resection. The defects in the control group were treated with end-to-end conventional anastomosis using polyglycolic 6–0 surgical thread and the experimental group with bacterial cellulose film by continuous suture using the same material. The animals were clinically evaluated throughout the experiment on days D150 (bacterial cellulose film E1), D225 (control group), and D330 (bacterial cellulose film E2) and by intraoperative ultrasound examination related to histopathological and biochemical findings.
Results
The intraoperative ultrasonography detected the changes resulting from the common bile duct anastomosis in the control group that produced a considerable incidence of ductal narrowing and obstruction to the biliary flow. In the bacterial cellulose film E2 group, there was an increase in inflammation intensity, granulomatous reaction, fibrosis, and vessels density, without producing bile duct dilation in the ultrasonography assessment. Biochemical analysis of liver enzymes yielded results in the normal range confirming preservation of liver function at the different post-surgery time points.
Conclusion
Bacterial cellulose film, when used as a graft for bile duct repair, proved to be a biocompatible material that produced a complete healing process and biliary flow continuity.
... Besides, due to its smaller size, minilaparoscopy allows a better visualization of the surgical field. Other more complex procedures have also been described [17][18][19] . ...
Two female patients, one 28 years-old, and the other 61 years-old, with a history of asthenia, purpura and thrombocytopenia (both <15,000 platelets / mm3). Once other etiologies were excluded, and the diagnosis of immune thrombocytopenic purpura (ITP) was established, corticoid therapy was started in both cases. However, the patients remained with a platelet count <20,000 / mm3, characterizing refractory ITP, and the splenectomy was indicated. The surgical team opted for a hybrid minimally invasive surgical procedure. Providing a better visualization of the surgical field, less abdominal trauma, greater technical dexterity, and early hospital discharge, the use of minilaparoscopic instruments proved to be a safe and effective approach for these patients.
... However, these instruments can also be used in hernia procedures and more complex surgeries. [17][18][19][20] It has become very popular in inguinal hernia repairs. When working in a limited space, such as in totally extraperitoneal (TEP) repair, smaller instruments have helped surgeons perform more precise movements and have a better visualisation of the surgical field. ...
The mini-laparoscopic cholecystectomy (MLC) was first performed in 1996, as the logical advancement of the conventional laparoscopic cholecystectomy. In Brazil, mini-laparoscopy was first performed in 1998, by Professors Peter Goh and Go Wakabaiashi, who performed a cholecystectomy using 3-mm instruments. The first study, with a considerable number of patients, was performed in Recife by Dr. Carvalho, and he reported that 719 patients were submitted to a MLC with a small rate of conversion for conventional laparoscopy. We discuss the development of mini-laparoscopy in Brazil for the past 20 years.
... Minilaparoscopy has also been shown to be safe and effective for other complex approaches. [5] This case reports a successful hybrid minilaparoscopic approach for the treatment of a non-parasitic giant hepatic cyst. Although there is no consensus on the ideal approach, cyst unroofing by hybrid minilaparoscopy in this case was a safe, effective and a low-morbidity option. ...
A female patient, 59-year-old, was complaining of abdominal pain in the right hypochondrium and mesogastrium for 6 months. Ultrasonography and abdominal computed tomography were performed, both confirming a large hepatic cyst (10.6 cm × 7.6 cm × 7.3 cm) on the left lobe. A hybrid minilaparoscopic resection was proposed. We opted for unroofing the cyst, and the procedure was uneventfully performed, with a total surgical time of 60 min. In the post-operative the patient did well, with minimal abdominal pain, being discharged on the 5th post-operative day, after drain removal due to the use of intravenous antibiotic therapy.
... In more precise and complex procedures, the low friction of the 3 mm instruments shows better results. [5][6][7][8] ...
We describe the original technique used for the treatment of a patient who presented with pain and bulging in the abdomen, who was diagnosed with Spigelian hernia (SH) using ultrasound. In this case, the hernia occurred in the anterolateral abdominal wall with herniation of the distal ileum and mesentery, in addition to a large right inguinal hernia. A mini-laparoscopic approach was proposed; due to Child-A hepatic cirrhosis, it was done by a hybrid technique, using a harmonic scalpel. The primary closure of the hernia defects was performed, followed by the placement of a polypropylene mesh in the preperitoneal space. The mesh was fixed. In this case, the inguinal hernia was homolateral to the SH. Following the surgery, the patient had no further complications, being discharged the day after the procedure.
... Other more complex procedures have also been described. [5] This is the second report in the literature of a giant splenic cyst resected by minilaparoscopy. ...
A female patient, 20 years old, with a history of a progressive increase in abdominal volume on the left side, starting 3 years ago, with no associated symptoms and no history of trauma. Ultrasonography and a computed tomography scan of the abdomen were performed, which revealed a large splenomegaly, and a partial minilaparoscopic splenectomy was indicated. We opted for unroofing of the cyst, and the procedure was uneventful, with a total surgical time of 47 min. The patient progressed clinically well, without abdominal pain, being discharged on the 2nd post-operative day.
... 27,28 Other more complex procedures were also described. 29 There are no reports in the literature about the resection of splenic cysts by minilaparoscopy. However, minilaparoscopy has been described for splenectomy. ...
A bypass procedure such as a hepaticoduodenostomy may be an alternative to the traditional choledochoduodenostomy in the management of the retained, impacted distal common bile duct stone especially in the presence of sepsis. In low-resource settings with lack of fluoroscopy, fibreoptic instruments (choledoscope) or radiologically guided wire baskets or balloons for stone retrieval, there are operative hazards in blindly exploring the common bile duct. We present herein a hepaticoduodenostomy performed for a retained, impacted distal common bile duct stone in a low-resource setting with a good outcome. This impacted stone had complicated an open cholecystectomy for acute cholecystitis by causing the dehiscence of the cystic duct stump as a result of distal biliary obstruction.
We report the cases of two patients, one 26 years-old male, and the other 43 years-old female, who had a history of high blood pressure and hypokalemia. The male also presented progressive tetraparesis six months before diagnosis. The female patient was diagnosed with systemic lupus erythematosus and Sjögren's syndrome. After investigation, using ultrasonography and abdominal computed tomography, both patients presented hypodense and solid nodular lesions in the adrenal gland, compatible with adenoma. The surgical team opted for a hybrid minimally invasive approach. Providing a better visualization of the surgical field, less abdominal trauma, and greater technical dexterity, the use of minilaparoscopic instruments proved to be a safe and effective approach for these patients. After the surgeries, the patients presented a better control of blood pressure and electrolytes, being discharged early in good clinical conditions.
