PubMed · 13698967
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D J FERNANDEZ TASENDE. 1960-11-09. [Cholecystostomy].. https://pubmed.ncbi.nlm.nih.gov/13698967/
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A 47-year-old patient presented with jaundice. Laboratory examinations confirmed cholestasis. The patient had a long history of chronic pancreatitis. Subsequently, cholecystectomy and a duodenum-preserving resection of the pancreatic head (Frey's surgery) had been performed. Endoscopic retrograde holangiography was done. The endoscope was inserted the normal way to the untouched papilla vateri. After injection of contrast medium, only the side-to-side choledocho-jejunal anastomosis but not the common bile duct could be visualized because the catheter spontaneously slipped into the jejunum via the side-to-side choledocho-jejunal anastomosis. After introducing a catheter percutaneously into the intrahepatic bile duct system, a long stenosis of the common bile duct could be visualized. It was possible to overcome the stenosis with a wire, but the wire also dislocated into the jejunum via the side-to-side choledocho-jejunal anastomosis and could not be placed through the papilla into the duodenum. The problem was solved in a tricky way: A wire was introduced into the common bile duct via the papilla and placed into the duodenum. A loop was brought in percutaneously and was also placed in the jejunum. With the loop, the wire was grabbed and taken out percutaneously. Now a biliary metal stent could be positioned correctly over the wire to expand the stenosis. After the procedure jaundice was cured quickly. The further course was uneventful with complete recovery.
The extrahepatic biliary tree was first visualized in 1918 when Reich injected bismuth and petrolatum and defined a biliary fistula, thus opening the field for further studies of the biliary tree. Mirizzi recorded the first series of intraoperative cholangiography in 1932 using static films. Later, the mobile C-arm image intensifier using a TV monitor was reported in a series by Berci and colleagues in 1978. They emphasized the importance of using routine cholangiography in all laparoscopic cholecystectomies. This procedure can be performed through the cystic duct or through the gallbladder with excellent visualization of the anatomy of the extrahepatic biliary tree, including the potential of finding bile duct stones, stricture, and tumor, as well as defining the function and anatomy of Oddi's sphincter. Numerous benefits of this technique can be observed, including early definition of a bile duct leak or injury. X-ray resolution will continue to improve as well as three-dimensional imaging, and intraoperative magnetic imaging cholangiopancreatography may be developed as the future intraoperative cholangiogram.
Flexible endoscopy has evolved from a diagnostic tool practiced predominantly by gastroenterologists to a minimally invasive surgical tool. Therapeutic endoluminal procedures have become the standard of care for many gastric, biliary, pancreatic and colonic maladies. New technologies are under investigation for endoscopic treatment of gastroesophageal reflux, morbid obesity, and ablation of premalignant tissue. In the future flexible endoscopes may play a role in "natural orifice" surgery, performing operations through the mouth or rectum without the need for external incisions.