Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “CYSTIC DUCT”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources
PubMed1979

Resistance and sphincter-like properties of the cystic duct.

The canine cystic duct, like that in man, has an extremely thin layer of muscle deep to the mucosal layer, surrounded by a dense layer of collagen fibers. The resistance to flow through the duct was studied in 16 anesthetized dogs by perfusing the duct with saline solution at constant pressure and recording the flow rate of the solution. The flow rate varied with respiratory movements, but there were also nonrespiratory variations which might be due to spontaneous sphincter-like contractions. Significant reductions in flow through the duct followed systemic intravenous or local intra-arterial injections of morphine or pharmacologic concentrations of adrenaline or cholecystokinin. It was concluded that an extremely small amount of muscle in the wall of the duct was capable of sphincter-like activity. The resistances to flow were the same in either direction through the duct, an indication that the prominent mucosal folds, valves of Heister, did not function as unidirectional valves. In view of the high resistance to flow through the duct and the possibility that sphincter-like activity may also occur under physiologic conditions, the function of the duct requires more attention than it has received in the past.

Animals↗
PubMed2001

Sealing of cystic duct with bipolar electrocoagulation.

BACKGROUND: The cystic duct leakage rate is still high. The aim of this study was to evaluate an alternative technique for securing the cystic duct using the Ligasure vessel sealing system. METHODS: Eight pigs were included in this pilot study. We performed a cholecystectomy, using the Ligasure system to sealing the cystic duct and artery. The pigs were killed 8 days after operation, and specimens of the cystic duct and common bile duct were removed for pathologic examination. RESULTS: There were no clinical complications other than two superficial wound infections. The sealing of the cystic duct and artery were both macroscopically and microscopically 100% sufficient. The maximum extension of the coagulative process in the sealed ducts was 0.25 mm on each side of the sealed area. CONCLUSIONS: The Ligasure system seems promising for securing the cystic duct and artery during cholecystectomy. Future studies should evaluate safety with this technique on a larger scale.

Animals↗
PubMed2006

An audit of cystic duct closure in laparoscopic cholecystectomies.

BACKGROUND: Cystic duct leak is an infrequent but potentially serious complication of laparoscopic cholecystectomy. The aims of this audit were to assess the efficacy of locking absorbable clips for closing the cystic duct and to compare the results with those for simple clips used previously. METHODS: The records for all laparoscopic cholecystectomies performed in one hospital over a 5-year period were reviewed. The results were compared using Fisher's exact test. RESULTS: Of 518 laparoscopic cholecystectomies attempted, 24 were excluded. There was no difference in age or sex ratio between the two groups. Cystic duct leaks were identified either on endoscopic retrograde choloangio pancreatography or at laparotomy. No cystic duct leak occurred in any of the 344 locking clip cases, as compared with 3 leaks in the 146 (2%) simple clip cases (p < 0.03). CONCLUSION: Locking clips are a safe and effective method for cystic duct closure. They are associated with a reduced cystic duct leak rate, as compared with that for simple clips.

Absorbable Implants↗
PubMed1983

[Parallel and spiral anomalies of the cystic duct].

Parallel and spiral anomalies of the cystic duct, that are found in every fourth--fifth patient, are of certain importance for the practical surgery. When at cholecystectomy a hidden long stump of the anomalous cystic duct is left it might result in the same complications which are described when a long external stump of the cystic duct is left. Analysing anatomical peculiarities and positions of the anomalous cystic ducts as regards to the common hepatic duct, found in 51 patients at operations, it was revealed: the length of the anomalous course of the cystic duct in 13 patients was 20-25 mm, in 30 patients--from 30 up to 50 mm, in 10 patients--60--75 mm. The parallel anomalies were revealed in 18 patients, the spiral ones--in 23 patients. In the latter cases the cystic duct adjoined the anterior, posterior and even the medial walls of the common hepatic duct and had not only an oblique-spiral course, but a transversal one, too. For these 6 variants certain working terms were suggested. In 10 patients mixed anomalies of the cystic ducts were found with its parallel and spiral disposition. Four types of the mixed anomalies were distinguished and they were also given certain working terms. The terms suggested for the variants of the cystic ducts could be helpful for medical documentation and for exact statistics of these anomalies.

Adult↗
PubMed2006

Dilatation of the intrahepatic bile duct associated with congenital anomalous junction of the cystic duct--a new disease entity.

We describe 3 children with dilatation of the intrahepatic bile duct, who had anomalous junctions of the cystic duct, 2 high and 1 low, without pancreaticobiliary maljunction. They were all male, and underwent excision of the gallbladder and the extrahepatic bile duct followed by a Roux-en-Y hepaticojejunostomy as a definitive surgery. Postoperatively, the dilated intrahepatic bile duct became normal in size. From these 3 cases, we propose a new disease entity-dilatation of the intrahepatic bile duct because of congenital anomalous junction of the cystic duct.

Bile Duct Diseases↗
PubMed1993

[Cholecysto-cholangiography as an alternative to cystic duct cholangiography in laparoscopic cholecystectomy].

Intraoperative cholangiography may be an important adjunct to laparoscopic cholecystectomy in order to prevent bile duct lesions. Laparoscopic cannulation of the cystic duct can be very difficult and time consuming. We therefore developed a simple technique of cholecystocholangiography. The gallbladder is punctured and filled with contrast medium after having localised the cystic duct and put a metal clip as a landmark. The study included 52 patients having either cholecystocholangiography or cystic duct cholangiography. In 13 out of 26 patients (50%) cholecystocholangiography failed because of obstruction of the cystic duct. The cholangiograms showed complete filling of the bile ducts in 5 (19%) and incomplete visualisation in 8 cases (31%). Cystic duct cholangiography showed significantly better results with good delineation of the biliary tree in 19 cases (73%). Five cholangiograms were suboptimal (19%) and only 2 studies failed (8%). The relation between cystic duct and common bile duct was clearly visible in 24 cases (92%) with cystic duct cholangiography compared with 13 cases (50%) with cholecystocholangiography. Cystic duct cholangiography has better success rates in delineating biliary anatomy in order to prevent bile duct injury. Cholecystocholangiography is a good alternative in cases where the cystic duct cannot be initially visualized.

Adult↗
PubMed1989

[External drainage of the bile ducts via the stump of the cystic duct to prevent postoperative complications in elderly patients].

Operated on were 165 elderly and 68 young patients for calculous cholecystitis complicated by choledocholithiasis and obstructive jaundice. Drainage through the cystic duct stump is the most effective method for external drainage of the common bile duct in operative interventions on the bile ducts in elderly patients, which permits to reduce considerably the incidence of postoperative complications.

Adult↗
PubMed1994

Cholecystocholangiography vs cystic duct cholangiography during laparoscopic cholecystectomy. A prospective controlled trial.

Intraoperative cholangiography performed during laparoscopic cholecystectomy provides an exact picture of the biliary anatomy. It may prevent iatrogenic bile duct injury and detect unsuspected common duct stones. Laparoscopic cannulation of the cystic duct can be difficult and time-consuming. We therefore evaluated the simpler technique of cholecystocholangiography by direct puncture and filling of the gallbladder with contrast medium. This technique was compared with cystic duct cholangiography in a prospective controlled trial of 69 patients. Cystic duct cholangiography (n = 38) showed significantly better results than cholecystocholangiography (n = 31) with optimal visualization of the biliary tree in 29 cases (76%) and seven cases (22%), respectively. The failure rate was 8% and 52%, respectively. Delineation of the cystic duct junction is important in order to prevent bile duct injury. The anatomy in this region was clearly delineated in 34 cases (89.5%) using cystic duct cholangiography but only in 11 cases (35.5%) with cholecystocholangiography. Cystic duct cholangiography revealed unsuspected common duct stones in three cases; however, choledocholithiasis was missed by cholecystocholangiography in at least two patients. Cystic duct cholangiography is clearly the optimal technique. In situations of unclear anatomy in which safe dissection of the cystic duct is not possible, cholecystocholangiography remains a useful alternative.

Adult↗
PubMed1993

Primary carcinoma of the cystic duct.

After we encountered one case of cystic duct carcinoma out of 110 cases of gallbladder carcinoma treated from 1976 to 1991, we reviewed the 14 treated Japanese cases, including our own, as well as the 18 Western cases hitherto reported in order to examine the clinical features of carcinoma of the cystic duct and to evaluate the various options for treatment. The patients' ages were similarly distributed between the Japanese and Western patients with a mean age of 62 years. Males were predominantly affected in the western countries with a ratio of male to female of 3.5:1; the ratio was similar in Japan. Gallstones were present in six of 18 Western cases and in two of 14 Japanese cases; both groups had a much lower rate of accompanying gallstones than did gallbladder carcinoma patients. Despite the depth of invasion, the prognosis of carcinoma of the cystic duct was relatively good, mainly owing to the absence of either lymph node metastases or distant metastasis. Although the lymph nodes and bile duct are not usually involved in carcinoma of the cystic duct, cholecystectomy, either with or without lymph node dissection, usually produced an unsatisfactory outcome, possibly due to bile duct invasion and perineural invasion. Thus, combined resection of the gallbladder and bile duct with lymph node dissection is the choice of treatment for carcinoma of the cystic duct.

Adult↗
PubMed1998

Complex cystic duct is associated with cholelithiasis.

The relationship between complex cystic ducts and cholelithiasis has seldom been investigated quantitatively. Thus we attempted a retrospective survey on two case series with and without cholelithiasis in a university hospital. A total of 500 patients who underwent endoscopic retrograde cholangiography were reviewed, 250 of whom had cholelithiasis and another 250 no gallstones. They were sampled at random during the period from 1979 through 1993. Parameters including the length, inner diameter and configuration of the cystic duct, and the angle formed by the cystic duct, and the axis of the gallbladder were compared between the groups with or without cholelithiasis. The patients with gallstones has significantly (p < 0.001) longer and narrower cystic ducts (a mean of 48 mm and 4 mm in length and diameter, respectively) than did those without stones (a mean of 28 mm and 7 mm, respectively). Moreover, patients with gallstones showed a significantly (p < 0.001) more acute angle between the gallbladder and the cystic duct than those without (a mean angle of 84 degrees and 119 degrees respectively). The overall frequency of the disfigurements of the cystic duct was significantly higher in the group with gallstones (99%) than in the group without (29%). The results therefore suggested that complex cystic ducts are associated with cholelithiasis.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1994

Cystic duct leaks in laparoscopic cholecystectomy.

BACKGROUND: Cystic duct leak (CDL) appears to complicate laparoscopic cholecystectomy (LC) more often than open cholecystectomy (OC). No mention of CDL was found in a literature review that covered 48,822 OCs and their complications. PATIENTS AND METHODS: Fifty-four patients who developed biliary tract injuries following LC were reviewed for: the time from LC to presentation, presenting symptoms, method of diagnosis, treatment, outcome, and follow-up. RESULTS: Seventeen of 54 biliary tract complications (31%) were CDLs. The CDLs presented at a median of 4 days after LC with pain (76%) and nausea and/or vomiting (35%). Endoscopic retrograde cholangiopancreatography (ERCP) defined the diagnosis and the anatomy of the leak in 11 patients (65%). Biliary endoprosthesis placement was employed in 8 patients, with concomitant sphincterotomy in 5 (63%), and resolved CDL in every case. Seven (88%) of these patients were asymptomatic at a median interval of 10 months after stent retrieval. Six patients (35%) underwent reoperation. Five had laparotomy with ligation of the cystic duct stump and 1 underwent laparoscopic examination with reclipping of the cystic duct stump. Five (83%) were asymptomatic at a median follow-up of 26 months. CDLs may result from inaccurate clip placement, perforations proximal to the clips, and stump necrosis, as documented at reoperation. CONCLUSIONS: CDLs occur more frequently in LC than in the OCs reported in the literature. Most leaks require intervention. ERCP with stent placement is the diagnostic and therapeutic procedure of choice and has a high success rate of resolving leaks. To forestall CDLs, it is important to place clips accurately and avoid electrocautery in the vicinity of the cystic duct.

Bile Ducts↗
PubMed1996

A new, secure drainage method from the cystic duct after choledocholithotomy using the cystic tube and the cystic clip: an experimental study.

The effectiveness of the cystic tube (C-tube) and the cystic clip (C-clip) for primary closure of the common bile duct after choledocholithotomy was examined in 10 dogs, followed by an observation period of either 3 months (n = 6) or 1 year (n = 4). No early complications were observed in any of the animals either during or after surgery. The laboratory data were within the normal range during the observation period. No bile leakage or slippage of the C-clip was evident on fistulography from the C-tube in animals examined 5 days after surgery. The tube could be pulled out easily from the cystic duct without any bile leakage or slippage of the clip. A second operation to confirm late complications showed no adhesions around the common bile duct, no bile duct stenosis similar to the Mirizzi syndrome, and no cystic changes of the bile duct or biloma. Our newly designed C-clip for primary closure of the common bile duct after a choledocholithotomy therefore appears to be beneficial and applicable to clinical patients undergoing traditional as well as laparoscopic surgery.

Animals↗
PubMed1996

Injury to a duplicated cystic duct during laparoscopic cholecystectomy.

Duplication of the cystic duct is a rare variation of the biliary system. It is important to pay attention to this variation to avoid intraoperative biliary system injury, especially during laparoscopic cholecystectomy. In a 66-year-old woman with gallstones, endoscopic retrograde cholangiopancreatography (ERCP) revealed no anomaly of the biliary system. At laparoscopic cholecystectomy, although intraoperative cholangiography demonstrated the second cystic duct, we misdiagnosed the duplication of cystic duct because preoperative ERCP had demonstrated normal anatomy. It was thought that the second cystic duct was dissected during the operation and the patient suffered from postoperative bile leakage. After reoperation, the patient recovered well. The diagnostic and therapeutic problems of such an anomaly are discussed below with the review of the literature.

Aged↗
PubMed1998

How often might a trans-cystic-duct stone extraction be feasible?

BACKGROUND: Although the sizes of the cystic duct and concomitant bile duct stones are fundamental in evaluating the possibility of a trans-cystic-duct approach as an alternative to cholangiotomy, no conclusive data are supplied in the reports on laparoscopic cholecystectomy. METHOD: The narrowest inner diameter of the cystic duct and the diameter of the largest concomitant bile duct stone are compared in a prospective study of 30 consecutive patients. RESULTS: The bile duct stones were smaller than the cystic duct in 14 patients, 47%, and of equal size in nine, 30%. They were larger than the cystic duct in the remaining seven patients, 23%, with a difference of only 1 mm in five patients and of 2 and 4 mm, respectively, in two. CONCLUSIONS: Physical conditions allowing a trans-cystic-duct stone extraction were present in 23 of 30 patients and an attempt might have been possible after, for example, cystic duct dilatation in a further five.

Adult↗
PubMed1993

Clinical evaluation of a low junction of the cystic duct.

The point of the junction of the cystic duct with the common hepatic duct was studied by means of various preoperative and intraoperative cholangiographic procedures and by gross intraoperative examinations in 468 surgical patients with biliary diseases. The cystic duct entered the hepatic duct at a very low position and was consequently long in 39 patients. The clinical significance of this abnormally low junction of the cystic duct was studied in comparison with 358 patients with gallstones with a normal cystic duct-hepatic duct junction. In the low-junction group with a short common bile duct several complications, including gallstone pancreatitis (7 patients), the Mirizzi syndrome (7), confluence stones (2), gallbladder cancer (3), and congenital dilation of the cystic duct (1), were demonstrated preoperatively. The anomalous junction of the cystic duct with the common bile duct may cause stagnation of bile and/or reflux of pancreatic juice into the bile duct, producing a choledochopancreatic ductal junction and posing difficulties at surgery.

Adult↗
PubMed1990

Ablation of the cystic duct and gallbladder: clinical observations.

The cystic duct and gallbladder were ablated in eight patients with acute gallbladder disease who had been treated with minicholecystostomy instead of cholecystectomy because of multiple risk factors. First, endoluminal transcatheter radio-frequency electrocoagulation of the cystic duct was performed under fluoroscopic control, which resulted in complete occlusion in all eight patients. Next, the mucosa of the isolated gallbladder was sclerosed with 95% ethanol and 3% sodium tetradecyl sulfate in one to four sessions; no analgesics were required. The gallbladder volumes of all patients, estimated by means of ultrasound, were 1.5-22 cm3 (average, less than 10 cm3) after a mean follow-up period of 5 months. One patient died of a cerebrovascular accident 15 months after sclerotherapy. In all surviving patients, the gallbladder fistulas are dry and obliterated. These early clinical data indicate that electrocoagulation permits reliable, safe obliteration of the human cystic duct. The authors believe that sclerotherapy of the isolated gallbladder is feasible without toxic effects but that their treatment needs adjustment to achieve complete ablation of the gallbladder mucosa in a shorter period and in all patients.

Aged↗