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PubMed1986

[Benign strictures of the bile ducts. Significance of adequate bile duct drainage for the prognosis and course of this disease].

Ninety-five patients with benign biliary strictures are presented in this study. All underwent reconstructive biliary surgery, either for proximal biliary strictures (Group A; 38 patients) or for distal biliary strictures (Group B; 57 patients). The type of bypass was individualized according to each patient's mechanical and anatomical characteristics as were assessed in our cholangiographic findings. For group A we used either a proximal to the stricture intrahepatic cholangiojejunostomy between Roux-en-Y jejunal loop and the main right or left hepatic ducts or multiple intrahepatic cholangiojejunostomies between segmental hepatic ducts and a Roux-en-Y jejunal loop. For Group B we chose between a choledocho- or hepaticoduodenostomy and a choledocho- or hepaticojejunostomy. There were three deaths due to sepsis, one in patients of group A and two among those of group B. Long-term results were satisfactory. None of our patients during a mean six year follow-up underwent further surgery for reasons related with either his/her operation or disease.

Adult↗
PubMed1998

Luminal cross-sectional area and tension-strain relation of the porcine bile duct.

The bile duct is a distensible tube serving to transport bile from the liver and gallbladder to the duodenum. The purpose of this study was to characterize the luminal cross-sectional area (CSA) and tension-strain properties during distension of the normal isolated porcine common bile duct in vitro. An impedance planimetric system located inside a balloon was used. Eleven porcine bile ducts were examined in two locations, in the hepatic duct and in the common bile duct. The CSAs obtained in the common bile duct were significantly higher than those in the hepatic duct in the pressure range 0-8 kPa (P < 0.001). The circumferential wall tension (T)-strain (epsilon) relations for both locations fitted to the exponential equation T = a.eb. epsilon with determination coefficients of 0.97 +/- 0.01. The a and b constants were not statistically different between the two locations indicating that the elastic properties did not differ. In conclusion, the luminal CSAs were larger in the common bile duct when compared to the hepatic duct and the tension-strain relations did not differ between the two segments of the bile duct.

Animals↗
PubMed1985

Changes of intrahepatic bile duct dilatation after surgery for congenital dilatation of the bile duct.

Of 47 patients suffering from congenital dilatation of the bile duct whose intrahepatic bile ducts could be clearly demonstrated by operative cholangiogram or preoperative ERCP, 39 patients (83%) had dilatation of the intrahepatic bile ducts. Follow-up studies in infants and children ranging from 1 year to 11 years after their corrective operation for congenital dilatation of the common bile duct showed no morbidity that was attributed to the presence of the dilatation of the intrahepatic bile ducts. ECHO grams in 21 patients revealed marked decrease in size of the intrahepatic bile ducts except for two patients with huge cystic dilatation of the intrahepatic bile ducts. These findings justify the employment of the standard operative procedure for the treatment of congenital dilatation of the bile duct even if it is associated with dilatation of the intrahepatic bile ducts.

Adolescent↗
PubMed1990

[A case of hyperplastic polypoid lesion in the common bile duct hard to differentiate from early bile duct carcinoma].

In a 72-year-old male carcinoma of the bile duct was suspected because of an abnormality on laboratory examination. Ultrasound showed the dilatation of extrabiliary duct. Endoscopic ultrasound revealed localized wall thickening of the common bile duct. ERCP demonstrated the dilatation of the CBD. Within the dilated duct a filling defect was present. Histology of the resected specimen disclosed hyperplasia of the epithelium in the CBD.

Aged↗
PubMed1989

Experimental detachment of the canine bile duct to evaluate mechanisms of the dilated bile duct.

The factors inducing biliary dilatation were studied morphologically and functionally by cholangiography and cholangiomanometry in experimental models of chronic biliary dilatation. These models were produced by four methods: Constriction of the lower bile duct (Group 1), formalin infusion into the duodenal papilla (Group 2), detachment of the extrahepatic bile duct (Group 3), and sphincterotomy (Group 4). Biliary dilatation was observed in the first three groups but not in the fourth group. An increase in the intraductal pressure due to blockage of the biliary outflow tract was considered to be the cause of biliary dilatation in Group 1 and 2. In Group 3, the function of the lower bile duct, including the papilla was intact, and reduced resistance of the bile duct wall and due to the loss of the support from the surrounding connective tissue was considered to have induced biliary dilatation. These results suggest that experimental chronic biliary dilatation can be produced by two approaches: 1) Blockage of bile flow in the papilla or the bile duct, and 2) detachment of the bile duct without disturbing bile flow.

Animals↗
PubMed1983

Morphological changes in the liver of the sea lamprey, Petromyzon marinus L., during metamorphosis: I. Atresia of the bile ducts.

The bile ducts in the liver of larval sea lamprey, Petromyzon marinus, undergo programmed degeneration during metamorphosis. The degenerative process is most dramatic in the middle metamorphic stages (3-5), and is asynchronous, occurring more rapidly in small peripheral biliary components than in larger, medial ducts. All classes of bile ducts within the biliary tree exhibit similar histological changes during regression. The initial evidence of degeneration in the epithelium is a folding of the basal lamina, and this is accompanied by cell shrinkage and disruption of cell order. "Shedding" of microvilli and cytoplasmic constituents then takes place at the apical surface resulting in the accumulation of periodic acid-Schiff positive membranous debris in the Lumen. The appearance of "hyalin bodies" in the lumen coincides with the depletion of intermediate-sized filaments from the cytoplasmic matrix. Numerous, large dense bodies, myelin figures, and autophagic vacuoles are consistently observed in necrotic cells. Following cytolysis, bile duct remnants become ensheathed within regions of fibrosis. Ultimately, these fibrous regions are replaced with cords of hepatocytes. By stage 7, all bile ducts have disappeared. The events of biliary atresia in lampreys are comparable to tissue regression which is associated with normal development and pathological conditions in other vertebrates but are particularly reminiscent of those in human biliary atresia. The unique ability of the adult lamprey to service without bile ducts enhances the value of this organism as an experimental model for studying human biliary atresia.

Animals↗
PubMed1987

Coexistent carcinoma in congenital dilatation of the bile duct and anomalous arrangement of the pancreatico-bile duct. Carcinogenesis of coexistent gall bladder carcinoma.

From 1972 to 1985, 40 cases of congenital dilatation of the bile duct (CDBD) were experienced in the department of the authors. Those consisted of 19 cases of anomalous arrangement of the pancreatico-bile duct (P-B anomaly), five of bile duct carcinoma, and two of gall bladder carcinoma. In addition, four patients who showed no dilatation of the bile duct in spite of the presence of a P-B anomaly were experienced, and coexistent gall bladder carcinoma was present in three of four cases. The incidence of bile duct carcinoma associated with CDBD is very high. However, coexistent gall bladder carcinoma in CDBD is a new topic, and coexistent intrahepatic bile duct carcinoma in CDBD is extremely rare. This report presents interesting and rare cases of coexistent carcinomas in these anomalies and investigates their carcinogenesis, particularly that of gall bladder carcinoma.

Adenocarcinoma, Papillary↗
PubMedDate not supplied

The management of bile duct stones.

Bile duct stones are almost always associated with gallbladder stones and coexist with gallbladder stones in approximately 10% of patients. The frequency of coexisting bile duct stones increases with advancing age. In patients with stones in both the gallbladder and bile duct, therapeutic options for the latter include laparoscopic or open exploration of the bile duct, and pre-operative and post-operative endoscopic sphincterotomy and stone extraction. Endoscopic sphincterotomy remains the treatment of choice for bile duct stones after cholecystectomy. However, management algorithms in individual institutions will be influenced by surgical and endoscopic expertise and by other factors such as overall costs. After surgical or endoscopic removal of bile duct stones, estimates of the lifetime risk of recurrent stones range from 5%-20%. Increased life expectancy and the apparent absence of simple preventative measures indicate that the burden of bile duct stones on health expenditure is likely to increase in many countries.

Bile Duct Diseases↗
PubMed1990

Diagnostic value of brush cytology in the diagnosis of bile duct carcinoma: a study in 65 patients with bile duct strictures.

Malignant strictures of the extrahepatic bile ducts are difficult to distinguish from benign strictures, particularly in patients with primary sclerosing cholangitis. Because attempts at diagnosing small cancers with fine-needle aspiration biopsy are not possible in the absence of an associated mass lesion and because the sensitivity of exfoliative biliary cytology is controversial, brush cytology has been used as a potential means of establishing a specific diagnosis of bile duct carcinoma. Herein we report our experience with this technique when performed on 65 patients over a 5-yr period. Each had at least one brushing. Thirty-seven were found to have bile duct carcinoma and 28 were found to have benign strictures. Of these 37, the first brushing was positive for malignancy in 15 (40%), whereas four (11%) had cells suspected but not diagnostic of malignancy. Thirteen patients with bile duct carcinoma whose initial brushings were negative for malignancy had second brushings. Of these, five (38%) had malignant cells, whereas three (24%) yielded suspicious cells. Three of the eight whose first two brushings were negative for malignancy were found to have malignant cells on the third brushing. In contrast, of the 28 patients with benign strictures, malignant cells were never found. However, in two patients, suspicious cells were reported with the first but not the second brushing. A single negative or suspicious cytological finding decreased the probability of bile duct carcinoma to 43%. Two and three sequential negative tests reduced the probability to 32% and 0%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Cholecystectomy without operative cholangiography. Implications for common bile duct injury and retained common bile duct stones.

OBJECTIVE: This study evaluated the selective use of endoscopic retrograde cholangiopancreatography (ERCP) in the context of laparoscopic cholecystectomy (LC) while minimizing the use of operative cholangiography. SUMMARY BACKGROUND DATA: There has been a long-standing debate between routine and selective operative cholangiography that has resurfaced with LC. METHODS: Prospective data were collected on the first 1300 patients undergoing LC at McGill University. Preoperative indications for ERCP were recorded, radiologic findings were standardized, and technical points for a safe LC were emphasized. RESULTS: A total of 106 patients underwent 127 preoperative ERCPs. Fifty patients were found to have choledocholithiasis (3.8%), and clearance of the common bile duct (CBD) with endoscopic sphincterotomy was achieved in 45 patients. The other five patients underwent open cholecystectomy with common duct exploration. Intraoperative cholangiography (IOC) was attempted in only 54 patients (4.2%), 6 of whom demonstrated choledocholithiasis. Forty-nine postoperative ERCPs were performed in 33 patients and stones were detected in 17 (1.3%), with a median follow-up time of 22 months. Endoscopic duct clearance was successful in all of these. The incidence of CBD injury was 0.38%, and a policy of routine operative cholangiography might only have led to earlier recognition of duct injury in one case. The rate of complication for all ERCPs was 9% and the associated median duration of the hospital stay was 4 days. The median duration of the hospital stay after open CBD exploration was 13 days. CONCLUSIONS: LC can be performed safely without routine IOC. The selective use of preoperative and postoperative ERCP will clear the CBD of stones in 92.5% of patients.

Adolescent↗
PubMed1977

Congenital cystic dilatation of the common bile duct as a cause of primary bile duct stone.

Of the 101 patients with congenital cystic dilatation of the common bile duct, eighty-eight with adult-type cysts are reported on. The association of primary bile duct stone and adult-type cyst of this anomaly is discussed and found to be higher than previously recognized. In the cases without calculi, abnormal arrangement of the pancreaticobiliary ductal system is indicated to play an important role in the manifestation of the symptom. The anatomic and clinical features and the results of treatment for this type of cyst are reviewed.

Adult↗
PubMed1985

Bile duct lesions and diminution in number of intrahepatic bile ducts in asymptomatic primary biliary cirrhosis.

Morphological changes of interlobular bile ducts in asymptomatic or symptomatic primary biliary cirrhosis (PBC) and chronic hepatitis with ductal lesions were investigated. It was supposed that bile duct lesions found in PBC and chronic hepatitis could be distinguished histologically. There were identical epithelial changes between symptomatic PBC and asymptomatic one, but granulomas were more often found in asymptomatic PBC than in symptomatic PBC. Numbers of interlobular bile ducts per portal tract and the rates of portal tracts without interlobular duct in asymptomatic PBC were intermediate between symptomatic PBC and chronic hepatitis. Serial sections revealed that some bile ducts were able to be followed by ductules in asymptomatic PBC. From these results, numbers of interlobular bile ducts are undoubtedly decreased in asymptomatic PBC but not so much as in symptomatic one. This observation may be attributable partially for taking asymptomatic course.

Aged↗
PubMed1998

Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones.

BACKGROUND: The management of stones in the common bile duct in the laparoscopic era is controversial. The three major options are preoperative endoscopic retrograde cholangiography (ERCP), laparoscopic exploration of the common bile duct (LECBD), or postoperative ERCP. METHODS: Between August, 1995, and August, 1997, 471 laparoscopic cholecystectomies were done in our department. In 427 (91%), satisfactory peroperative cholangiography was obtained. In 80 (17%) of these cases there were stones in the common bile duct, 40 patients were randomised to LECBD and 40 to postoperative ERCP. If LECBD failed, patients had either open exploration of the common bile duct or postoperative ERCP. If one postoperative ERCP failed, the procedure was repeated until the common bile duct was cleared of stones or an endoprosthesis was placed to prevent stone impaction. The primary endpoints were duct-clearance rates, morbidity, operating time, and hospital stay. Analyses were by intention to treat. FINDINGS: Age and sex distribution of patients was similar in the randomised groups. Duct clearance after the first intervention was 75% in both groups. By the end of treatment, duct clearance was 100% in the laparoscopic group compared with 93% in the ERCP group. Duration of treatment was a median of 90 min (range 25-310) in the laparoscopic group (including ERCPs for failed LECBD) compared with 105 min (range 60-255) in the postoperative ERCP group (p = 0.1, 95% CI for difference -5 to 40). Hospital stay was a median of 1 day (range 1-26) in the laparoscopic group compared with 3.5 days (range 1-11) in the ERCP group (p = 0.0001, 95% CI 1-2). INTERPRETATION: LECBD is as effective as ERCP in clearing the common bile duct of stones. There is a non-significant trend to shorter time in the operating theatre and a significantly shorter hospital stay in patients treated by LECBD.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1995

Bile duct injury and bile leakage in laparoscopic cholecystectomy.

The introduction of laparoscopic cholecystectomy has been associated with an increased incidence of bile duct injury. This review presents the incidence of bile duct injury in reported series and examines the role of the learning curve and other contributing factors. There is good evidence to suggest that, with adequate training and experience, the incidence of biliary injury can be reduced to a level comparable to that of open cholecystectomy. Continued audit is required to ensure that the low complication rates achieved in selected centres with wide experience are reproduced by the surgical community in general.

Bile↗