Volume 3 Issue 4
Research Article: Evaluation of Management Protocols for Post-Cholecystectomy Iatrogenic Biliary Injuries
Ahmed M. Abdel Modaber*, Ahmed Hammad and Vusal Aliyev
In this study, 33 patients with post cholecystectomy bile duct injuries were assessed, of which 22 were females and 11 males. The ages of the patients ranged between 30 and 65 years. 4 patients were diagnosed intra - operatively while 23 patients were diagnosed in the post-operative period. The time of presentation of patients diagnosed postoperatively varied significantly among the patients ranging from few days to 3 months. Twenty one patients were presented clinically with obstructive jaundice with or without cholangitis. Two patients were presented with biliary peritonitis while 4 patients were presented with external biliary fistulae and 2 patients with an intra-abdominal collection. All patients were assessed through a thorough history taking and physical examination, in addition to complete laboratory work-up. Abdominal ultrasound was done as a routine primary investigation for all patients. It was very accurate in the detection of intrahepatic biliary dilatation and intraperitoneal collections and their aspiration. ERCP was successfully performed as a preoperative investigation with accurate results documenting the level of bile duct injuries, failure in one case; also it was successful in management of 9 cases. MRCP was done as a preoperative diagnostic tool for 8 patients. It showed excellent results in accurately specifying the level of the injury, and the degree of dilatation of the proximal biliary tree. PTC was a successful preoperative diagnostic tool in two patients, clearly delineating the proximal biliary tree and identifying the level of injury. PTC with external drainage of the biliary tree (PTD) was avoided to keep the advantage of finding dilated bile ducts in subsequent planned surgery shortly afterwards. Management depended largely on time of diagnosis. Patients were managed immediately. 12 patients were, managed by non - surgical treatment through ERCP or US guided drainage. 17 patients were managed by surgery by bilioenteric anastomosis. The four patients diagnosed intraoperatively were managed immediately, one patient with partial injury of the CBD at the level of the cystic duct was repaired primarily over a T - tube, another patient had completely transected CBD were repaired by end - to - end anastomosis of the CBD on a T-tube and two patients had an immediate hepaticojejunostomy. Twelve patients were managed non - surgically. Three of them had US guided drainage of an intra-abdominal collection of bile, three patient with bile leaks had ERCP Sphincterotomy and stent insertion alone and six patients with partially occluded CHD with bile leak had an ERCP performed with Sphincterotomy, balloon dilatation of the stricture followed by stent insertion. Seventeen patients underwent elective surgical repair of their bile duct injuries, in this group patients had Roux - en Y hepaticojejunostomy performed to 16 cases. One case was managed by choledechoduodonostomy. Short term results were generally satisfactory. The short term morbidity of the patients who underwent the operative procedures included. One patient developed a transient attack of cholangitis, which was controlled by antibiotics. One patient developed jejunal fistula and two patients developed re-stricture. There was one mortality case due to hepatorenal failure. The short - term morbidity of the patients who underwent the endoscopic procedures included one patient developed pancreatitis and another case developed cholangitis. They are treated conservatively. This study revealed the following findings and recommendations: ERCP has the advantage of being diagnostic and therapeutic modality as it can be used in detection of level of injury, stenting and dilatation of strictures. MRCP has excellent standard in determining the exact site of injury and in demonstrating of the exact anatomy of the proximal biliary tree. PTC is helpful in identifying the proximal extent of complete segmental and major bile duct injuries and obstruction. A Roux - en Y choledoco - or hepaticojejunostomy is the procedure of choice if the defect is more than 1 cm long or is detected a long time after the injury. Safe surgery during cholecystectomy should be the rule in practice.
Cite this Article: Abdel Modaber AM, Hammad A, Aliyev V. Evaluation of Management Protocols for Post-Cholecystectomy Iatrogenic Biliary Injuries. Int J Hepatol Gastroenterol. 2017;3(4): 091-098.
Published: 20 December 2017
Research Article: Non-Invasive Fibrosis Scores and Liver Stiffness Changes in Chronic Hepatitis C after Sofosbuvir-based Treatment
Hend I. Shousha*, Marwa K. Mehassab, Mai I. Mehrez, Shahira A. Afifi, Marwa Elsharkawy, Mai Hamed and Rasha A. Abdelaziz
Background: The precise evaluation of hepatic fibrosis is crucial in the management of Chronic Hepatitis C (CHC). Multiple non-invasive serological scores and devices have been used in the accurate prediction of fibrosis however; early changes in non-invasive biomarkers of liver fibrosis following antiviral therapy are widely unknown. We aim to evaluate changes of liver stiffness and 6 non-invasive serological fibrosis scores, easy to calculate particularly in poor areas, following sofosbuvir- based treatment.
Methods: This is a cohort study that included 155 CHC Egyptian patients. Transient elastography values were recorded as well as Aspartate Aminotransferase-To-Platelet Ratio Index (APRI), FIB-4, Lok score, fibrosis index, King Score and fibro Q score were calculated at baseline and 12 weeks post-treatment.
Results: There was a significant decline of aminotransferases and hemoglobin levels in all patients. There was a significant improvement in all studied fibrosis scores 12 weeks post-treatment except the fibrosis index. Liver stiffness measurements were significantly lower 12-weeks post-treatment (10 ± 8.06 vs 9.27 ± 8.51 kPa, P-value = 0.001). 145 (93.6%) patients achieved sustained virological response. There was no difference between responders and non-responders in baseline or post treatment liver stiffness or fibrosis scores values.
Conclusion: Sofosbuvir-based treatment resulted in a clinically significant improvement in parameters of liver fibrosis.
Cite this Article: Shousha HI, Mehassab MK, Mehrez MI, Afifi SA, Elsharkawy M, et al. Non-Invasive Fibrosis Scores and Liver Stiffness Changes in Chronic Hepatitis C after Sofosbuvir-based Treatment. Int J Hepatol Gastroenterol. 2017;3(4): 085-090.
Published: 27 November 2017
Image Article: Laser Spectroscopy, Laser-Induced Breakdown Spectroscopy and Laser-Induced Plasma Spectroscopy Comparative Study on Malignant and Benign Human Cancer Cells and Tissues with the Passage of Time under Synchrotron Radiation
In the current study, we have experimentally and comparatively investigated and compared malignant human cancer cells and tissues before and after irradiating of synchrotron radiation using Laser Spectroscopy, Laser-Induced Breakdown Spectroscopy (LIBS) and Laser-Induced Plasma Spectroscopy (LIPS). It is clear that malignant human cancer cells and tissues have gradually transformed to benign human cancer cells and tissues under synchrotron radiation with the passage of time (Figures 1-3) [1-102].
Cite this Article: Heidari A. Laser Spectroscopy, Laser-Induced Breakdown Spectroscopy and Laser-Induced Plasma Spectroscopy Comparative Study on Malignant and Benign Human Cancer Cells and Tissues with the Passage of Time under Synchrotron Radiation. Int J Hepatol Gastroenterol. 2017;3(4): 079-084.
Published: 27 November 2017
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