MyMedR

Fulltext Early identification of the critical view of safety in laparoscopic cholecystectomy using indocyanine green fluorescence cholangiography: A randomised controlled study

Koong JK, Ng GH, Ramayah K, Koh PS, Yoong BK

Asian J Surg, 2021 Mar;44(3):537-543.

PMID: 33223453 DOI: 10.1016/j.asjsur.2020.11.002

BACKGROUND: Achieving critical view of safety (CVS) is vital during laparoscopic cholecystectomy (LC). There is no known study determining use of indocyanine green fluorescence cholangiography (ICGFC) in early identification of CVS during LC. This study aims to compare use of ICGFC in LC against conventional LC in early identification of CVS.

METHODOLOGY: Patients undergoing LC in a single centre were randomized into ICGFC-LC and conventional LC. Surgery was performed by a single surgeon and the time taken to achieve CVS from the time of gallbladder fundus retraction was measured. Difficulty level for each surgery was rated and analysed using a modified scoring system (Level 1- Easy to Level 4-Very difficult).

RESULTS: 63 patients were recruited where mean time (min) to achieve CVS was 22.3 ± 12.9 in ICGFC-LC (n = 30) and 22.8 ± 14.3 in conventional LC (p = 0.867). The time taken to achieve CVS was shorter in ICGFC-LC group across all difficulty levels, although not significant (p > 0.05). No major complication was observed in the study.

CONCLUSIONS: This study had shown ICGFC-LC reduces time to CVS across all difficulty levels but not statistically significant. ICGFC-LC maybe useful in difficult LC and in surgical training.

TRIAL REGISTRATION: Clinical Trials NCT04228835.

STUDY GRANT: UMMI Surgical - Karl Storz Distributor (Malaysia).

Matched MeSH terms: Cholangiography*

Congenital duplication of the gall bladder: review of the literature and report of a case

Ramanathan T

Med J Malaya, 1971 Jun;25(4):305-6.

PMID: 4261308

Matched MeSH terms: Cholangiography

The management of residual bile duct calculi

Salleh HB

Med J Malaysia, 1975 Mar;30(3):195-201.

PMID: 1160678

Matched MeSH terms: Cholangiography

Fulltext Percutaneous transhepatic cholangiography -- its place in obstructive jaundice

Chew PH, Leong LC, Ting PTM, Nath SK

Med J Malaysia, 1982 Dec;37(4):365-9.

PMID: 7167090

The case notes of twelve jaundiced patients, on whom percutaneous transhepatic cholangiography (PTC) were performed, are reviewed. PTC was carried out to differentiate the patients with intrahepatic cholestasis from those with extrahepatic biliary obstruction, and to identify the site and nature of the block. In eleven cases, the biliary trees were visualised, with the sites of obstruction in those present demonstrated and confirmed at subsequent laparotomies. There was no serious side effect from the procedure. PTC in our hands has proved an invaluable aid in the investigation of the icteric patients.

Matched MeSH terms: Cholangiography/methods*

Fulltext Right posterior segmental hepatic duct: role of intraoperative cholangiogram to prevent extrahepatic biliary duct injuries

Ikhwan SM, Zamri Z, Hairol O, Razman J, Affirul C

International Medical Journal Malaysia, 2015;14(2):63-66.

MyJurnal

Extrahepatic bile ducts constitute a significant anatomic site for surgeons when performing hepatobiliary
operations from minor procedure such as cholecystectomy to major operation such as hepatectomy. The
challenges for surgeon in performing such cases increase when congenital variance of biliary tree occurs which
may lead to unintentional bile duct injuries. We reported a case of a lady who presented with obstructive
jaundice secondary to huge distal common bile duct stone. The presence of right posterior segmental hepatic
duct, which rarely occurs, was discovered during intraoperative cholangiogram before common bile duct
exploration. The operation was successful without incidence of biliary duct injury.

Matched MeSH terms: Cholangiography

A prospective multicentre study evaluating the performance of the modified simple biliary atresia scoring system in predicting biliary atresia

Mahat N, Chiang LW, Chen Y, Razak NHA, Abdullah MY, Sanmugam A, et al.

Pediatr Surg Int, 2024 Aug 27;40(1):244.

PMID: 39191932 DOI: 10.1007/s00383-024-05830-w

PURPOSE: Early diagnosis of biliary atresia (BA) is critical for best outcomes, but is challenged by overlapping clinical manifestations with other causes of obstructive jaundice in neonates. We evaluate the performance of the modified Simple BA Scoring System (SBASS) in diagnosing BA.

METHODS: We performed a prospective, cross-sectional study on infants with cholestatic jaundice (June 2021-December 2022). Modified SBASS scoring was applied and compared to the eventual diagnosis (as per intraoperative cholangiogram (IOC) and liver histopathology). The score (0-6), consists of gall bladder length 0.7(+ 2), gamma-glutamyl transferase (GGT) ≥ 200 U/L (+ 2).

RESULTS: 73 were included: Fifty-two (71%) had BA. In the non-BA group, 6 (28%) had percutaneous cholangiography (PTC) while 15 (72%) had intraoperative cholangiogram (IOC). At a cut-off of 3, the modified SBASS showed sensitivity of 96.2%, specificity of 61.9% and overall accuracy of 86.3% in diagnosing BA. Area under receiver operating characteristic curve was 0.901. GGT had the highest sensitivity (94.2%), while triangular cord sign showed the highest specificity at 95.2%.

CONCLUSION: The SBASS provides a bedside, non-invasive scoring system for exclusion of BA in infantile cholestatic jaundice and reduces the likelihood of negative surgical explorations.

Matched MeSH terms: Cholangiography/methods

Fulltext Hepatic calculi

Balasegaram M

Ann Surg, 1972 Feb;175(2):149-54..

PMID: 5059599

Matched MeSH terms: Cholangiography

Cholestasis in very low birth weight infants who received parenteral nutrition

Rohana, J., Latinah, M., Thambidorai, C.R., Kaur, B.

Malaysian Journal of Paediatrics and Child Health, 2005;14(1):21-26.

MyJurnal

A retrospective study was conducted to evaluate the magnitude, clinical course and risk factors of cholestasis in surviving very low birth weight (VLBW) infants who received parenteral nutrition at the neonatal intensive care unit (NICU) of Hospital Universiti Kebangsaan Malaysia. Cholestasis was defined as direct hyperbilirubinaemia of >34 mmol/L. Between 1St July 2000 to 31St March 2001, 58 VLBW infants received parenteral nutrition (PN). Forty seven infants survived to discharge. Complete data was obtained from 43 (90.1%) infants. Thirteen (30.2%) of these infants developed cholestasis. The cholestasis persisted beyond the age of 6 weeks in 8 infants and they underwent hepato imino diacetic acid (HIDA) scan. The HIDA scan was reported as normal in 2 infants and inconclusive in 6 infants. Operative cholangiography. (OTC) was then performed in these infants and were all normal. The cholestasis finally resolved in all infants. Analysis of risk factors revealed that duration of assisted ventilation and PN and the presence of patent ductus arteriosus (PDA) had significant correlation with the development of cholestasis. These factors together with lower mean gestational age increased the likelihood of persistent cholestasis beyond 6 weeks of life in these infants. In conclusion cholestasis is common in VLBW infants who received parenteral nutrition. Although the clinical course seems benign, in a significant proportion of these infants it may persist longer and put them at increased risk of requiring invasive investigations.

Matched MeSH terms: Cholangiography

Biloma and biliary fistula associated with hepatorrhaphy for liver injury

Shahrudin MD, Noori SM

Hepatogastroenterology, 1997 Mar-Apr;44(14):519-21.

PMID: 9164529

To review our experience in managing post-hepatorrhaphy complications in liver trauma.

Matched MeSH terms: Cholangiography

Multifocal mucus secreting papillary adenocarcinoma of the bile duct causing obstructive jaundice

Khan TF, Sherazi ZA, Alias NA, Mahmood Z

Ann Acad Med Singap, 1993 Mar;22(2):251-3.

PMID: 8363342

We present a 64-year-old Malay lady who had undergone a choledochoduodenostomy (CDD) two years ago for obstructive jaundice. She was admitted with jaundice and underwent ultrasonography, percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangio pancreatography (ERCP) and computed tomographic (CT) scanning of the liver and biliary tree. All the investigations confirmed a type IVa choledochal cyst. At operation, the grossly dilated biliary system was packed with a thick mucoid material and the mucosa of the bile ducts was visibly abnormal with scattered nodules. This mucoid material had caused occlusion of the entire biliary tree resulting in obstructive jaundice. To the best of our knowledge, this is probably the first report of obstructive jaundice caused by thick mucus. The peculiar management problems of this case and the risk of malignant change in choledochal cysts are discussed.

Matched MeSH terms: Cholangiography

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