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  1. Article ; Online: Utilization of Laparoscopic Choledochoscopy During Bile Duct Exploration and Evaluation of the Wiper Blade Maneuver for Transcystic Intrahepatic Access.

    Nassar, Ahmad H M / Gough, Vivienne / Ng, Hwei J / Katbeh, Tarek / Khan, Khurram

    Annals of surgery

    2023  Volume 277, Issue 2, Page(s) e376–e383

    Abstract: Objective: This study aims to examine the indications, techniques, and outcomes of choledochoscopy during laparoscopic bile duct exploration and evaluate the results of the wiper blade maneuver (WBM) for transcystic intrahepatic choledochoscopy.: ... ...

    Abstract Objective: This study aims to examine the indications, techniques, and outcomes of choledochoscopy during laparoscopic bile duct exploration and evaluate the results of the wiper blade maneuver (WBM) for transcystic intrahepatic choledochoscopy.
    Summary of background data: Choledochoscopy has traditionally been integral to bile duct explorations. However, laparoscopic era studies have reported wide variations in choledochoscopy availability and use, particularly with the increasing role of transcystic exploration.
    Methods: The indications, techniques, and operative and postoperative data on choledochoscopy collected prospectively during transcystic and choledo- chotomy explorations were analyzed. The success rates of the WBM were evaluated for the 3 mm and 5 mm choledochoscopes.
    Results: Of 935 choledochoscopies, 4 were performed during laparoscopic cholecystectomies and 931 during 1320 bile duct explorations (70.5%); 486 transcystic choledochoscopies (52%) and 445 through choledochotomies (48%). Transcystic choledochoscopy was utilized more often than blind exploration (55.7%% vs 44.3%) in patients with emergency admissions, jaundice, dilated bile ducts on preoperative imaging, wide cystic ducts, and large, numerous or impacted bile duct stones. Intrahepatic choledochoscopy was successful in 70% using the 3 mm scope and 81% with the 5 mm scope. Choledochoscopy was necessary in all 124 explorations for impacted stones. Twenty retained stones (2.1%) were encountered but no choledochoscopy related complications.
    Conclusions: Choledochoscopy should always be performed during a chol- edochotomy, particularly with multiple and intrahepatic stones, reducing the incidence of retained stones. Transcystic choledochoscopy was utilized in over 50% of explorations, increasing their rate of success. When attempted, the transcystic WBM achieves intrahepatic access in 70%-80%. It should be part of the training curriculum.
    MeSH term(s) Humans ; Gallstones/surgery ; Laparoscopy/methods ; Common Bile Duct/surgery ; Cholecystectomy, Laparoscopic/methods ; Catheterization
    Language English
    Publishing date 2023-01-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000004912
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Uk I Zs.35/1: Show issues Location:
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    ab Jg. 2022: Lesesaal (EG)

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  2. Article ; Online: Timely computed tomography scan diagnoses spigelian hernia: a case study.

    Gough, Vivienne M / Vella, Mark

    Annals of the Royal College of Surgeons of England

    2009  Volume 91, Issue 8, Page(s) W9–10

    Abstract: A spigelian hernia is a rare cause of acute abdominal pain and its diagnosis is often difficult to make. A CT scan of the patient demonstrated an incarcerated spigelian hernia containing small bowel which had subsequently reduced spontaneously. The ... ...

    Abstract A spigelian hernia is a rare cause of acute abdominal pain and its diagnosis is often difficult to make. A CT scan of the patient demonstrated an incarcerated spigelian hernia containing small bowel which had subsequently reduced spontaneously. The patient underwent laparoscopic repair of her spigelian hernia the following day and made a fast and uneventful recovery. This case illustrates the importance of imaging a patient whilst symptomatic if the diagnosis of a spigelian hernia is entertained.
    MeSH term(s) Abdominal Pain/diagnostic imaging ; Abdominal Pain/etiology ; Female ; Hernia, Ventral/diagnostic imaging ; Hernia, Ventral/surgery ; Humans ; Laparoscopy ; Middle Aged ; Time Factors ; Tomography, X-Ray Computed
    Language English
    Publishing date 2009-11-13
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 80044-2
    ISSN 1478-7083 ; 0035-8843
    ISSN (online) 1478-7083
    ISSN 0035-8843
    DOI 10.1308/147870809X450629
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Uk I Zs.234: Show issues Location:
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  3. Article ; Online: Observational study of intra-abdominal pressure monitoring in acute pancreatitis.

    Aitken, Emma L / Gough, Vivienne / Jones, Anna / Macdonald, Angus

    Surgery

    2014  Volume 155, Issue 5, Page(s) 910–918

    Abstract: Background: Intra-abdominal hypertension (IAH) is predictive of adverse outcome in critically ill patients; however, its role in acute pancreatitis is unclear, and prospective studies are lacking. We aimed to determine the overall incidence and ... ...

    Abstract Background: Intra-abdominal hypertension (IAH) is predictive of adverse outcome in critically ill patients; however, its role in acute pancreatitis is unclear, and prospective studies are lacking. We aimed to determine the overall incidence and predictive value of IAH on mortality in acute pancreatitis.
    Methods: Transvesical IAP was measured on admission and every 4 hours within high-dependency unit/intensive care unit. Serum biochemistry and physiologic parameters permitted calculation of Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment, Imrie, and Ranson scores. The primary end point was 30-day mortality.
    Results: A total of 218 patients with acute pancreatitis were recruited; 30-day mortality was greater in patients with IAH (IAP ≥12 mmHg; 37%) than no IAH (2%; P < .001). A total of 14% of patients had IAH on admission; another 3% developed IAH in hospital. Mortality was greater in the latter group (37% vs 50%; P < .01). In the majority of cases IAH developed in line with other organ failure; however, there were several patients in whom the development of IAH appeared to be the sentinel event before rapid clinical decline. An IAP threshold of 9 mmHg had best predictive value for mortality (sensitivity 86%, specificity 87%; area under the ROC curve 0.91). This finding was comparable with other validated markers of severe pancreatitis (Imrie ≥3: sensitivity 51%, specificity 70%; Acute Physiology and Chronic Health Evaluation II: sensitivity 67%, specificity 96%; C-reactive protein >150: sensitivity 89%, specificity 83%).
    Conclusion: IAP is a good predictor of mortality and organ failure in acute pancreatitis and compares favorably with other validated prognostic scores. Whether IAH is a phenomenon causative of organ failure or an epiphenomenon, occurring in conjunction with other organ dysfunction, remains unclear.
    MeSH term(s) Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Critical Care/methods ; Female ; Humans ; Incidence ; Intra-Abdominal Hypertension/diagnosis ; Intra-Abdominal Hypertension/epidemiology ; Intra-Abdominal Hypertension/etiology ; Intra-Abdominal Hypertension/physiopathology ; Male ; Middle Aged ; Pancreatitis/complications ; Pancreatitis/mortality ; Pancreatitis/physiopathology ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Sensitivity and Specificity ; Survival Rate
    Language English
    Publishing date 2014-05
    Publishing country United States
    Document type Journal Article ; Observational Study
    ZDB-ID 202467-6
    ISSN 1532-7361 ; 0039-6060
    ISSN (online) 1532-7361
    ISSN 0039-6060
    DOI 10.1016/j.surg.2013.12.028
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Uk I Zs.129: Show issues Location:
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  4. Article ; Online: Intrahepatic choledochoscopy during trans-cystic common bile duct exploration; technique, feasibility and value.

    Gough, Vivienne / Stephens, Nathan / Ahmed, Zubir / Nassar, Ahmad H M

    Surgical endoscopy

    2012  Volume 26, Issue 11, Page(s) 3190–3194

    Abstract: Background: Transcystic laparoscopic common bile duct exploration (TC-LCBDE) is advantageous for exploring the bile duct. Choledochoscopy, however, may be quite challenging to perform transcystically because the cystic duct is usually narrow, duct ... ...

    Abstract Background: Transcystic laparoscopic common bile duct exploration (TC-LCBDE) is advantageous for exploring the bile duct. Choledochoscopy, however, may be quite challenging to perform transcystically because the cystic duct is usually narrow, duct anatomy may be unfavorable, and not all stones are amenable to transcystic extraction. Convention suggests that it is technically very difficult to visualize the intrahepatic bile ducts with transcystic choledochoscopy, due to the angle of insertion of the cystic into the common bile duct (CBD). However, we have performed intrahepatic choledochoscopy successfully, moving the choledochoscope from the CBD into the common hepatic duct by using what we have termed a "wiper blade maneuver". The purpose of this study was to confirm how often this was possible.
    Methods: A search of a prospectively collected database of patients undergoing routine intraoperative cholangiography (IOC) and laparoscopic CBD exploration under the care of a single consultant surgeon was performed.
    Results: A total of 592 LCBDEs were performed between September 1992 and January 2011; 325 were transcystic explorations. Of these, 72.5 % were female and 56 % were admitted acutely. Exploration and duct clearance was performed by blind Dormia basket trawling in 63 %. The choledochoscope was utilized in 120 cases (37 %). The 3-mm choledochoscope was used in 66 (55 %) and the 5-mm scope in 54 (45 %). Intrahepatic choledochoscopy was performed in 49 patients (40.8 %). Length of surgery was 40-350 min (median 90 min; standard deviation 49 min).
    Conclusions: It is technically challenging to perform intrahepatic choledochoscopy with a 3-mm choledochoscope due to its narrow gauge. The more rigid 5-mm scope is thus preferred, but is limited in TCE because its effective use depends on the presence of a dilated cystic duct. Despite the technical limitations of both caliber scopes, we have demonstrated that intrahepatic choledochoscopy during TCE is possible, with each, in 40 % of cases.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Common Bile Duct ; Cystic Duct ; Endoscopy, Digestive System/methods ; Feasibility Studies ; Female ; Gallstones/surgery ; Hepatic Duct, Common ; Humans ; Laparoscopy ; Male ; Middle Aged ; Prospective Studies ; Young Adult
    Language English
    Publishing date 2012-05-12
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-012-2315-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 2214: Show issues Location:
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