Laparoscopic-assisted clearance of protein plugs in the common channel in children with choledochal cysts

Diao, Mei; Li, Long; Zhang, Jinshan; Wei, Cheng

doi:10.1016/j.jpedsurg.2010.06.011

Cited by 12 publications

(7 citation statements)

References 9 publications

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“…Of protein plug detection cases, only 20%–30% of protein plugs remain in the common channel or pancreatic duct until the diversion procedure. Even if such plugs persist, most of them can be removed through the narrow distal segment of the lower bile duct, only a few cases requiring pancreatic ductotomy . If complete resection of the pancreatic duct is performed, care is required so as to avoid postoperative pancreatic duct stenosis .…”

Section: Chapter Iv: Treatments and Diagnosismentioning

confidence: 99%

“…If complete resection of the pancreatic duct is performed, care is required so as to avoid postoperative pancreatic duct stenosis . There are also reports on the use of small‐diameter endoscopy in the protein plug removal in the common channel . However, while there is a consensus on the need for protein plug removal during the diversion procedure, it is not known how frequently pancreatitis and other postoperative problems result when protein plugs remain.…”

Section: Chapter Iv: Treatments and Diagnosismentioning

confidence: 99%

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Japanese clinical practice guidelines for congenital biliary dilatation

Ishibashi

Shimada

Kamisawa

et al. 2017

J Hepatobiliary Pancreat Sci

115

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Until now, there have been no practical clinical guidelines for congenital biliary dilatation (CBD). In this review article, the Japanese Study Group on Congenital Biliary Dilatation (JSCBD) propose to establish clinical practice guidelines for CBD. Because the evidence-based literature is relatively small, we decided to create guidelines based on the consensus of experts, using the medical literature for reference. A total of 20 clinical questions (CQs) were considered by the members of the editorial committee responsible for the guidelines. The CQs included the distinct aspects of CBD: (1) Concepts and Pathology (three CQs); (2) Diagnosis (six CQs); (3) Pancreaticobiliary Complications (three CQs); Treatments and Prognosis (eight CQs). Each statements and comments for CQs were made by the guidelines committee members. CQs were finally approved after review by members of the editorial committee and the guidelines evaluation board of CBD. These guidelines were created to provide assistance in the clinical practice of CBD management; their contents focus on clinical utility, and they include general information on CBD to make this disease more widely recognized.

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Section: Chapter Iv: Treatments and Diagnosismentioning

confidence: 99%

Section: Chapter Iv: Treatments and Diagnosismentioning

confidence: 99%

Japanese clinical practice guidelines for congenital biliary dilatation

Ishibashi

Shimada

Kamisawa

et al. 2017

J Hepatobiliary Pancreat Sci

115

View full text Add to dashboard Cite

show abstract

“…However, when they remain incarcerated in the common channel or the narrow distal segment, biliary drainage, such as percutaneous transhepatic biliary drainage, laparotomic/laparoscopic external drainage (such as T-tube drainage or external cholecystostomy), and drainage performed through endoscopic procedures (indwelling transnasal tube, stenting, sphincterotomy), or emergency surgery may be necessary [74,82]. Most protein plugs disappear after drainage and even when such plugs persist until biliary diversion is performed, most of them can be removed through the narrow distal segment, only a few cases requiring pancreatic ductotomy or the use of small-diameter endoscopy [109,110]. Furthermore, complete resection of the intrapancreatic bile duct may help avoid the postoperative formation of protein plugs that may cause further symptoms [111].…”

Section: Commentsmentioning

confidence: 99%

Japanese clinical practice guidelines for pancreaticobiliary maljunction

et al. 2012

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There have been no clinical guidelines for the management of pancreaticobiliary maljunction (PBM). The Japanese Study Group on Pancreaticobiliary Maljunction (JSPBM) has proposed to establish clinical practice guidelines on how to deal with PBM, with the support of the Japan Biliary Association (JBA). Because the body of evidence-based literature is relatively small, we decided to create guidelines based on the consensus of experts, using the medical literature for reference. A total of 46 clinical questions (CQs) were considered by the members of the editorial committee responsible for the guidelines. The CQs covered distinct aspects of PBM: (1) Concepts and Pathophysiology (10 CQs); (2) Diagnosis (10 CQs); (3) Pancreatobiliary complications (9 CQs); and (4) Treatments and prognosis (17 CQs). Statements and comments for each CQ were prepared by the guidelines committee members and collaborating partners. The CQs were completed after review by members of the editorial committee, meetings of this committee, public comments on the homepages of the JSPBM and the JBA, public hearings, and assessment and approval by the guidelines evaluation board. PBM includes cases where the bile duct is dilated (PBM with biliary dilatation) and those in which it is not (PBM without biliary dilatation). In these guidelines, PBM with biliary dilatation is defined as being identical to congenital biliary dilatation of Todani type I (except for type Ib) and type IV-A, both of which are accompanied by PBM in almost all cases. These guidelines are created to provide assistance in the clinical practice of PBM management; their contents focus on clinical utility, and they include general information on PBM to make this disease more widely recognized.

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“…[ 16 18 ] Our center also reported clearance of protein plugs and/or stones in the common channel and biliary ducts by laparoscopic intubation. [ 18 19 ] However, we supposed that there are several limitations in this technology, which was listed as follows. Firstly, it's easy to rinse fragile protein plugs, whereas to rinse and remove stones may be much more difficult.…”

Section: Discussionmentioning

confidence: 99%

Combination of laparoscopy and endoscopy for fusiform choledochal cysts

et al. 2016

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OBJECTIVE:The purpose of the study was to elucidate the efficacy of laparoscopy and endoscopy in the treatment of fusiform choledochal cysts (CDC).MATERIALS AND METHODS:Between June 2006 and June 2012, 18 patients with fusiform CDC were treated in our hospital. All the 18 patients presented abdominal pain, and 13 presented jaundice. 18 patients presented elevated serum and urinary amylase, when abdominal pain appeared. All the patients underwent laparoscopic and endoscopic surgery successfully. The clinical presentation, radiological features and surgical treatment were analyzed. The postoperative symptoms, laboratory examination and bile duct changes were evaluated during follow-up term.RESULTS:Intraoperative cholangiography showed filling defect, dilatation of the common channel and pancreatic ducts visualization in 18 patients, including 9 patients of pancreatic duct dilatation. The protein plugs and/or stones were removed completely under laparoscopy and endoscopy in 18 patients. Patients were followed-up for 3 months to 6 years. The biochemical and ultrasound examination showed no increase in pancreatic amylase and recurrence of the stones in the common channel and pancreatic duct.CONCLUSIONS:The children with congenital fusiform biliary dilatation presented abdominal pain. Patients presented elevated serum and urinary amylase, when abdominal pain occurred. Filling defect and dilatation of the common channel showed by cholangiography. Laparoscopy and endoscopy clearance of the protein plugs and/or stones in the common channel in congenital fusiform biliary dilatation is effective, and the long-term result is good.

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Laparoscopic-assisted clearance of protein plugs in the common channel in children with choledochal cysts

Cited by 12 publications

References 9 publications

Japanese clinical practice guidelines for congenital biliary dilatation

Japanese clinical practice guidelines for congenital biliary dilatation

Japanese clinical practice guidelines for pancreaticobiliary maljunction

Combination of laparoscopy and endoscopy for fusiform choledochal cysts

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