Pancreatic Surgery

Influence of normograde versus retrograde catheterization of bile ducts in dogs treated for gallbladder mucocele

“…9,11,29,30 Finally, findings indicative of sustained or worsened cholestasis might be due to other hepatocellular diseases or to extension of the pathologic process underlying GBM into the intrahepatic biliary ducts or hepatic parenchyma, causing intrahepatic biliary stasis or hepatic necrosis. 1,11,25,26,28 Although dogs catheterized RG suffered persistent gastrointestinal signs as well as persistent or worsened elevations in TB concentrations at discharge, survival was not negatively impacted. All dogs in the present study survived surgery, and survival to discharge and long-term survival did not differ between groups.…”

“…10,12,15,16,20,[26][27][28] Other factors include surgical manipulation in the right cranial abdomen, specific handling of the pancreas and duodenum, duodenal or biliary reflux, and concurrent endocrinopathies. 4,12,[26][27][28] Although the incidence of postoperative pancreatitis was similar between groups, it is possible that some dogs experienced subclinical postoperative pancreatitis following RG catheterization, causing EHBO within the peripancreatic portion of the CBD and prolongation of elevations in TB. 5,6,10,11,15,16,[25][26][27][28] Both bile and bacterial laden fluid may leak from a dehisced duodenotomy incision or an area of compromise in the biliary tree.…”

“…4,12,[26][27][28] Although the incidence of postoperative pancreatitis was similar between groups, it is possible that some dogs experienced subclinical postoperative pancreatitis following RG catheterization, causing EHBO within the peripancreatic portion of the CBD and prolongation of elevations in TB. 5,6,10,11,15,16,[25][26][27][28] Both bile and bacterial laden fluid may leak from a dehisced duodenotomy incision or an area of compromise in the biliary tree. As most cases of BP did not undergo exploratory surgery or necropsy, we were unable to discern the source of bile leakage in all dogs.…”

“…Pancreatitis was a major complication following cholecystectomy for dogs in both groups. Factors common to dogs in both groups that may have led to postoperative pancreatitis include hyperbilirubinemia, hemorrhage, and potential for endotoxin‐mediated inflammatory responses, including hypotension causing decreased systemic perfusion and hypoperfusion of the pancreas 10,12,15,16,20,26‐28 . Other factors include surgical manipulation in the right cranial abdomen, specific handling of the pancreas and duodenum, duodenal or biliary reflux, and concurrent endocrinopathies 4,12,26‐28 .…”

“…Factors common to dogs in both groups that may have led to postoperative pancreatitis include hyperbilirubinemia, hemorrhage, and potential for endotoxin‐mediated inflammatory responses, including hypotension causing decreased systemic perfusion and hypoperfusion of the pancreas 10,12,15,16,20,26‐28 . Other factors include surgical manipulation in the right cranial abdomen, specific handling of the pancreas and duodenum, duodenal or biliary reflux, and concurrent endocrinopathies 4,12,26‐28 . Although the incidence of postoperative pancreatitis was similar between groups, it is possible that some dogs experienced subclinical postoperative pancreatitis following RG catheterization, causing EHBO within the peripancreatic portion of the CBD and prolongation of elevations in TB 5,6,10,11,15,16,25‐28 …”