A purely endoscopic management approach for Type V Mirizzi syndrome.
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ABSTRACT:
SUBMITTER: Al Ghamdi SS
PROVIDER: S-EPMC8351458 | biostudies-literature | 2021 Aug
REPOSITORIES: biostudies-literature
Publications
A purely endoscopic management approach for Type V Mirizzi syndrome.
Al Ghamdi Sarah S SS Bejjani Michael M Ghandour Bachir B Khashab Mouen A MA
VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy 20210609 8
Video 1A purely endoscopic management approach for Type V Mirizzi syndrome. ...[more]
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Project description:BackgroundMirizzi syndrome is an uncommon complication of longstanding gallstone disease. Pre-operative diagnosis is challenging, and to date, there is no consensus on the standard management for this condition. Until recently open cholecystectomy was the standard of care for type II Mirizzi syndrome (McSherry classification). The objective of this study was to assess the incidence and management of type II Mirizzi syndrome in patients with proven or suspected choledocholithiasis undergoing laparoscopic common bile duct (CBD) exploration and present our experience in the laparoscopic management of this rare condition over the last 21 years.MethodsProspective data collection of eleven cases of type II Mirizzi syndrome amongst a series of 425 laparoscopic bile duct explorations was performed between 1998 and 2019. Demographic, clinical, diagnostic, intra-operative, and post-operative data were recorded.ResultsThe incidence of type II Mirizzi syndrome was 2.6% in 425 laparoscopic CBD explorations. All operations were completed laparoscopically with closure of the defect over a decompressed CBD (T-tube n = 3, antegrade stent n = 5, transcystic drain n = 2), and in one case a non-drained duct was closed with Endoloop. Stone clearance rate was 100% (11 cases). In two patients the transinfundibular approach was used in conjunction with holmium laser lithotripsy to enable choledochoscopy and successful stone clearance. Three patients were complicated in the post-operative period with bile leak (n = 2) and lower respiratory tract infection (n = 1). An incidental gallbladder carcinoma was found in one patient.ConclusionLaparoscopic management of type II Mirizzi syndrome is feasible and safe when performed by experienced laparoscopic foregut surgeons. Laparoscopy and choledochoscopy can be combined with novel approaches and techniques to increase the likelihood of treatment success.
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Project description:Objective:To investigate the safety and feasibility of endoscopic nasogallbladder drainage (ENGBD) combined with laparoscopic surgery for Mirizzi syndrome type I with acute cholecystitis. Methods:An analysis of 4 patients with type I Mirizzi syndrome with acute cholecystitis admitted to the First Hospital of Jilin University. Results:The patients underwent ENGBD, and laparoscopic surgery was evaluated postoperatively. All four patients successfully recovered from this combined surgical approach. Conclusion:The combination of ENGBD and laparoscopic surgery is safe and feasible for the treatment of patients with type I Mirizzi syndrome accompanied by acute cholecystitis. This approach may reduce the traumatic stress on patients and is worthy of widespread implementation.
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Project description:BackgroundThe epidermoid cyst as a pineal region tumor is an infrequent pathology and with few descriptions in literature. Its prevalence in the third ventricle is 0,0042% of all intracranial tumors. To achieve a complete exéresis we used an endoscopic supracerebellar-infratentorial approach, surgical technique for pineal region approach.ObjectivesThe purpose of this work is to show the surgical technique of this novel approach for the treatment of a very infrequent disease.Methods16 years old male patient with history of diabetes insipidus and chronic headaches (m-RS 1). Brain MRI showed a lesion with hyperintensity in T2WI and hypointensity in T1WI. It presents peripheral enhancement with gadolinium and restricted diffusion pattern in DWI. The pituitary stalk also showed enhancement with contrast. Germ cell tumor was a possible diagnosis but tumor cell markers were negative in CSF samples. We decided to make the purely endoscopic approach to the region to make a biopsy and a possible resection. Intraoperative pathology result informed an epidermoid tumor, so we continued with the complete exeresis of the tumor.ResultsWe achieved a complete resection of a third ventricle epidermoid cyst with a purely endoscopic supracerebellar-infratentorial approach and a skull base rigid endoscope in a 16 years old male patient. The patient has recovered without any sequelae, headaches free but persistence of diabetes insipidus (m-RS 1).Conclusion: The purely endoscopic supracerebellar-infratentorial approach is a safe option to the surgical management of third ventricle pathologies, in this case, an epydermoid cyst.
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Project description:Video 1Endoscopic management of Bouveret syndrome with electrohydraulic lithotripsy.
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Project description:IntroductionMirizzi syndrome is an infrequent complication of long-standing cholelithiasis. Extrinsic compression of the common hepatic duct is usually caused by an impacted stone in Hartmann's pouch or cystic duct resulting in the development of cholecystobiliary fistula. This syndrome is classified based on the presence and severity of cholecystobiliary fistula. Mirizzi syndrome is challenging to diagnose preoperatively and may require complex biliary surgical procedures for resolution.ResultsWe present three patients with Mirizzi syndrome with different clinical presentations. All were successfully treated by cholangioscopy with electrohydraulic lithotripsy. Endoscopic treatment is a safe alternative with a high success rate. Single-operator cholangioscopy combined with lithotripsy has been shown to have a 90-100% success rate in the treatment of biliary stones.ConclusionHerein, we present our experience treating Mirizzi syndrome with single-operator cholangioscopy guided electrohydraulic lithotripsy. Difficult management of Mirizzi syndrome has led to research of new treatment options to minimize the risk of high-rate complications. Single-operator cholangioscopy in combination with laser lithotripsy is an adequate and safe alternative for the treatment of this condition.
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Project description:BackgroundTuberculum sellae meningioma (TSM), a common benign tumor in the sellae region, usually causes neurological deficits, such as vision impairment, by squeezing the peripheral neurovascular structures. Surgical management is recommended as the optimal strategy for TSM treatment and vision restoration. However, it remains challenging to resect TSM in the traditional transcranial approach (TCA). Recently, the endoscopic endonasal approach (EEA) has emerged as an effective option in skull base surgeries. Besides the effectivity, the advantages and limitations of EEA in TSM surgery remain controversial.ObjectWe compared the surgical outcomes and complications between TCA and EEA surgeries to identify the principles in TSM surgical management.MethodsRetrospective analysis was performed on the patients, who underwent TSM surgery in Wuhan Union Hospital between January 2017 and December 2021. The patients were assigned to TCA or EEA group according to the surgery they experienced. All patients were analyzed with the extent of tumor resection, vision outcome, postoperative complications, and follow-up results.ResultsA total of 112 patients were enrolled in this study, including 78 in TCA group and 34 in EEA group. The mean follow-up was 20.5 months (range 3-36 months). There were no statistically significant differences in patient demographic data, preoperative symptoms, and tumor characteristics between TCA and EEA groups. Both TCA and EEA surgeries are effective in TSM resection with relatively high gross total resection rates (85.9% in TCA vs. 91.2% in EEA, p > .05). Meanwhile, EEA surgery has a better outcome in vision restoration or stabilization than TCA surgery (74.6% in TCA vs. 93.1% in EEA, p < .05). Whereas EEA surgery causes more occurrences of cerebrospinal fluid (CSF) leakage than TCA surgery (0% in TCA vs. 11.8% in EEA, p < .05).ConclusionBoth TCA and EEA surgeries are effective in TSM resection. EEA surgery has a better outcome in vision restoration or stabilization than TCA surgery, but induces higher risk of CSF leakage. As each approach has unique advantages and limitations, we must take all aspects into consideration, including approach feathers, tumor characteristics, and clinical requirements, to make the optimal choice in TSM surgical management.
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