한국간담췌외과학회지 (Annals of Hepato-Biliary-Pancreatic Surgery)

  • 제27권4호
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  • Pages.366-371
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  • 2023
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  • 2508-5778(pISSN)
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  • 2508-5859(eISSN)
한국간담췌외과학회 (The Korean Association of Hepato-Biliary-Pancreatic Surgery)
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Feasibility of laparoscopic cholecystectomy for symptomatic gallstone disease with portal cavernoma: Can prior portal vein decompression be avoided?

  • Bappaditya Har (Department of Surgical Gastroenterology, Santokba Institute of Digestive Surgical Sciences, Santokba Durlabhji Memorial Hospital and Medical Research Institute) ;
  • Siddharth Mishra (Department of Surgical Gastroenterology, Santokba Institute of Digestive Surgical Sciences, Santokba Durlabhji Memorial Hospital and Medical Research Institute) ;
  • Ayyar Srinivas Mahesh (Department of Surgical Gastroenterology, Santokba Institute of Digestive Surgical Sciences, Santokba Durlabhji Memorial Hospital and Medical Research Institute) ;
  • Ankur Shrimal (Department of Surgical Gastroenterology, Santokba Institute of Digestive Surgical Sciences, Santokba Durlabhji Memorial Hospital and Medical Research Institute) ;
  • Rajesh Bhojwani (Department of Surgical Gastroenterology, Santokba Institute of Digestive Surgical Sciences, Santokba Durlabhji Memorial Hospital and Medical Research Institute)
  • 투고 : 2023.03.20
  • 심사 : 2023.05.29
  • 발행 : 2023.11.30
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초록

Backgrounds/Aims: Biliary surgery in patients with extrahepatic portal vein obstruction with portal cavernoma (PC) is technically challenging, and associated with the risk of bleeding. Therefore, prior portal vein decompression is usually recommended before definitive biliary surgery. Only a few studies have so far reported the safety of isolated laparoscopic cholecystectomy. We aimed to evaluate our experience of laparoscopic cholecystectomy in patients with PC without prior portal decompression. Methods: Prospectively maintained data for patients with PC who underwent laparoscopic cholecystectomy for symptomatic gallstone disease without portal decompression were analyzed. Clinical features, imaging, intraoperative factors, conversion rate, complications of surgery, and long-term outcomes were assessed. Results: Sixteen patients underwent cholecystectomy without portal decompression from 2012 to 2021, of which interventions 14 were laparoscopic cholecystectomies. One patient required conversion (7.1%) to open surgery. Jaundice was present in 5 patients (35.7%), and underwent endoscopic stone clearance before surgery. Median intraoperative blood loss, operative time, and hospital stay were 100 mL (20-400 mL), 105 min (60-220 min), and 2 days (1-7 days), respectively. Blood transfusion was required in two patients (14.2%). Prior endoscopic or percutaneous intervention was associated with significant blood loss and prolonged intraoperative time. Conclusions: In centers with experience, prior portal decompression can be avoided in patients with PC requiring isolated cholecystectomy to treat gallstones or their complications. Laparoscopic surgery is safe and feasible for these patients, and gives excellent outcomes in the selected group.

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참고문헌

  1. Dhiman RK, Saraswat VA, Valla DC, Chawla Y, Behera A, Varma V, et al. Portal cavernoma cholangiopathy: consensus statement of a working party of the Indian national association for study of the liver. J Clin Exp Hepatol 2014;4(Suppl 1):S2-S14.  https://doi.org/10.1016/j.jceh.2014.02.003
  2. Duseja A. Portal cavernoma cholangiopathy-clinical characteristics. J Clin Exp Hepatol 2014;4(Suppl 1):S34-S36.  https://doi.org/10.1016/j.jceh.2013.05.014
  3. Sarin SK, Guptan RC, Malhotra S. Increased frequency of gallstones in cirrhotic and non-cirrhotic portal hypertension. J Assoc Physicians India 2002;50:518-522. 
  4. Sasturkar SV, Agrawal N, Arora A, Kumar MPS, Kilambi R, Thapar S, et al. Laparoscopic cholecystectomy in patients with portal cavernoma without portal vein decompression. J Minim Access Surg 2021;17:351-355.  https://doi.org/10.4103/jmas.JMAS_106_20
  5. Llop E, de Juan C, Seijo S, Garcia-Criado A, Abraldes JG, Bosch J, et al. Portal cholangiopathy: radiological classification and natural history. Gut 2011;60:853-860.  https://doi.org/10.1136/gut.2010.230201
  6. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213.  https://doi.org/10.1097/01.sla.0000133083.54934.ae
  7. Malkan GH, Bhatia SJ, Bashir K, Khemani R, Abraham P, Gandhi MS, et al. Cholangiopathy associated with portal hypertension: diagnostic evaluation and clinical implications. Gastrointest Endosc 1999;49(3 Pt 1):344-348.  https://doi.org/10.1016/S0016-5107(99)70011-8
  8. Ullah Wani H, Kochhar R, Nagi B, Nain C, Ahmed B. Bile composition in patients with noncirrhotic portal hypertension. Internet J Gastroenterol 2008;8. 
  9. Girish SP, Reddy JMB. Surgical management of portal biliopathy - a prospective analysis. Acad J Surg 2020;3:176-182.  https://doi.org/10.47008/ajs/2020.3.1.38
  10. Agarwal AK, Sharma D, Singh S, Agarwal S, Girish SP. Portal biliopathy: a study of 39 surgically treated patients. HPB (Oxford) 2011;13:33-39.  https://doi.org/10.1111/j.1477-2574.2010.00232.x
  11. Dalvi AN, Deshpande AA, Doctor NH, Maydeo A, Bapat RD. Laparoscopic cholecystectomy in patient with portal cavernoma and portal hypertension. Indian J Gastroenterol 2001;20:32-33. 
  12. Bhatia P, John S, Kalhan S, Khetan M. Primary laparoscopic cholecystectomy in patients with portal cavernoma and non-obstructive portal biliopathy: two case reports. J Minim Access Surg 2014;10:161-162.  https://doi.org/10.4103/0972-9941.134885
  13. Panda N, Das R, Das S, Bandopadhyay SK, Barman D, Mondol R. Laparoscopic cholecystectomy in a patient with portal cavernoma. J Surg 2015;10:295-296.  https://doi.org/10.7438/1584-9341-10-4-11
  14. Chattopadhyay S, Govindasamy M, Singla P, Varma V, Mehta N, Kumaran V, et al. Portal biliopathy in patients with non-cirrhotic portal hypertension: does the type of surgery affect outcome? HPB (Oxford) 2012;14:441-447.  https://doi.org/10.1111/j.1477-2574.2012.00473.x
  15. Bhatia V, Jain AK, Sarin SK. Choledocholithiasis associated with portal biliopathy in patients with extrahepatic portal vein obstruction: management with endoscopic sphincterotomy. Gastrointest Endosc 1995;42:178-181.  https://doi.org/10.1016/S0016-5107(95)70080-3
  16. Sezgin O, Oguz D, Altintas E, Saritas U, Sahin B. Endoscopic management of biliary obstruction caused by cavernous transformation of the portal vein. Gastrointest Endosc 2003;58:602-608. https://doi.org/10.1067/S0016-5107(03)01975-8