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      Call for Papers: Artificial Intelligence in Gastroenterology

      Submit here before May 31, 2024

      About Digestion: 3.2 Impact Factor I 6.4 CiteScore I 0.914 Scimago Journal & Country Rank (SJR)

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      Differences in Post-Cholecystectomy Bile Duct Injury Care: A Comparative Analysis of 2 Different Health-Care Public Institutions in a Low- and Middle-Income Country: Southeast Mexico

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          Abstract

          Background: Mexican health system structure allows us to study the differences in bile duct injury (BDI) management. The study aimed to assess the differences in patients with complex BDI in 2 different public sector institutions using a new proposed standard terminology. Methods: Retrospective review (2008–2019) in 2 public institutions (IMSS/SESVER). Bismuth-Strasberg E injuries with hepaticojejunostomy were included. Data are presented in a tabular reporting system. The outcomes were percent of patients attaining primary patency, loss of primary patency, and actuarial primary patency rate. Results: Seventy-eight patients (IMSS: n = 37; SESVER: n = 41) without differences in demographic and preoperative assessment were studied. BDI occurred mostly in outside hospitals. Open cholecystectomy was the most common index operation in SESVER (73%, p = 0.02). IMSS had more surgeries ( p = 0.007) and repair attempts ( p = 0.06) prior to referral. Magnetic resonance cholangiopancreatography was more commonly used in IMSS patients. Biliary stents (45%) and cholangitis (29%) were more common in IMSS ( p < 0.05). IMSS patients had longer follow-up than SESVER ( p < 0.05). No differences in primary patency rates (IMSS: 89%, SESVER: 97%) and actuarial patency rates were noted. Discussion: Despite differences in referral, preoperative, and operative events, good BDI repair outcomes can be achieved. Longer follow-up is needed to monitor these outcomes.

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          The accordion severity grading system of surgical complications.

          D Linehan, Steven M. Strasberg, Irana W. Hawkins (2009)
          A severity grading system is essential to reporting surgical complications. In 1992, we presented such a system (T92). Its use and that of systems derived from it have increased exponentially. Our purpose was to determine how well T92 and its modifications have functioned as a severity grading system and to develop an improved system for reporting complications. 129 articles were studied in detail. Twenty variables were searched for in each article with particular emphasis on type of study, substitution of qualitative terms for grades, grade compression, and cut-points if grade compression was used. We also determined relative distribution of complications and manner of presentation of complications. T92 and derivative classifications have received wide use in surgical studies ranging from small studies with few complications to large studies of complex operations that describe many complications. There is a strong tendency to contract classifications and to substitute terms with self evident meaning for the numerical grades. Complications are presented in a large variety of tabular forms some of which are much easier to follow than others. Current methods for reporting the severity of complications incompletely fulfill the needs of authors of surgical studies. A new system-the Accordion Severity Grading System-is presented. The Accordion system can be used more readily for small as well as large studies. It introduces standard definition of simple quantitative terms and presents a standard tabular reporting system. This system should bring the field closer to a common severity grading method for surgical complications.
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            Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis.

            Toshihiko Mayumi, Kohji Okamoto, Tadahiro Takada … (2018)
            Management bundles that define items or procedures strongly recommended in clinical practice have been used in many guidelines in recent years. Application of these bundles facilitates the adaptation of guidelines and helps improve the prognosis of target diseases. In Tokyo Guidelines 2013 (TG13), we proposed management bundles for acute cholangitis and cholecystitis. Here, in Tokyo Guidelines 2018 (TG18), we redefine the management bundles for acute cholangitis and cholecystitis. Critical parts of the bundles in TG18 include the diagnostic process, severity assessment, transfer of patients if necessary, and therapeutic approach at each time point. Observance of these items and procedures should improve the prognosis of acute cholangitis and cholecystitis. Studies are now needed to evaluate the dissemination of these TG18 bundles and their effectiveness. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
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              Biliary strictures: classification based on the principles of surgical treatment.

              H Bismuth, P. Majno (2001)
              The classification of biliary strictures used at Hopital Paul Brousse is based on the lowest level at which healthy biliary mucosa is available for anastomosis. The classification is intended to help the surgeon choose the appropriate technique for the repair. Type I strictures, with a common duct stump longer than 2 cm, can be repaired without opening the left duct and without lowering the hilar plate. Type II strictures, with a stump shorter than 2 cm, require opening the left duct for a satisfactory anastomosis. Lowering the hilar plate is not always necessary but may improve the exposure. Type III lesions, in which only the ceiling of the biliary confluence is intact, require lowering the hilar plate and anastomosis on the left ductal system. There is no need to open the right duct if the communication between the ducts is wide. With type IV lesions the biliary confluence is interrupted and requires either reconstruction or two or more anastomoses. Type V lesions are strictures of the hepatic duct associated with a stricture on a separate right branch, and the branch must be included in the repair. Although this classification is intended for established strictures, it is commonly used to describe acute bile duct injuries. The surgeon must be aware, however, that the established stricture is generally one level higher than the level of the injury at the original operation.
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                Author and article information

                Journal
                Journal ID (publisher-id): DSU
                Journal ID (nlm-ta): Dig Surg
                Journal ID (doi): 10.1159/issn.0253-4886
                Title: Digestive Surgery
                Publisher: S. Karger AG
                ISSN (Print): 0253-4886
                ISSN (Electronic): 1421-9883
                Publication date Subscription-year: 2020
                Publication date (Print): November 2020
                Publication date (Electronic): 23 August 2020
                Volume: 37
                Issue: 6
                Pages: 472-479
                Affiliations
                [_a] aOrgan Transplantation and General Surgery, IMSS UMAE Hospital de Especialidades, Veracruz, Mexico
                [_b] bOrgan Transplantation and General Surgery, SESVER Hospital de Alta Especialidad “Virgilio Uribe”, Veracruz, Mexico
                [_c] cSurgical Oncology, SESVER Hospital de Alta Especialidad “Virgilio Uribe”, Veracruz, Mexico
                [_d] dGeneral Surgery, IMSS UMAE Hospital de Especialidades, Veracruz, Mexico
                Author notes
                *Gustavo Martínez-Mier, Alacio Perez 928-314, Veracruz 91910 (Mexico), gmtzmier@hotmail.com
                Article
                Publisher ID: 509706 Other ID: Dig Surg 2020;37:472–479
                DOI: 10.1159/000509706
                PubMed ID: 32829340
                SO-VID: b1a67da5-be28-45ff-a336-9d26cf515340
                Copyright © © 2020 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 30 April 2020
                Date accepted : 23 June 2020
                Page count
                Figures: 1, Tables: 4, Pages: 8
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Oncology & Radiotherapy,Gastroenterology & Hepatology,Surgery,Nutrition & Dietetics,Internal medicine
                Keywords: Outcomes,Bile duct injury repair,Bile duct injury,Bile duct patency,Hepatobiliary surgery
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy, Gastroenterology & Hepatology, Surgery, Nutrition & Dietetics, Internal medicine
                Keywords: Outcomes, Bile duct injury repair, Bile duct injury, Bile duct patency, Hepatobiliary surgery

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