S360 POSTERS (PB01-PB05) BILIARY
Conclusions: In patients with recurrent biliary colic, non-
visualization of gallbladder activity on hepatobiliary scin-
tigraphy was related with the degree of inflammation in the
gallbladder, while GBEF was related with muscular hy-
pertrophy of the gallbladder.
PB03-32
LAPAROSCOPIC CHOLECYSTECTOMY
- TWO-DECADE EXPERIENCE OF OVER
3000 CASES FROM A TERTIARY CARE
CENTER
V. Bansal1, A. Baksi1, M. Jain1, A. Krishna1, P. Om1,
S. Kumar1, H. Bhattacharjee1, P. Garg2 and M. Misra3
1
Department of Surgical Disciplines, 2Department of
Gastroenterology, AIIMS, and 3Department of Surgical
Disciplines, Mahatma Gandhi University of Medical Sci-
ences, India
Introduction: Laparoscopic Cholecystectomy (LC) re-
mains the gold standard for benign gall bladder diseases. It
is associated with higher risk of biliary injury (0.1%-1.5%)
resulting in prolonged morbidity, decreased overall sur-
vival. This complication counterpoises the benefit of min-
imal invasive surgery. If we adopt the principle of safe
cholecystectomy under supervision, laparoscopic chole-
cystectomy can be done safely even in difficult situations.
Methods: Retrospective review of the data of patients who
underwent LC in a single surgical unit from January 2003 -
December 2018 at a tertiary care center was done. 5 con-
sultants and 12 residents (operating ratio of 70:30) con-
ducted the surgeries. Demographic variables, intra
operative findings, conversion rate, morbidity and mortality
were evaluated.
Results: A total of 3095 patients underwent LC in the
mentioned period, 75.05% females and 24.95% males.
Difficult calot’s triangle anatomy was identified in - 66
(2.132%) patients. 30 (0.969%) were converted to open
procedure with one major bile duct injury (CBD transec-
tion), one accessory duct injury and one lateral CBD injury.
31 (1.01%) patients developed post operative bile leak. 15
(48.3%) patients were managed by ERCP and 10 (32.2%)
underwent re-laparoscopy. 6 (19.35%) patients required pig
tail drainage. None of the patients developed bile duct
stricture in long term follow up.
Conclusion: LC offers shorter hospital stay and low
morbidity. Procedure is safe and effective both for un-
complicated and complicated cholelithiasis. The incidence
of major Bile Duct Injury can be kept to minimum with
proper training and supervision in a tertiary care centre.
PB03-33
GALL STONE IS “ACTIVE” IN ELDERLY
MALES
J. Dong1, C. Sun2, X. Wang2, C. Xiang2, L. Gong2,
J. Dong1, J. Zeng2, S. Yang2 and L. Wang2
1
Hepatopancreatobiliary Center, Beijing Tsinghua
Changgung Hospital, School of Clinical Medicine, and
2
Hepatopancreatobiliary Center, Beijing Tsinghua
Changgung Hospital, Tsinghua University, China
Introduction: Complicated gall stone disease (GSD) is a
common surgical entity worldwide. However, the age
distribution of complicated GSD has not been well
described. We studied the age distribution of complicated
GSD in both males and females, and compare the metabolic
traits between the complicated GSD group and the non-
complicated group.
Methods: We consecutively assembled a retrospective
cohort of patients with GSD at Beijing Tsinghua Chang-
gung Hospital from 1/11/2015 to 1/10/2019.
Results: Out of the 1395 patients, 859 (42.6% male) and
536 (35.6% male) patients were with and without compli-
cated GSD. The number of females with complications
peaked in the fifth decades, so did that without complica-
tions(p=0.217). However, the age distribution in males was
significantly different (p=0.005). The number of males with
complications peaked in the sixth decades, while the peak
of that without complications appeared in the fifth decades.
The frequency of complicated GSD was higher among
males aged >60 years than that among males aged 60
years (72.7% vs. 61.3%, p=0.006). 35.6% and 21.6%
female patients aged 60 years with and without compli-
cated GSD had dyslipidemia(p=0.000). The percentages in
the males aged 60 years were 55.5% and
34.8%(p=0.000). In females or males aged >60 years, there
was no significant difference in the two groups (32.4% vs.
42.1%, p=0.092 and 41.4% vs. 47.4%, P=0.423). Nor hy-
pertension or diabetes were significantly different between
the groups with and without complications.
Conclusion: GSD is “active” in elderly males. Patients
aged 60 years were more likely to develop complications
with dyslipidemia.
PB04 - Biliary: Surgical Outcomes
PB04-04
EARLY LAPAROSCOPIC
CHOLECYSTECTOMY USING THE
BAILOUT PROCEDURE FOR ACUTE
CHOLECYSTITIS WITH SEVERE
LOCAL INFLAMMATION
K. Asai, M. Watanabe, M. Kujiraoka, H. Moriyama,
R. Watanabe, N. Kakizaki, S. Teraoka and Y. Saida
Surgery, Toho University Ohashi Medical Center, Japan
Introduction: The Tokyo Guidelines 2018 have proposed
a bailout procedure that includes the fundus first technique
and subtotal cholecystectomy to prevent bile duct injury
and vasculo-biliary injury in acute cholecystitis (AC) with
severe local inflammation, especially at Calot’s triangle.
The study aim was to assess the influence of laparoscopic
cholecystectomy (LC) using the bailout procedure for AC
with severe local inflammation.
Patients and methods: A total of 362 patients were
enrolled during 15-year study period. The median preop-
erative length of hospitalization was 1 day (range, 0-30
days). The patient’s characteristics, therapeutic strategies,
and operative results were compared between the former
period (n = 260) and a recent 3-year period (n = 102).
Results: In both groups, approximately 20% of the patients
with taking antithrombotic agents, and approximately 30%
of the patients had severe local inflammation, including
gangrenous cholecystitis. Early LC within 4 days after
admission was predominantly performed in the recent
period (100 cases, 98.0%, p < 0.001). Conversion to open
surgery decreased from 6.5% to 1.0%, and postoperative
HPB 2021, 23 (S1), S334eS387
 POSTERS (PB01-PB05) BILIARY
complication was decreased from 4.2% to 2.0%. The post-
operative and total length of hospitalization were signifi-
cantly shorter in the recent period than in the earlier period
(3 days and 5 days, respectively).
Conclusions: Active performance of the bailout procedure
and technical modification were associated with fewer
conversion to open surgery and postoperative complica-
tions, leading to significant decreases in the postoperative
and total length of hospitalization for AC patients with
severe local inflammation.
PB04-08
OUTCOME OF POST
CHOLECYSTECTOMY BILE DUCT
INJURY MANAGEMENT IN A HIGH
VOLUME REFERRAL CENTER IN IRAN
N. Fakhar1,2, S. Y. Zarghami2, A. Jafarian2 and
S. H. Dashti2
1
Surgery, and 2Hepatobiliary and Visceral Transplant
Research Center, Tehran University of Medical Sciences,
Iran, Islamic Republic of Korea
Introduction: However more than a century pass from first
cholecystectomy and iatrogenic bile duct injury, still this is
a big problem, here we report our experience in a high
volume referral center in Iran about handling of this
complication.
Methods: We collect data of 59 patient who referred us ,
suspected to post-cholecystectomy bile duct injury for 3
years since may 2016 both retrospectively through review
of charts and calling them and prospectively by regular out-
patient visit.
Results: In this period 59 patients with age range of 20 to
74y/o referred our center, 15 male and 44 female. 21 patients
underwent definite repair in 2 weeks from injury,17 patient
after 2 weeks and before 6 weeks and 21 patients after 6
weeks. The most common presenting feature was bilious
drain discharge, MRCP and ERCP was falsely negateive in
23.07% and 11.53% repsctively and the most reliable point
was primary surgeon think of “something is wrong during
surgery”.17% of patients had failed repair in original hos-
pital and 33.9% had exploration ,irrigation and drain-
age.laboratory abnormality just in 66% of patients detected,
most injuries was in Bismuth classII(18%),III(16%)and
IV(16%),and Rt hepatic artery injury detected in 27(45.8%)
patients.hepatectomy did in two patients and two patients
died. No significant deference found when interval from
injury to definite surgery compared between groups.
Conclusion: Best decision for patients suspected to bile
duct injury is referring to a high volume center at any time
before exploration and with any interval from injury, HPB
surgeon can go for repair.
PB04-09
SURGERY FOR RECURRENT BILIARY
CARCINOMA: RESULTS FOR 5
RECURRENT CASES
S. Hata, A. Kuroda, M. Hayasaka, K. Yamaguchi,
M. Teruya and M. Kaminishi
Department of Gastrointestinal Surgery, Showa General
Hospital, Japan
HPB 2021, 23 (S1), S334eS387
S361
Introduction: Typically chemotherapy has been used as
standard treatment and surgeries were rarely performed for
recurrent extrahepatic biliary carcinoma (RBC). Thus
whether surgery for RBC is feasible has remained unclear.
Methods: From 2013 to 2019, 5 patients underwent radical
resection for RBC at our institution. We retrospectively
reviewed the medical data.
Results: Recurrence sites were liver metastasis in 3 patients
(LM group) and local or bile duct recurrence in 2 patients
(BD group). In the LM group, the underlying pathology
was distal bile duct carcinoma, gallbladder carcinoma and
ampullary carcinoma. Limited resections of the liver were
performed for all 3 patients in the LM group. There was no
morbidity nor mortality. 1 patient with liver metastasis of
gallbladder carcinoma survived 6 years after surgery for
RBC. The other 2 patients had recurrence at 9 and 14
months after surgery. In the BD group, the underlying pa-
thology was distal bile duct carcinoma and proximal bile
duct carcinoma. 1 patient underwent pancreaticoduode-
nectomy in the primary surgery and extended right hemi-
hepatectomy for RBC. The other underwent central
bisegmentectomy of the liver in the primary surgery and
right lateral sectionectomy of the liver for RBC. There was
morbidity in 1 patient but no mortality. Both patients could
achieve curative resection and survive without recurrence
for 9 and 2 months after surgery for RBC.
Conclusion: Surgery for RBC is technically demanding
procedure but appears feasible and have a possibility of
offering longer survival for selected patients but we should
be cautious of indication.
PB04-10
INCIDENCE AND IMPACT OF
CONCOMITANT VASCULAR INJURIES
IN POST-CHOLECYSTECTOMY BILE
DUCT STRICTURE: A PROSPECTIVE
STUDY WITH MR ANGIOGRAPHY
S. Galodha1,2, R. Saxena2, S. G2, R. Singh2,
A. Behari2 and V. K. Kapoor2
1
G I Surgery & Liver Transplantation, AIIMS, and 2Sur-
gical Gastroenterology, SGPGIMS, India
Introduction: Impact of concomitant vascular biliary
injury (VBI) on post- cholecystectomy benign biliary
stricture (BBS) repair is still debatable with studies both in
favor and against. In our study we look for incidence of
VBI and impact on long-term outcomes.
Methods: Consecutive patients with BBS during the period
December 2010 to May 2012 were included. Magnetic
resonance angiography (MRA) with MRCP was done prior
to repair. Long-term outcomes were analyzed as per
McDonald grading.
Results: 36 patients were included in the study. Median age
was 36 (15-70) years and 28 (78%) were females. 10 pa-
tients (28%) had prior failed repair. 23 (64%) patients had
high strictures (Bismuth Type 3). VBI was present in 22
(61%) involving right hepatic artery (RHA). Of these,
laparoscopic cholecystectomy was performed in 18 patients
(82%). Additionally right portal vein injury was present in
one patient. In patients with prior failed repair 5 (50%) had
RHA injury. 34 patients underwent Roux en Y hepatico-
jejunostomy (RYHJ). Median blood loss was 300ml (range
50-950). Median duration of surgery was 5 hours (range 2-