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Choledochal cysts (CCs) are an important risk factor for cholangiocarcinoma, though their etiology remains debated. Given the vital role of bile fluid in digestive processes within the biliary system, examining such mechanisms from the perspective of bile fluid dynamics may offer additional insights for clinical use. This study utilized magnetic resonance imaging (MRI)-based patient-specific scans for detailed reconstruction and further employed the computational fluid dynamic method to assess the physiological functions of each system, including refilling and emptying processes. The impact of bile rheological property was also examined. Key biomechanical parameters—pressure and wall shear stress (WSS)—were displayed on a two-dimensional plane via surface mapping for enhanced visualization and comparative analysis. Outcomes demonstrated a significant reduction in bile flow velocity in CCs patients due to common bile duct's anatomical features and bile's shear-thinning, non-Newtonian nature, with a notable increase in pressure drop observed. In healthy biliary systems, WSS variations were minimal; however, in CCs patients, extreme WSS differences were found, with the highest WSS in the segmental bile duct and the lowest in the dilatation area, presenting a magnitude difference of approximately 1000. CCs one showed WSS levels 100–250 times higher than healthy ones in the common bile duct. Bile rheological properties substantially affect pressure and WSS patterns, particularly WSS, where pathological bile caused a tenfold increase in WSS compared to healthy bile. The findings aimed to enhance the understanding of biliary fluid mechanics in CCs and offer insights into selected fluidic variables for future microfluidic chip experiments. [ABSTRACT FROM AUTHOR]

Background: This study was designed to investigate whether 3D laparoscopic common bile duct (LCBDE) could improve surgical outcomes in choledocholithiasis patients compared with 2D LCBDE. Method: Propensity score-matched analysis was performed to balance the bias in baseline characteristic between two groups. Results: 213 patients underwent 3D LCBDE and 212 patients receiving 2D LCBDE were enrolled in this study. The operation time and blood loss in 3D group were significantly less than that in 2D group. After propensity score matching, a total of 114 paired cases were selected from the two groups. The operation time and blood loss in 3D group remain significantly lower than in 2D group. In the end, the subgroup analysis based on abdominal adhesion level was performed and it was observed that for patients with adhesion level 1 and level 2, 3D surgery could obviously decrease the operation time and intraoperative blood loss. Conclusions: 3D LCBDE would significantly reduce operation time, blood loss, and conversion rate to laparotomy in choledocholithiasis patients versus 2D LCBDE. For patients with abdominal adhesions level 1 and level 2, 3D LCBDE could provide better surgical outcomes than 2D LCBDE. [ABSTRACT FROM AUTHOR]

Background: A history of abdominal biliary tract surgery has been identified as a relative contraindication for laparoscopic common bile duct exploration (LCBDE), and there are very few reports about laparoscopic procedures in patients with a history of abdominal biliary tract surgery.Methods: We retrospectively reviewed the clinical outcomes of 227 consecutive patients with previous abdominal biliary tract operations at our institution between December 2013 and June 2019. A total of 110 consecutive patients underwent LCBDE, and 117 consecutive patients underwent open common bile duct exploration (OCBDE). Patient demographics and perioperative variables were compared between the two groups.Results: The LCBDE group performed significantly better than the OCBDE group with respect to estimated blood loss [30 (5-700) vs. 50 (10-1800) ml; p = 0.041], remnant common bile duct (CBD) stones (17 vs. 28%; p = 0.050), postoperative hospital stay [7 (3-78) vs. 8.5 (4.5-74) days; p = 0.041], and time to oral intake [2.5 (1-7) vs. 3 (2-24) days; p = 0.015]. There were no significant differences in the operation time [170 (60-480) vs. 180 (41-330) minutes; p = 0.067]. A total of 19 patients (17%) in the LCBDE group were converted to open surgery. According to Clavien's classification of complications, the LCBDE group had significantly fewer postoperative complications than the OCBDE group (40 vs. 57; p = 0.045). There was no mortality in either group. Multiple previous operations (≥ 2 times), a history of open surgery, and previous biliary tract surgery (including bile duct or gallbladder + bile duct other than cholecystectomy alone) were risk factors for postoperative adhesion (p = 0.000, p = 0.000, and p = 0.000, respectively).Conclusion: LCBDE is ultimately the least invasive, safest, and the most effective treatment option for patients with previous abdominal biliary tract operations and is especially suitable for those with a history of cholecystectomy, few previous operations (< 2 times), or a history of laparoscopic surgery. [ABSTRACT FROM AUTHOR]