is bile duct surgery dangerous

Surgery for bile duct cancer aims to remove the cancer and some healthy tissue around the tumour. Sign up for free and be the first to get notified about updates. 1994;74:781807. This increases the risk of the cancer coming back. At the same time, a BDI involving the hepatic duct confluence (Bismuth type IV) [3] was demonstrated on magnetic resonance cholangiopancreatography (MRCP) (Fig. Surg Clin North Am. The main treatments include surgery, chemotherapy and treatment to help reduce your symptoms. This will stop the problem of gallstones reoccurring. Bile Duct Injury - StatPearls - NCBI Bookshelf Tantia O, Jain M, Khanna S, Sen B. Iatrogenic biliary injury: 13,305 cholecystectomies experienced by a single surgical team over more than 13 years. This results in the distal arteries of the bile duct becoming the end arteries. Liver damage can cause similar symptoms to biliary obstruction, so the doctor may also ask about alcohol or drug use as well as sexual practices. Unhealthful dietary choices are one factor that can increase the risk of gallbladder disease. In this case, the gallbladder will have to be removed so as to treat the condition. A blockage can cause bile to build up in your gallbladder or liver. The blood supply of the biliary ductal system and its relevance to vasculobiliary injuries following cholecystectomy. One of the most common complications of the surgery involves injury to the bile duct during the procedure, which can result in bile leaking into the abdomen or disrupting the normal flow of bile from the liver. ERCP: Procedure, Surgery & Complications - MedicineNet This increased incidence in adults may be attributed to institutional referral bias. A 68-year-old Black African female with several past laparotomies including a cholecystectomy forty-one . Choledochal cysts are disproportionate dilatations of the biliary system. It releases bile when you eat a meal with fats. the cystic duct and the artery) entering the gallbladder. This increase is justified, according to some authors, by the advance in hepatobiliary imaging techniques. Eur J Gastroenterol Hepatol. A blocked duct is more likely to get infected. and as the leak continued, a self-expandable metallic stent (day 15.) Cholecystectomy (gallbladder removal) - Mayo Clinic 2023 Healthline Media UK Ltd, Brighton, UK. 3b) [21], which in the long-term proved to be a successful and durable option. Nature reviews gastroenterology & hepatology, 2020. (Call), 907-276-3679 Type I is the injury of the common bile duct or common hepatic duct >2cm from the hepatic duct confluence while type II involves the proximal common hepatic duct <2cm from the confluence. Your US state privacy rights, We are committed to providing, safe and successful surgical procedures by combining best-in-class patient care with state-of-the-art equipment. Ismael HN, Cox S, Cooper A, Narula N, Aloia T. The morbidity and mortality of hepatojejunostomy for complex bile duct injuries: a multi-institutional analysis of risk factors and outcomes using NSQIP. Surgery for bile duct cancer aims to remove the cancer and some healthy tissue around the tumour. JM Banales and others Complete excision of the cyst is the best treatment strategy to avoid long-term complications especially malignant transformation, recurrent cholangitis and gallstones. This content does not have an English version. Less than 3 out of every 10 people (less than 30%) diagnosed with bile . Your treatment team monitor you and help you recover whilst you are in the hospital. 2017;19(4):3528. After liver . This is when a persons skin and the whites of their eyes turn yellow. Gallbladder Removal: Purpose, Risks, and Procedure - Healthline The diagnosis was confirmed by magnetic resonance imaging, which clearly showed typical features of focal nodular hyperplasia. You have tests before your operation to check that you are well enough for a general anaesthetic and that you'll make a good recovery. Silva MA, Coldham C, Mayer AD, Bramhall SR, Buckels JA, Mirza DF. Therefore, biliary-enteric reconstruction performed as close to the biliary confluence as possible provides the best chance for a good outcome. An emergent relaparotomy was performed. The bile duct can be found in the abdomen which makes for a long and large incision. The stump of the left duct to be anastomosed had been displaced deep down dorsally making the posterior part of the biliary anastomosis of Roux-en-Y hepaticojejunostomy very difficult to perform. The so-called classic triad of intermittent jaundice, abdominal mass, and pain was found in a minority of cases according to most case series. This article explores some of the leading causes of bile duct obstruction, its symptoms, diagnosis, and treatment. Part of Click Here. liver ultrasound says bile duct enlarged. Your surgeon may be able to remove it and some of the surrounding liver tissue. Correspondence to The postoperative course was uneventful. The most accepted theory in explaining the pathogenesis of choledochal cyst is Babbitts theory of the anomalous pancreaticobiliary duct junction precluding normal sphincter development at the anomalous pancreaticobiliary duct junction. The recovery itself can last as long as 12 weeks. The PTC drain was removed 4weeks following surgery and the patient was discharged home 41days after cholecystoduodenostomy (103days following initial surgery). Aranha GV, Prinz RA, Greenlee HB. Laparoscopic cholecystectomy (LC) with laparoscopic common bile duct exploration (LCBDE) is gaining traction for the management of choledocholithiasis. Lancet Oncology, 2019. The postoperative course was uneventful and the patient was discharged home 7days after surgery. ERCP: Preparation, Recovery, Long-Term Care - Verywell Health This was due to the confluence disruption (Fig. Privacy Liver transplantation may be indicated in extreme cases with a combined vascular and biliary injury resulting in acute liver failure or if secondary biliary cirrhosis develops [26, 28]. World J Surg. We avoid using tertiary references. Unfortunately, it is common for bile duct cancer to come back even after surgery. A few hours following the second ERC procedure, the patient presented with sudden abdominal pain, hypotension and a drop in hemoglobin from 12.2 to 6.6mg/l due to a splenic rupture that was confirmed by the CT scan. Biliary cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow up Traditionally, BDIs have been classified using the Bismuths classification that is based on the location of injury within the biliary tract (Fig. This resulted in control of infection and improvement of general condition of the patient, who was then scheduled for a re-laparotomy with right hepatectomy. The authors declare that they have no competing interests. Bile ducts are the drainpipes that connect your liver, pancreas and gallbladder, allowing bile to digest food and cleanse the organs of waste. First of all, the laparoscopic surgery causes much less discomfort due to the fact that the incisions are smaller and thus quicker to heal. These clinical findings were corroborated by other studies. The first patient sustained an unrecognized, Bismuth type I common bile duct injury (Fig. Researchers have found links between gallstones and obesity. Someone with severe or frequent symptoms may need to have their gallbladder removed. Etiology. Magnetic cholangiopancreatography (MRCP) showing a transected right posterior sectoral duct about 6weeks following left hepatectomy (arrow). It can be difficult for the surgeon to remove a clear margin around bile duct cancersbecause of the position of the bile ducts and their closeness to other organs. Nevertheless, the patient was accepted for surgery due to the significant growth of the tumor (up to 6cm in diameter) which doubled its size within 2years. Contact us Call Now. She remains well at present at 90months post cholecystectomy and 85months following biliary reconstruction. Northover JMA, Terblanche J. Delayed diagnosis of type of injury with an ongoing biliary leak as well as the management in a non-specialized general surgical units are still the main factors affecting the outcome. All the bile that was drained externally (7501000ml/daily) was recirculated back to the gastrointestinal tract together with enteral feeding supplied via a nasojejunal feeding tube. Their treatment and prognosis vary, based on the type, severity . The procedure is done under general anesthesia. taking immunosuppressant medications, as some can result in infections that block the bile duct, abdominal pain, usually in the upper right side, higher than usual levels of alkaline phosphatase, higher than usual levels of liver enzymes, magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiogram (PTCA), endoscopic retrograde cholangiopancreatography (ERCP). It is also commonly referred to as biliary obstruction. You usually have chemotherapy with a drug called capecitabine for 6 months after surgery. Bile contains cholesterol and bile salts that help the gut to digest fats. Article Your doctor will check how well your liver works before your operation. Ann Surg. 5), which impaired the development of collateral circulation within the hilar plate [24]. Referral pattern and timing of repair are risk factors for complications after reconstructive surgery for bile duct injury. 2012;17(2):3844. 2008;22(4):107786. post cholecystectomy pain and nausea 3 months after op, Still sick after gall bladder removal 6 weeks ago, To anyone who has had gallbladder surgery - Biliary stenting. It is most commonly an iatrogenic complication of cholecystectomy (surgical removal of the gallbladder), but can also be caused by other operations or by major trauma. (Fax), Copyright Bile Duct Injury - an overview | ScienceDirect Topics In view of this, surgery was limited to splenectomy, abdominal lavage and drainage. In type III, the injury is located at the confluence with the ceiling of it still being intact whereas type IV involves the destruction of the confluence with the left and right hepatic duct being separated [3]. You need to enable JavaScript to run this website. Ann R Coll Surg Engl. Legumes. 2016;18(9):71825. We have previously described an isolated right posterior BDI sustained during laparoscopic cholecystectomy, when misidentification of the duct draining into the gall bladder, the cystic or common hepatic duct may cause the biliary problem [31]. The pancreatic duct is a tube that runs from the pancreas and connects to the common bile duct just before entering the duodenum. 2014;36(2):1059. However, a laparoscopic procedure performed on the bile duct is rarely conducted by a biliary surgeon. At 57days post cholecystectomy the patient was referred to us with an ongoing bile leak and sepsis. A laparoscopic procedure can also be applied to remove the cyst. 2019; (in press). Bile Duct Surgery: Causes, Symptoms, Diagnosis & Surgical Procedure All rights reserved. SA Khan and others You may wake up in the intensive care unit or a high dependency recovery unit after your operation. 5). your general health. Iatrogenic bile duct injuries (BDIs) are mostly associated with laparoscopic cholecystectomy but may also occur following gastroduodenal surgery or liver resection. Am Surg. This may require placing an additional drain. Herein we report a series of 3 patients with complex BDIs sustained during three different surgical procedures, ie. Fluorescent imaging with Indocyanine green during laparoscopic cholecystectomy in patients at increased risk of bile duct injury. Surgeries . During surgery, the patient required blood transfusion with inotropic support and her condition was unstable. She was discharged home with two abdominal (biliary and jejunostomy) drains, 15days following right hepatectomy. A blockage can sometimes result from an injury that occurs during a medical procedure, such as gallbladder surgery or endoscopy. Your surgeon will talk to you about the risk of the cancer coming back, and help answer any of your questions about the operation. Timeline of complications presenting the sequence of events in the postoperative period of each case. 2006;93(2):15868. No clear-cut guidelines exist to define the timing of biliary repair. Bile duct injuries: spectrum, mechanisms of injury and their prevention. Br J Surg. This is because most people are diagnosed when the cancer has already spread to other parts of the body. A bile duct stone is a gallstone that becomes trapped in the bile duct. Bile duct cancer immunotherapy treatment: What to expect Symptoms may include nausea and vomiting, loss of appetite, and abdominal. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. laparoscopic cholecystectomy, Billroth type II gastric resection and left hepatectomy. The gallbladder stores and releases bile. Choledochal cysts can sometimes cause bile duct obstructions. Complications also become more serious over time, especially when there is a blockage in the bile ducts. The right posterior duct may also originate from the left hepatic duct in about 616% of individuals [32], (Fig. PubMed However, increased incidence in adults has been reported in many case series of both children and adults. Olive oil. In the meantime, a symptomatic fluid collection located in the pouch of Douglas was drained surgically (day 8.) Based on the Todani modification of the Alonso-Lej classification, we found 35 cases of type?I? Many patients experience a case of spontaneous excretion of the stone into the intestine. The postoperative course was complicated by a persistent bile leak via a surgical drain (250350ml/daily). Ogata S, Kianmanesh R, Belghiti J. Doppler assessment after right hepatectomy confirm the need to fix the remnant left liver in the anatomical position. Biliary strictures can be caused by: Any damage done to the bile duct (for example, after gallbladder removal surgery) Passage of gallstones to the bile duct. 2017;24(3):24552. Nutritional approaches to prevention and treatment of gallstones. A PTC drain was left in place for external biliary drainage, together with antibiotic therapy, until clinical and laboratory signs of surgical site infection subsided. The specialist care team looking after you will: Bile duct injuries during laparoscopic cholecystectomy. Difficult iatrogenic bile duct injuries following different types of upper abdominal surgery: report of three cases and review of literature. Biliary injury may lead to several complications and may even cause death if not diagnosed in time and managed properly. Difficult iatrogenic bile duct injuries following different types of upper abdominal surgery: report of three cases and review of literature, https://doi.org/10.1186/s12893-019-0619-0, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. 6). Symptoms may include nausea and vomiting, loss of appetite, and abdominal pain. They also look at how well you are overall. New research shows that immunotherapy can also help treat this form of cancer . Complications after bile duct surgery can be serious. Volume 27, Pages 28-37, Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update Once they occur, the timing of their recognition and a precise diagnosis of type of injury are both essential to plan the treatment properly. The check-up transanastomotic bile drain cholangiogram (b) showing an open hepaticojejunostomy with the contrast flowing from the right posterior sectoral duct into the Roux limb of jejunum. Hepatectomy (Liver Resection) Surgery: Procedure & Recovery The patient was discharged home 21days after biliary reconstruction (181days following the initial surgery). Bile Duct Leaks A small hole anywhere along the bile ducts can cause bile to leak into the abdominal cavity. Br J Surg. Considering a wide diameter of the cystic duct (Fig. Primary biliary cholangitis - Symptoms and causes - Mayo Clinic At Alaska cancer treatment center Far North Surgery, we are committed to providing our patients with advanced surgical procedures in a caring and compassionate environment. Biliary Stricture: Symptoms, Causes, Treatments & Tests - Cleveland Clinic Overview A cholecystectomy (koh-luh-sis-TEK-tuh-me) is a surgical procedure to remove your gallbladder a pear-shaped organ that sits just below your liver on the upper right side of your abdomen. The incidence of choledochal cysts shows significant geographic variation, being higher in the Asian population and reaching up to 1 in 1000. There is a low incidence of complications. PubMed Central Patients suffering from gallstones may have smaller stones that pass from the gallbladder into the bile duct. These are often accompanied by the right hepatic arterial injuries [9, 23] which was also seen in the second of our patients in whom the viability of biliary tree and parenchyma of the right hemi-liver became seriously compromised (Fig. Infected bile ducts (acute cholangitis). The type you have depends on the type of cell the cancer started in, and which part of the bile ductis affected. In such cases, the right posterior sectoral duct is at risk of an injury while left hepatectomy is being done. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Residual lithiasis is the presence of stones in the common bile duct, ignored after one or more biliary interventions. Stewart L, Robinson TN, Lee CM, Liu K, Whang K, Way LW. This helps to avoid long-term complications of the cyst including pancreatitis, cholangitis, choledocholithiasis, biliary cirrhosis and malignant transformation. Stewart L, Way LW. While other causes of bile duct obstructions are not usually preventable, being aware of the risk factors and symptoms means that people can seek medical assistance as soon as they realize there may be a problem. Consensus has established that the best treatment for choledochal cysts is surgical excision whenever possible. Long-term biliary function after reconstruction of major bile duct injuries with hepaticoduodenostomy or hepaticojejunostomy. J Am Coll Surg. If this is not possible (like in tumors located close to the liver hilum), MRCP prior to left hepatectomy may alert the surgeon on biliary anatomical variants at risk for injury. Biliary enteric bypass for benign and malignant disease. 2012;99(8):112936. They differed with regard to the type and mechanism of injury (Bismuth type I, IV and V) [4] with each one requiring an individual treatment strategy (Fig. They will then treat the cancer with a mix of chemotherapy and radiotherapy, depending on its type, size, and location. Ann Surg. Bile duct cancer is often treatable. Gallstone Pancreatitis: Definition, Symptoms & Treatment - Cleveland Clinic Vol 17, Pages 557-588, Capecitabine compared with observation in resected biliary tract cancer (BILCAP): a randomised, controlled, multicentre, phase 3 study 1) [3, 4], no endoscopic and/or radiological therapy is feasible and the patients require surgical remedies [5]. The gallbladder is a digestive system organ that stores and releases bile to digest fat. This is caused by abnormal dilatation of the bile duct. PubMedGoogle Scholar. Iatrogenic biliary injury most commonly occurs by misidentifying the common bile duct for the cystic duct during laparoscopic cholecystectomy [2], with an incidence of 0.3 to 0.7%, which is historically three times higher than in open cholecystectomy. 2008;90(3):2436. Bile duct stones: Symptoms, causes, and treatment - Medical News Today The type of treatment you have depends on the stage of your cancer and your general health. Bile reflux may accompany the reflux of stomach acid (gastric acid) into your esophagus. Biliary strictures: classification based on the principles of surgical treatment. Both of these complications of cholecystitis require emergency surgery to remove the gallbladder. To achieve complete cyst excision, accurate recognition of the beginning and the termination of the cyst is mandatory. Bile duct injury (BDI) represents an important clinical problem in terms of morbidity and mortality following biliary surgery. It's an extremely painful condition. Bile duct cancer is also called cholangiocarcinoma. How do I recognize gallbladder inflammation? The lack of bilirubin in the bile can also cause dark urine and pale stools. Perihilar bile duct cancer develops in the bile ducts just outside the liver, where the right and left hepatic ducts join together. Following surgery, the patient presented with increasing jaundice (bilirubin of 9mg/dl on day 7.) The bile ducts carry bile, secreted by the liver to digest fats, to the gallbladder and small intestine. We will notify our patients if and when our office is affected. Billroth II gastric resection, laparoscopic cholecystectomy and left hepatectomy. Surgery to remove bile duct cancer isnt for everyone. The gallbladder helps the body digest and absorb fat. Surg Endosc. 2005;92(5):5925. Possible problems include bleeding and liver failure. 1995;130(10):11238. Percutaneous transhepatic cholangiogram (PTC) performed 10days following Billroth II gastric resection showing a dilated biliary tree and cystic duct with the abrupt stop of the contrast (arrow) within the common bile duct (a); The check-up cholangiogram (b) performed 3weeks after cholecystoduodenostomy confirming an undisturbed passage of the common hepatic and common bile duct into the duodenum via an open cystic duct and anastomosis between gallbladder neck and the duodenum (arrow). Endoscopic Retrograde Cholangio-Pancreatography: Why And When? We know that it is common to struggle with your mental health when you have cancer or care for someone with cancer. The recovery time is notably shorter as well as return to full functionality. Liver resection and transplantation in the management of iatrogenic biliary injury. Ankylosing Spondylitis Pain: Fact or Fiction, https://medicine.georgetown.edu/divisions/gastroenterology/knowledge/biliary-obstruction, https://surgery.ucsf.edu/conditions--procedures/choledochal-cysts.aspx, http://archive.foundationalmedicinereview.com/publications/14/3/258.pdf, https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones, http://www.cpmc.org/advanced/liver/patients/topics/bileduct-profile.html, Type 2 diabetes: Ultra-processed foods may cancel out benefits of Mediterranean diet, Alzheimer's disease: Testing sense of smell may help identify those at greater risk. Connor S, Garden OJ. Internal scarring is also a lesser risk when it comes to this type of procedure. Bile is a dark-green fluid secreted by the liver to digest fats, and it's stored in the gallbladder. The recovery itself can last as long as 12 weeks. A DASH diet pattern includes these Mediterranean diet foods but also encourages low-fat dairy and the limitation of red meat and sodium. A laparoscopic bile duct bypass treats the condition where the bile drainage is blocked causing bile accumulation in the blood. The risk of biliary injury is higher during laparoscopic cholecystectomy than during open . Surgery to remove distal bile duct cancer usuallyincludes removing: Doctors call this operation a pancreaticoduodenectomy (pank-ree-at-ic-oh dew-oh-den-ek-tom-ee). Strasberg SM, Hertl M, Soper NJ. The authors received no financial support for the research and publication of this article. In such cases, typically classified according to the Bismuth-Strasberg classification (Fig. This can again develop into jaundice, pancreatitis and cancer if untreated. The postoperative course was complicated by an early biliary leak, for which a relaparotomy, abdominal lavage and drainage was performed on postoperative day 4. Samo G, Al-Sarira AA, Ghaneh P, Fenwick SW, Malik HZ, Poston GJ. It is the most often used surgery to treat pancreatic cancer that's confined to the head of the pancreas. Having a gallstone in the bile duct can be intensely. The self-expandable metallic stent was endoscopically removed at 7months following primary surgery. This network of ducts is part of the biliary system. Bile duct cancer is also called cholangiocarcinoma. Older age. Important Note Regarding Appointment Availability - There are different types of bile duct cancer. You need to be generally fit to have this operation. It is a rare type of cancer that develops in the small tubes that connect the liver and gallbladder to the small bowel. Only a small percentage of bile duct cancers are resectable when they're first found. Resolution of Liver Function Tests After Laparoscopic Common Bile Duct 1996;83(10):135660. It also contains a waste product called bilirubin. Provided by the Springer Nature SharedIt content-sharing initiative. Cookies policy. Suite D350 Bile duct injury in the era of laparoscopic cholecystectomy. Bismuth H, Majno PE. 3b). Our general surgeon & surgical oncologist Dr. Madhu Prasad is highly trained and qualified in performing minimally invasive procedures for treating bile duct problems. It may include surgery, chemotherapy and radiotherapy. Another condition pertaining to this area is the appearance of choledocal cysts. Healthcare Digital Marketing by GMR Web Team, Alaska cancer treatment center Far North Surgery, general surgeon & surgical oncologist Dr. Madhu Prasad, what is bariatric surgery and how does it work, Hiatal Hernia Revealed: Causes, Symptoms, Solutions, Pancreatic Cancer: Causes, Symptoms, and Treatment Explained, Recovering from Abdominal Surgery: Essential Dos and DonTs, Understanding the Symptoms, Causes, and Treatment Options of Femoral Hernias, An In-Depth Guide to Inguinal Hernia Surgery, Healthcare Digital Marketing by GMR Web Team, Tumors in the gallbladder, pancreas, bile ducts, or liver, Pain in the upper right side of the abdomen, Cholangiography (X-ray of the bile ducts), Endoscopic retrograde cholangiopancreatography (ERCP), Magnetic resonance cholangiopancreatography (MRCP). On admission, the patient was found jaundiced (serum bilirubin of 5.6mg/dl) with a bile leak (200400ml/daily) and right lobe liver abscesses (Fig. Precise and accurate delineation of the biliary system mandates cholangiography with the advantage of non-invasive magnetic resonance cholangiopancreatography over endoscopic retrograde cholangiopancreatography. Our general surgeon & surgical oncologist Dr. Madhu Prasad is highly trained and qualified in performing minimally invasive procedures for treating bile duct problems. Lubikowski J, Post M, Bialek A, Kordowski J, Milkiewicz P, Wojcicki M. Surgical management and outcome of bile duct injuries following cholecystectomy: a single-center experience. Therefore, the use of a Roux limb is always preferable if the bile duct has been transected completely. The risk of biliary injury is higher during laparoscopic cholecystectomy than during open cholecystectomy. This theory is supported by radiological detection of anomalous pancreaticobiliary duct junction or by a high level of amylase in the cyst fluid. Stones can be removed during an ERCP by using an endoscope. The PTC confirmed a Bismuth type I BDI [3]. Cancer in the bile duct or pancreas. Br J Surg. Causes Complications Overview Bile reflux occurs when bile a digestive liquid produced in your liver backs up (refluxes) into your stomach and, in some cases, into the tube that connects your mouth and stomach (esophagus). Blockage of the pancreatic duct. Nabil Gadelhak, Ahmed Shehta, and Hosam Hamed; Diagnosis and management of choledochal cyst: 20 years of single center experience, Important notification about information and brand names, www.nhs.uk/conditions/bile-duct-cancer/treatment/, Reasons to Avoid Getting Gallbladder Removed, Cholecystectomy: A procedure for abdominal pain, Gallstones natural treatments- a more effective natural remedy than surgery, Gallbladder removal: Recovery and post surgery problems, Cholecystectomy - Laparoscopic Surgery for Gallbladder Removal, Gallbladder Removal Recovery: What You Need To Know If You Are Preparing For Cholecystectomy, Biliary Atresia: Definition, Causes, Symptoms, What To Expect When You Have Your Gallbladder Taken Out, Things You Must Know If You Were Born Without A Gallbladder, Causes And Symptoms Of Gallbladder Problems. Typical hepatic duct confluence (a) with common hepatic duct bifurcation into the right and left hepatic ducts.

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