Advantages of multidisciplinary management of bile duct injuries occurring during cholecystectomy

Nuzzo, Gennaro; Giuliante, Felice; Giovannini, Ivo; Murazio, Marino; D’Acapito, Fabrizio; Ardito, Francesco; Vellone, Maria; Gauzolino, Riccardo; Costamagna, Guido; Stasi, Carmine Di

doi:10.1016/j.amjsurg.2007.05.046

Cited by 74 publications

(59 citation statements)

References 18 publications

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“…[2][3][4][5][8][9][10][11][12] Few studies have reported a standard treatment for biliary strictures after BDI, and most surgeons treated this condition according to their own experience and preference. 3,[13][14][15] Patients always missed proper treatment in the initial operation or in the early postoperative time.…”

Section: Discussionmentioning

confidence: 99%

“…However, for most strictures after BDI such as cases in our study, RYHJ is the standard treatment and the longterm clinical success rate is as high as 70-90%. 3,[8][9][10][11][12] Some patients who undergo RYHJ for BDI may experience incapacitating biliary symptoms, such as jaundice or recurrent cholangitis. 30 However, in addition to anastomotic strictures, RYHJ failure may be attributed to several other isolated or associated pathogenic factors including intrahepatic calculi, intrahepatic stricture, and improper technical construction of the Roux-en-Y limb.…”

Section: Liu H Et Al Int Surg J 2015 May;2(2):179-186mentioning

confidence: 99%

“…6,7 There are controversies over optimal strategy for surgical management of BDI, especially for biliary strictures after BDI. Biliary reconstruction and Roux-en-Y hepaticojejunostomy (RYHJ) are believed to be the choice of treatment in most cases, 3,[8][9][10][11][12] but few reports have specifically analyzed the outcomes. The purpose of this study was to determine the ABSTRACT Background: There are controversies over the optimal surgical strategy for the management of complicated biliary strictures after Bile Duct Injury (BDI).…”

Section: Introductionmentioning

confidence: 99%

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Biliary reconstruction and Roux-en-Y hepaticojejunostomy for the management of complicated biliary strictures after bile duct injury

et al. 2015

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INTRODUCTIONBile Duct Injury (BDI) remains to be a serious complication of biliary surgery. The reported incidence of major BDI is about 0.5% [1][2][3][4][5] and is still on the rise with the advent of laparoscopic techniques, seriously affecting the patient's quality of life. 6,7 There are controversies over optimal strategy for surgical management of BDI, especially for biliary strictures after BDI. Biliary reconstruction and Roux-en-Y hepaticojejunostomy (RYHJ) are believed to be the choice of treatment in most cases, 3,[8][9][10][11][12] but few reports have specifically analyzed the outcomes. The purpose of this study was to determine the ABSTRACT Background: There are controversies over the optimal surgical strategy for the management of complicated biliary strictures after Bile Duct Injury (BDI). The purpose of this study is to investigate the efficacy of biliary reconstruction and Roux-en-Y hepaticojejunostomy (RYHJ) for this condition. Methods: Included in this single-center retrospective clinical study were 10 patients with the diagnosis of BDIassociated biliary strictures between July 2010 and July 2013. Results: The 10 patients included 6 women (60%) ranging in age from 26 to 64 years with a mean of 48.6 years. They were patients who failed in repeated conservative, interventional, endoscopic therapies in other hospitals. The interval between the initial operation causing BDI and this operation in our hospital was less than 3 months in 2 patients, less than 6 months in 2 patients, and more than a year in 3 patients. According to the Strasberg classification of BDI, there were 3 cases of type E2, 1 case of type E3, 6 cases of type E4, one patient with type E2 also had right hepatic duct injury besides common bile duct injury. All the 10 patients received biliary reconstruction and RYHJ based on their bile duct conditions. The non-traumatic technique was used in all cases, knowing that the diameter of the bile duct reconstructed was about 1.5 to 3cm. Two patients received segment I hepatectomy; 3 patients received biliary supporting tube placement during operation, which was removed 6 months after operation; and 3 patients received reconstruction of the hepaticojejunostomy anastomosis. All patients recovered well after a mean length of postoperative hospital stay of 9.2 days (range 7 to 13 days). By July 2013, the patients has been followed up for a mean of 19.9 months (range 4 to 36 months), during which no incisional complication, hemorrhage, bile leak, biliary re-stricture, acute pancreatitis, acute cholangitis, or cystic artery pseudoaneurysm occurred in any patients. The level of serum total bilirubin and conjugated bilirubin remained within the normal range. Conclusions: According to the Strasberg classification and the bile duct condition, appropriate biliary reconstruction and RYHJ for BDI-related biliary strictures can bring good outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Liu H Et Al Int Surg J 2015 May;2(2):179-186mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Biliary reconstruction and Roux-en-Y hepaticojejunostomy for the management of complicated biliary strictures after bile duct injury

et al. 2015

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“…Traditionally benign biliary strictures in CP are treated by surgery, but as with all surgeries the procedure is invasive and can involve significant morbidity especially if patients have other accompanying co-morbidities such as CP and/or liver disease. Morbidity and mortality of surgical treatment of post-operative biliary strictures is low, with mortality rates ranging from 0%-2.2%, whereas post-operative morbidity rates approaching almost 43% in some studies [74][75][76] . The multiple stent placement technique was initially popularized by Costamagna et al [40] for the treatment of postoperative strictures.…”

Section: Stricturesmentioning

confidence: 99%

Endoscopic management of chronic pancreatitis

Oza

Kahaleh²

2013

WJGE

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Chronic pancreatitis (CP) is a common gastrointestinal illness, which affects the quality of life with substantial morbidity and mortality. The management includes medical, endoscopic and surgical approaches with the need for interaction between various specialties, calling for a concerted multidisciplinary approach. However, at the time of this publication, guidelines to establish care of these patients are lacking. This review provides the reader with a comprehensive overview of the studies summarizing the various treatment options available, including medical, surgical and endoscopic options. In addition, technological advances such as endoscopic retrograde cholangiopancreatogrophy, endoscopic shock wave lithotripsy and endoscopic ultrasound can now be offered with reasonable success for pancreatic decompression, stricture dilatation with stent placement, stone fragmentation, pseudocyst drainage, and other endoscopic interventions such as celiac plexus block for pain relief. We emphasize the endoscopic options in this review, and attempt to extract the most up to date information from the current literature. The treatment of CP and its complications are discussed extensively. Complications such as biliary strictures. pancreatic pseudocysts, and chronic pain are common issues that arise as long-term complications of CP. These often require endoscopic or surgical management and possibly a combination of approaches, however choosing amongst the various therapeutic and palliative modalities while weighing the risks and benefits, makes the management of CP challenging. Treatment goals should be not just to control symptoms but also to prevent disease progression. Our aim in this paper is to advocate and emphasize an evidence based approach for the management of CP and associated long term complications.

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“…However, even in a high volume biliary surgery center with extensive experience, the incidence of stricture after repair surgery of BDI still reaches 10-20% (23,24). Only 1/3-1/2 of BDI can be diagnosed in time, more than 70% of BDI is initially repaired by surgeons who do not specialize in such repair surgery (25,26).…”

Section: Introductionmentioning

confidence: 99%