Bile Duct Injury after Cholecystectomy: Surgical Therapy

Renz, Bernhard W.; Bösch, Florian; Angele, Martin K.

doi:10.1159/000471818

Cited by 75 publications

(64 citation statements)

References 69 publications

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“…It is well agreed that intraoperatively diagnosed partial divisions of bile ducts should be closed by suture and abdominal drains placed in the area [43,44]. In our study, 8 cases of intraoperative BDI were managed by primary defect closure.…”

Section: Discussionmentioning

confidence: 64%

Postcholecystectomy bile duct injuries: evolution of surgical treatment

et al. 2019

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Introduction Bile duct injuries (BDIs) still occur during laparoscopic cholecystectomy. Although management of such complications is challenging, collaboration of a multidisciplinary team and development of treatment methods and materials often lead to the successful treatment. Materials and methods Medical records of 67 patients who have experienced bile duct injures after laparoscopic cholecystectomy were retrospectively reviewed. All injures were classified according to the European Association for Endoscopic Surgery ATOM classification and investigated by manifestation of the injury, surgical repair technique, early and late complications. Results In 28 (41.8 %) patients with partial divisions, the surgical treatment of BDI was completed with endoscopic retrograde cholangiopancreatography (ERCP) and stenting while in 14 (20.1%) cases, the defect of bile duct was closed by suture. End-to-end ductal anastomosis was performed for 6 (13.4%) patients with complete division while 19 (28.3%) patients underwent hepaticojejunostomy. We followed up 58 (92.1%) of 63 patients. The mean follow-up duration was 25.7 (3 - 123) months. Twenty-three (39.7%) patients were found with strictures. Discussion Intraoperative detection and management of BDIs is crucial to achieve good results. The routine intraoperative cholangiography and possibilities of repair by initial surgeons in peripheral hospitals remain controversial. Stenting with a covered self-expanding metal stent is promising for the patients with partial divisions of bile ducts. Initial hepaticojejunostomy is often a preferred treatment for transected bile ducts because of lower rate of anastomosis strictures. However, as end-to-end anastomosis is more physiological, and endoscopy allows successful management of the strictures, we suggest choosing this treatment when possible Recommendation for paperwork content: Classifying bile duct injuries according to the new ATOM classification may be useful in the decision of the most appropriate treatment in each case.

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Section: Discussionmentioning

confidence: 64%

Postcholecystectomy bile duct injuries: evolution of surgical treatment

et al. 2019

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“…Especially these complications tend to be more frequent after laparascopic cholecystectomies (LC), with up to 3% of incidence. [1] One of the most important reason leading to biliary injury during LC is the variant anatomy of extrahepatic bile duct. Stewart-Way classification is the most useful classification for iatrogenic bile duct injuries after LC.…”

Section: Introductionmentioning

confidence: 99%

Posterior Sectoral Biliary Duct Injury During Laparascopic Cholecystectomy: Case Report

Karakas¹

2019

Laparosc Endosc Surg Sci

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Biliary injuries are common after a cholecystectomy. One of the most important reasons for biliary injury during laparoscopic cholecystectomy (LC) is variant anatomy of the extrahepatic bile duct. Described in this report is a rare complication of a LC that included a posterior right sectoral duct injury. A 45-year-old woman was referred with peritonitis, including a large quantity of fluid in the abdomen. She had undergone an LC at a state hospital 14 days before the referral. Pouchography revealed a connection between the site of fluid collection and the posterior sector of the right main bile duct. An exploratory laparotomy revealed a dissected right posterior sector channel. A Roux-en-Y hepaticojejunostomy was constructed with no complication. Surgical experience, training, and maintaining a critical view toward safety are the most important factors to prevent bile duct injuries after LC. Care taken with anatomical variance of the extrahepatic biliary tree is also a key factor in the prevention of iatrogenic biliary injuries. Posterior sector injuries should be kept in mind; however, hepaticojejunostomy is a feasible method to overcome this potential complication after the elimination of any intra-abdominal infection.

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“…a profound knowledge of the interdisciplinary management of these severe postoperative complications [1][2][3][4][5][6]. Each of the medical specialties has its limitations and very special indications regarding the treatment of anastomotic leakages.…”

mentioning

confidence: 99%

“…Furthermore, the surgical treatment options of bile duct injury after cholecystectomy are given by Renz, Bösch and Angele [2]. The diagnosis and treatment of a bile duct injury after cholecystectomy is the domain of endoscopy.…”

mentioning

confidence: 99%

“…The diagnosis and treatment of a bile duct injury after cholecystectomy is the domain of endoscopy. Reoperation is required for the definitive repair of complete dissection or complete obstruction of the bile duct [2]. The special risks associated with laparoscopic bile duct injuries as well as the classification of bile leakages and bile duct obstruction and the principles of surgical management are described in this article [2].…”

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confidence: 99%

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