Classification and management of bile duct injuries

Abstract

To review the classification and general guidelines for treatment of bile duct injury patients and their long term results. In a 20-year period, 510 complex circumferential injuries have been referred to our team for repair at the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" hospital in Mexico City and 198 elsewhere (private practice). The records at the third level Academic University Hospital were analyzed and divided into three periods of time: GⅠ-1990-99 (33 cases), G Ⅱ-2000-2004 (139 cases) and GⅢ-2004-2008 (140 cases). All patients were treated with a Roux en Y hepatojejunostomy. A decrease in using transanastomotic stents was observed (78% vs 2%, P = 0.0001). Partial segment Ⅳ and Ⅴ resection was more frequently carried out (45% vs 75%, P = 0.2) (to obtain a high bilioenteric anastomosis). Operative mortality (3% vs 0.7%, P = 0.09), postoperative cholangitis (54% vs 13%, P = 0.0001), anastomosis strictures (30% vs 5%, P = 0.0001), short and long term complications and need for reoperation (surgical or radiological) (45% vs 11%, P = 0.0001) were significantly less in the last period.The authors concluded that transition to a high volume center has improved long term results for bile duct injury repair. Even interested and tertiary care centers have a learning curve.

Management of Post-Cholecystectomy Benign Bile Duct Strictures: Review

“…Compared with earlier reports, where the mortality ranged from 5% to 8% [62,63], in the last decade there has been a considerable decline in the operative mortality with many large series reporting zero perioperative deaths [64][65][66][67]. Considering that these results are from tertiary care centers where more severe injuries would be referred, usually after one or more previous attempts at repair, surgical reconstruction is a safe procedure in experienced hands.…”

Serie de Casos: Manejo de Lesión Iatrogénica de Vía Biliar en el Hospital José Carrasco Arteaga.

“…Estudios indican que la VCS es la forma más segura y difundida para disminuir la probabilidad de lesión de vía biliar durante la colecistectomía laparoscópica y debe ser asumida en forma sistemática y rutinaria, en comparación con la colangiografía intraoperatoria y la ecografía laparoscópica [14].…”

“…Como lo demostraron varios estudios el uso de esta técnica ha llevado a mejores resultados, destacan también los factores de buen pronóstico para una anastomosis bilioentérica: A. menor uso de endoprótesis transhepáticas, B. Resección del segmento IV con anastomosis intrahepática, C. Anastomosis amplia, D. Conductos bien vascularizados, E. Drenaje completo del árbol biliar, F. Uso de material de sutura adecuado con nudos por fuera de la anastomosis y G. Ausencia de lodo o litos biliares [13,14].…”

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“…In the last decade, with perfected surgical techniques and management of biliary strictures addressed, there is a considerable decrease in operative mortality with many consistent series reporting zero perioperative deaths (Mercado, et al, 2011). Risk factors adversely affecting the survival rate are age, repeated reconstructive surgery, significant comorbid medical condition, sepsis, bile, and secondary biliary cirrhosis.…”