Endoscopic and Surgical Management of Iatrogenic Biliary Tract Injuries

Abstract

BACKGROUND: Iatrogenic biliary tract injury (BTI) is a rare complication but has high risks of morbidity and mortality when it is not early noticed. Although the treatment varies depending on the size of injury and the time until the injury is noticed, endoscopic and percutaneous interventions are usually sufficient. However, it should be remembered that these interventions may cause major complications in the following years, such as biliary stricture, recurrent episodes of cholangitis and even cirrhosis. In this paper, we aimed to present our approach to BTI following cholecystectomy and our treatment management in the light of the literature. METHODS:The medical records of 105 patients who were treated for BTI between January 2015 and July 2019 were evaluated retrospectively. The majority of the patients consisted of the patients who underwent cholecystectomy at an external medical center and were referred to our clinic due to biliary leakage (BL). Patients were grouped according to Strasberg classification determined by the place of leakage. RESULTS:Among 105 patients included in this study, 55 were male, and 50 were female. Mean age was 55.2 ±16.26 years (range, 21-93 years). According to Strasberg classification, type A, B, C, D and E injuries were detected in 57, 1, 3, 29 and 15 patients, respectively. Eighty-five patients were successfully treated with endoscopic and percutaneous interventions, while 20 patients underwent surgery. CONCLUSION:In all patients with suspected BTI, a detailed screening and appropriate treatment provide a significant decline in morbidity and mortality. Therefore, early diagnosis is very important for both early and late outcomes.

Management of hepatic artery trauma during hepato-pancreato-biliary procedures: Evolving approaches, clinical outcomes, and literature review

“…On the other hand, in our series consisting of patients referred to our hospital due to biliary tract trauma, primary repair was performed in cases with additional arterial trauma during dissection. [ 12 ] After the reconstructions, the continuity of the HA blood flow was checked with pulsation control. Doppler USG, which is frequently used in the literature and can show the degree and limitation of liver perfusion, could not be used.…”

Is subtotal cholecystectomy safe and feasible? Short‐ and long‐term results

“…Although cholecystectomy is usually considered as an “easy” procedure, it can be arduous in such situations, and the incidences of some rare postcholecystectomy complications may also increase. Biliary duct injury, major vessel injury, or damage to surrounding tissues after cholecystectomy are the most feared complications associated with high morbidity and early mortality 1 . Therefore, in cases where dissection of hepatocystic (Callot) triangle is difficult or impossible due to inflammation, adhesions, or obscured anatomy, SC which is mostly considered as a damage control surgery may be preferred rather than TC.…”

“…Cholecystectomy is still the gold standard treatment for symptomatic gallstones and one of the most common surgical procedures performed by surgeons. However, some major complications such as bile duct injury (BDI), bile leak, and vessel injury may develop 1 . These unpleasant conditions may lead to repeated surgical interventions, long recovery period, decreased quality of life, and even death 2 …”