Iatrogenic Biliary Strictures: Surgical Experience with 39 Patients

Rohde, Luis Augusto; Costa, Mário Sérgio Borges da; Wendt, Luis Roberto; Corleta, Oly Campos; Ferreira, Marcelo Alves

doi:10.1155/1997/84803

Cited by 4 publications

(3 citation statements)

References 20 publications

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“…Our 20 years of experience has produced excellent long-term results in more than 90% of patients, a percentage comparable to the best results in the literature [16,23,31,35]. We have pointed out rigorous diagnostic and therapeutic courses that can lead to the best results on first repair.…”

Section: Late Repairsupporting

confidence: 62%

Surgical Treatment of Iatrogenic Lesions of the Proximal Common Bile Duct

2001

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Between January 1979 and September 1999 a series of 96 patients were operated on at our institution for iatrogenic biliary injuries, and among them 62 involved the proximal biliary tract. Injuries, according to the Strasberg classification, were type E2 in 18 patients, type E3 in 29 patients, and type E4 in 15 patients. The most frequent primary surgical procedures were laparoscopic cholecystectomy in 27 of the 62 patients (43.6%) and open cholecystectomy in 30 patients (48.3%). Previous repair had been attempted in 25 patients (40.3%). A total of 58 cholangiojejunostomies were performed. Repair had been performed directly, and a T-tube had been left in the main bile duct in four patients with E2 Strasberg lesions. Postoperative death occurred in four patients (6.4%). Outcome was graded as excellent, good, or poor depending on clinical symptoms, liver function tests, and the need for reintervention due to anastomotic stricture. The final outcome was evaluated in 54 patients. The mean follow-up was 5.9 +/- 0.3 years, with the longest follow-up 10.2 years. Following our first repair 49 of the 54 patients (90.7%) had excellent results, 1 (1.9%) had good results, and 4 (7.4%) had poor results. None of the patients who underwent immediate or early repair had complications. Diagnostic and therapeutic courses are given on the basis of the type of lesion and the timing of repair. We emphasize the importance of timing (i.e., carrying out surgical repair as soon as possible) and of cholangiojejunostomy reconstruction in respect to defined technical principles. Moreover, we believe that repair treatment at a hepatobiliary center with multidisciplinary competence greatly influences the final long-term outcome.

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Section: Late Repairsupporting

confidence: 62%

Surgical Treatment of Iatrogenic Lesions of the Proximal Common Bile Duct

2001

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“…This is in contrast to the Bismuth classification for post‐surgical BBS. This classification is very useful to guide surgical management but this approach now is largely outdated .…”

Section: Managementmentioning

confidence: 99%

Management of benign biliary strictures: current status and perspective

Kaffes

2015

J Hepatobiliary Pancreat Sci

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Benign biliary strictures are common and occur either from hepato-biliary surgery or from diseases including chronic pancreatitis and primary sclerosing cholangitis, among others. The treatment of many such strictures is endoscopic with evolving new approaches especially with fully covered metal stents. The only classification system available is for postoperative strictures with the intention to guide surgical correction. There is no useful classification system to guide both assessment and management of benign biliary strictures. This proposed classification is relevant to patient care in assisting diagnosis and endoscopic management.

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“…Em termos médios, naquela ocorre em 0,1% e nesta em 0,6%. Ainda é, portanto, seis vezes mais freqüente na CVL e ocorre com mais freqüência na via biliar proximal, sendo mais grave 13,14 . A incidência de vazamento biliar referida na literatura na CL varia consideravelmente.…”

Section: Em Doenças Da Vesícula Biliarunclassified

Cirurgia videolaparoscópica nas doenças biliopancreáticas

Rohde

Freitas²,

Osvaldt³

et al. 2000

Rev. Col. Bras. Cir.

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RESUMO: Com a experiência adquirida na cirurgia da vesícula biliar, a videocirurgia está sendo indicada cada vez mais em outras doenças. Decorridos 15 anos da primeira cirurgia, os autores avaliam os resultados e analisam as perspectivas deste procedimento nas doenças biliopancreáticas. Seguem a proposta que divide este procedimento em procedimentos de rotina, avaliação e desenvolvimento. Nas doenças da vesícula biliar, a colecistectomia laparoscópica é considerada padrão ouro, levando vantagem em todos os itens sobre a laparotômica, excluídas as lesões da via biliar e o vazamento biliar pelo coto cístico. Enfatizam situações especiais: da colecistite aguda, da colecistectomia durante a gravidez, da vesícula em porcelana e do câncer da vesícula. Comentam as perspectivas da videocirurgia nas complicações da colecistectomia laparoscópica. No tratamento da coledocolitíase, consideram o procedimento como em avaliação pela falta de ensaios clínicos prospectivos randomizados com grupo controle comparáveis e acompanhados por prazo de tempo maior. Nas doenças do pâncreas, a videocirurgia é um procedimento em desenvolvimento, com exceção da pancreatite aguda biliar não complicada, que se beneficia com a colecistectomia laparoscópica. O mesmo ocorre com as cirurgias de derivação para desobstrução da via biliar. Embora factíveis dentro dos princípios da cirurgia convencional, faltam estudos comparativos com outras técnicas existentes analisando eficácia e efetividade.A primeira colecistectomia laparoscópica foi realizada em 1985 por Mühe, na Alemanha, sem videocirurgia 1 . A partir de 1987, com Mouret & Dubois 2 , o método passou a ser mais divulgado, substituindo gradativamente a colecistectomia por laparotomia. Nos dias de hoje, a colecistecto-mia videolaparoscópica é considerada o padrão ouro no tratamento da colelitíase 3 .Com a experiência adquirida na cirurgia da vesícula biliar, a videocirurgia está sendo indicada cada vez mais em outras doenças. Decorridos quase 15 anos da primeira cirurgia, é objetivo deste trabalho uma avaliação dos resultados obtidos e uma análise das perspectivas nas doenças biliopancreáticas.

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Iatrogenic Biliary Strictures: Surgical Experience with 39 Patients

Abstract: The authors report their

Cited by 4 publications

References 20 publications

Surgical Treatment of Iatrogenic Lesions of the Proximal Common Bile Duct

Surgical Treatment of Iatrogenic Lesions of the Proximal Common Bile Duct

Management of benign biliary strictures: current status and perspective

Cirurgia videolaparoscópica nas doenças biliopancreáticas

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