Long-term Results of a Primary End-to-end Anastomosis in Peroperative Detected Bile Duct Injury

Reuver, Philip R. de; Busch, Olivier R.; Rauws, E. A. J.; Laméris, Johan S.; Gulik, T.M. van; Gouma, Dirk J.

doi:10.1007/s11605-007-0087-1

Cited by 68 publications

(64 citation statements)

References 28 publications

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“…If the defect is limited or absent, an end-to-end biliary anastomosis on a drain may be performed. DeReuver reported 91% stricture free results at 7 years follow up in 56 patients after end-to-end anastomosis (13). If the surgeon is not comfortable with the injury, drainage of the hepatic pedicle and sub-hepatic region should be performed, and patient transferred to a tertiary center (14,15).…”

Section: Discussionmentioning

confidence: 99%

Bile duct injuries after laparoscopic cholecystectomy: 11-year experience in a tertiary center

Martin¹,

Uldry²,

Demartines³

et al. 2016

BST

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Section: Discussionmentioning

confidence: 99%

Bile duct injuries after laparoscopic cholecystectomy: 11-year experience in a tertiary center

Martin¹,

Uldry²,

Demartines³

et al. 2016

BST

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“…Most of the injuries (result of the combination of ischemic injury and/or loss of substance) do not allow a tension free, well vascularized anastomosis (as is the case of liver transplantation). The result is early dehiscence and/or fistulization with late stenosis that in some cases in experienced groups has a good long term outcome [26] . Hepatoduodenostomy also has the same disadvantages.…”

Section: Institutional Experiencementioning

confidence: 99%

Classification and management of bile duct injuries

Mercado¹

2011

WJGS

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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.

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“…Proponents, on the other hand, proposed T-tube repair if there is no segmental loss of the bile duct [27,28]. In addition to simplicity of the technique, strictures following T-tube repair is salvageable either by radiological intervention or revision surgery, in the form of HJ without much difficulty [28]. Simple ligature around the CBD, in our opinion, devitalizes lesser segment of the bile duct compared to transected one.…”

Section: Discussionmentioning

confidence: 99%

“…End-to-end repair of transected CBD over the T-tube is associated with a high failure rate, hence not recommended by some authors [5,26]. Proponents, on the other hand, proposed T-tube repair if there is no segmental loss of the bile duct [27,28]. In addition to simplicity of the technique, strictures following T-tube repair is salvageable either by radiological intervention or revision surgery, in the form of HJ without much difficulty [28].…”

Section: Discussionmentioning

confidence: 99%

Management of Bile Duct Injury at Various Stages of Presentation: Experience from a Tertiary Care Centre

et al. 2012

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The clinical presentation, management and outcome of all patients with bile duct injury who presented to our tertiary care centre at various stages after cholecystectomy were analyzed. The patients were categorized into three groups: group A-patients in whom the injury was detected during cholecystectomy, group B-patients who presented within 2 weeks of cholecystectomy and group C-patients who presented after 2 weeks of cholecystectomy. Our team acted as rescue surgeons and performed 'on-table' repair for injuries occurring in another unit or in another hospital. Strasberg classification of bile duct injury was followed. In group A, partial and complete transections were managed by repair over T-tube and high hepaticojejunostomy, respectively. Patients in group B underwent endoscopic retrograde cholangiogram and/ or magnetic resonance cholangiogram to evaluate the biliary tree. Those with intact common bile duct underwent endoscopic papillotomy and stenting in addition to drainage of intraabdominal collection when present. For those with complete transection, early repair was considered if there was no sepsis. In presence of intra-abdominal sepsis an attempt was made to create controlled external biliary fistula. This was followed by hepatico jejunostomy at least after 3 months. Group C patients underwent hepaticojejunostomy at least 6 weeks after the injury. The outcome was graded into three categories: grade A-no clinical symptoms, normal LFT; grade B-no clinical symptoms, mild derangement of LFT or occasional episodes of pain or fever; grade C-pain, cholangitis and abnormal LFT; grade D-surgical revision or dilatation required. Fifty nine patients were included in the study and the distribution was group A-six patients, group B-33 patients and group C-20 patients. In group A, one patient with complete transection of the right hepatic duct (type C) and partial injury to left hepatic duct (LHD) underwent right hepaticojejunostomy and repair of the LHD over stent. Two patients with type D and three patients with type E 2 injury underwent repair over T-tube and hepaticojejunostomy, respectively. In group B, all except one of the 18 patients with type A injury underwent endoscopic papillotomy and stenting. The bile leak subsided at a mean interval of 8 days in all, except one patient who died of fulminant sepsis. Of the 15 patients with type E injury, five underwent hepaticojejunostomy after a minimum gap of 3 months. Early repair was considered in 10 patients. Twenty patients in group C underwent hepaticojejunostomy. In a mean follow-up of 40 months, the outcome was grade A in 54 patients, grade B in three patients (one from each of the three groups) and grade D in one patient (group C). The latter patient with a type E3 injury developed recurrent stricture and cholangitis necessitating percutaneous transhepatic dilatation. The high success rate of bile duct repair in the present study can be attributed to the appropriate timing, meticulous technique and the tertiary care experience.Keywords Cholecystect...

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Long-term Results of a Primary End-to-end Anastomosis in Peroperative Detected Bile Duct Injury

Cited by 68 publications

References 28 publications

Bile duct injuries after laparoscopic cholecystectomy: 11-year experience in a tertiary center

Bile duct injuries after laparoscopic cholecystectomy: 11-year experience in a tertiary center

Classification and management of bile duct injuries

Management of Bile Duct Injury at Various Stages of Presentation: Experience from a Tertiary Care Centre

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