Major Bile Duct Injuries During Laparoscopic Cholecystectomy

Lillemoe, Keith D.; Martin, Scot A.; Cameron, John L.; Yeo, Charles J.; Talamini, Mark A.; Kaushal, Sunjay; Coleman, Jo Ann; Venbrux, Anthony C.; Savader, Scott J.; Osterman, Floyd A.; Pitt, Henry A.

doi:10.1097/00000658-199705000-00003

Cited by 196 publications

(53 citation statements)

References 34 publications

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“…In a review of 18 patients who had immediate repair of the biliary injury sustained during laparoscopic cholecystectomy, the failed operative procedures resulted in progression of the biliary injury and development of biliary fibrosis and hepatic lobar atrophy [17]. The importance of these injuries being managed by an experienced surgeon is universally accepted [17, 18]. In a study of 88 patients sustaining bile duct injury, repair by the primary surgeon was successful in only 17% of cases, whereas repair by tertiary care biliary surgeons resulted in a 94% success rate [18].…”

Section: Discussionmentioning

confidence: 99%

“…The importance of these injuries being managed by an experienced surgeon is universally accepted [17, 18]. In a study of 88 patients sustaining bile duct injury, repair by the primary surgeon was successful in only 17% of cases, whereas repair by tertiary care biliary surgeons resulted in a 94% success rate [18]. End-to-end anastomosis of the transected bile duct, as had been performed in 2 of our patients, is an operation which has a high chance of failure due to ischemia of the cut ends of the bile duct and has a high failure rate.…”

Section: Discussionmentioning

confidence: 99%

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Reoperative Surgery for Postcholecystectomy Bile Duct Injuries

et al. 2002

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Background: Surgical repair for a postcholecystectomy bile duct injury can be complicated by the development of an anastomotic stricture which necessitates re-intervention. The authors reviewed their experience with patients requiring re-operation after unsuccessful surgical repair of the bile duct injury, to analyze the possible causes of the failure of the operative procedure and the long-term outcome following revisional surgery. Methods: Retrospective analysis of the records of 41 patients referred to a tertiary care center for the management of recurrent stricture following surgical repair performed for a postcholecystectomy bile duct injury. Results: Before referral, 69 operative procedures had been performed on these 41 patients. Factors likely to be associated with increased chances of failure of the biliary reconstructive procedures included presentation with cholangitis after the biliary injury, no cholangiographic study before the surgical repair and surgical intervention within 3 weeks of the injury. Thirty-seven (90%) patients were found to have strictures at or above the level of confluence of right and left hepatic ducts, while at the time of the index repair only 12 (29%) patients had an injury at that level. Revisional surgery in all the patients was a Roux-en-Y hepaticojejunostomy. One patient died, 2 patients with multiple previous operations developed recurrence and needed intervention again. Over a mean follow-up period of 4.2 years, 90% patients had a satisfactory outcome. Conclusion: Development of recurrent stricture following surgical repair of a postcholecystectomy biliary injury can be related to the technique and timing of the surgical procedure, the complication may therefore be avoidable in some patients. In experienced hands the results of revisional surgery are good but are adversely affected as the number of previous repairs increases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reoperative Surgery for Postcholecystectomy Bile Duct Injuries

et al. 2002

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“…Although the Hepp-Couinaud reconstruction appears to offer some advantages, it has never been tested in a comparative trial; on the other hand, it cannot be used in all injuries. Bismuth type V injuries would require separate duct anastomoses [26, 27] and sometimes hepatic resection [28]. Lillemoe et al [26] have described a technique similar to that used for a left-sided approach, by resecting the base of the gallbladder fossa, exposing the right ducts to allow separate anastomoses to be fashioned.…”

Section: Introductionmentioning

confidence: 99%

“…Bismuth type V injuries would require separate duct anastomoses [26, 27] and sometimes hepatic resection [28]. Lillemoe et al [26] have described a technique similar to that used for a left-sided approach, by resecting the base of the gallbladder fossa, exposing the right ducts to allow separate anastomoses to be fashioned. Regardless of the potential superiority of one technique over the other, however, the most important prognostic factor of morbidity and long-term functional outcome after biliary reconstruction is probably the surgeon.…”

Section: Introductionmentioning

confidence: 99%

Vascular Injuries in Laparoscopic Cholecystectomy: An Underestimated Problem

Tzovaras

Dervenis²

2006

Dig Surg

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Background: Bile duct injury is a severe complication of laparoscopic cholecystectomy and many reports focus on this topic, especially regarding the long-term success of repair of these injuries. There is some concern, however, as to whether concomitant vascular injuries can jeopardize reconstruction of a bile duct injury following laparoscopic cholecystectomy. Methods: A review of the current literature on the clinical significance and management of a concomitant vascular injury to the outcome of reconstruction of bile duct injuries following laparoscopic cholecystectomy. Relevant articles were extracted through PubMed, with secondary references obtained from key articles. Results: Although the relevant literature is generally poor, there is a trend of appearance of relatively large series on the topic over the last five years, as opposed to case reports or small series during the previous decade. Conclusion: The disruption of the hepatic arterial flow during laparoscopic cholecystectomy is usually well tolerated in an otherwise healthy patient. There is strong evidence that concomitant vascular injuries do not have any impact on mortality after biliary reconstruction. There is also evidence that does increase overall morbidity, but when it comes specifically to long-term anastomotic stricture formation, there is no strong evidence to support a negative impact of a concomitant vascular injury; this is especially true for centers/surgeons with HPB interest.

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“…The use of preoperative PTCD is still controversial. Some centers use PTCD as a standard procedure in all cases of major bile duct injuries to perform surgery on an elective base [12]. 290 However, there is no evidence generally supporting the standard use of PTCD in all cases [13].…”

Section: Diagnostic Proceduresmentioning

confidence: 99%