Management of Major Biliary Complications After Laparoscopic Cholecystectomy

Branum, Gene D.; Schmitt, Colleen M.; Baillie, John; Suhocki, Paul V.; Me, Baker; Davidoff, Andrew M.; Branch, Stan; Chari, Ravi S.; Cucchiaro, Giovanni; Murray, Elizabeth; Pappas, Theodore N.; Cotton, Peter B.; Meyers, William C.

doi:10.1097/00000658-199305010-00014

Cited by 165 publications

(104 citation statements)

References 4 publications

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“…It is necessary that the biliary anatomy is defined including all ductal segments as this information is the most important factor in the success of any operative repair (24). The so-called "isolated segments VI and VII" are suspected if these ducts aren't visualized on cholangiography, and then a CT scan or magnetic resonance cholangiography should be performed (19,38). It has been observed that in the majority of the repairs performed without preoperative cholangiography (96%) or with incomplete cholangiography (69%) then success is reduced significantly (24).…”

Section: Injuries Recognized In the Postoperative Periodmentioning

confidence: 99%

“…These injuries lead to high morbidity, mortality, and prolonged hospitalization (18). If major bile duct injury (MBDI) occurs, then it requires a skilled and experienced hepatobiliary surgeon at a tertiary referral center (19). Collaboration with surgeons, interventional radiologists and gastroenterologists is usually necessary for the care of such injuries.…”

Section: Introductionmentioning

confidence: 99%

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Biliary tract injuries after lap cholecystectomy—types, surgical intervention and timing

Karanikas

Bozali

Vamvakerou³

et al. 2016

Ann. Transl. Med.

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Bile duct lesions, including leaks and strictures, are immanent complications of open or laparoscopic cholecystectomy (LC). Endoscopic procedures have gained increasing potential as the treatment of choice in the management of postoperative bile duct injuries. Bile duct injury (BDI) is a severe and potentially life-threatening complication of LC. Several series have described a 0.5% to 0.6% incidence of BDI during LC. Early recognition and an adequate multidisciplinary approach are the cornerstones for the optimal final outcome. Suboptimal management of injuries often leads to more extensive damage to the biliary tree and its vasculature. Early referral to a tertiary care center with experienced hepatobiliary surgeons and skilled interventional radiologists would appear to be necessary to assure optimal results.

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Section: Injuries Recognized In the Postoperative Periodmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Biliary tract injuries after lap cholecystectomy—types, surgical intervention and timing

Karanikas

Bozali

Vamvakerou³

et al. 2016

Ann. Transl. Med.

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“…At a later stage of the disease, surgical re-exploration is often difficult because of infection, edema, and scarring in the periportal area [2,4,6]. Furthermore, when the leak involves the intrahepatic ducts, hepatic lobectomy is sometimes required [9].…”

Section: Surgical Interventionmentioning

confidence: 99%

Percutaneous Transhepatic Biliary Drainage in the Management of Post-surgical Biliary Leaks

Popat¹,

Thakkar²,

Deshmukh³

et al. 2016

Indian J Surg

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The aim of this study was to evaluate the efficacy of percutaneous transhepatic biliary drainage (PTBD) in the treatment of post-surgical biliary leaks and its efficacy in restoring the integrity of bile ducts. One hundred and fifty-seven patients with a post-surgical biliary leak were treated by means of percutaneous transhepatic biliary drainage. The biliary leak was due to laparoscopic procedures in 114 patients, while 43 patients had postoperative leak following open surgery. Percutaneous transhepatic biliary drainage was performed with an 8-to 10-F catheter, with the side holes positioned proximal to the site of extravasation to divert bile flow away from the leak site. The established biliary leaks at the site of origin were diagnosed at an average of 7 days (range 2-150 days) after surgery. In all cases, percutaneous access to the biliary tree was achieved. In 62 patients, biliary leak completely healed after drainage for 10-50 days (mean, 28 days) while 89 patients underwent surgical reconstruction subsequently. PTBD is a feasible, effective, and safe procedure for the treatment of post-surgical biliary leaks. It is therefore a reliable alternative to surgically repair smaller biliary leaks, while in patients with large defects, it helps prepare patients for surgical reconstruction.

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“…The most common mechanism is the so called 'Classic Injury'. This occurs when the operator misidentifies between the cystic duct and the common bile duct during the dissection of Calot's triangle (23,24,25,26). The bile duct is inadvertently transected and common hepatic duct is dissected upwards up to the hilum.…”

Section: Mechanisms Of Bile Duct Injurymentioning

confidence: 99%

“…The routine use of operative cholangiogram as a preventive measure of bile duct injuries (BDI) is controversial (33,34,35,36). However, there is a consenscious that the use of intra operative cholangiogram (IOC) enhances the chance of detection of BDI (18,20,34,37).…”

Section: F Role Of Operative Cholangiogrammentioning

confidence: 99%

Management and prevention of iatrogenic bile duct injury

Silva¹

2011

Sri Lanka j Surg

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Management of Major Biliary Complications After Laparoscopic Cholecystectomy

Abstract: Successful management of bile duct injury after laparoscopic cholecystectomy requires careful understanding of the mechanisms, considerable preoperative assessment by experts, and a multidisciplinary approach.

Cited by 165 publications

References 4 publications

Biliary tract injuries after lap cholecystectomy—types, surgical intervention and timing

Biliary tract injuries after lap cholecystectomy—types, surgical intervention and timing

Percutaneous Transhepatic Biliary Drainage in the Management of Post-surgical Biliary Leaks

Management and prevention of iatrogenic bile duct injury

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