Minimally invasive management of biliary leakage after cholecystectomy

Kulikovsky, Vladimir F.; Yarosh, A L; Karpachev, Aleksandr A.; Солошенко, А. В.; Nikolayev, S. B.; Bitenskaya, Ekaterina Pavlovna; Linkov, N. A.; Gnashko, Angela V.

doi:10.17116/hirurgia2018436-40

Cited by 6 publications

(4 citation statements)

References 6 publications

(8 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Biliary fistulas can often go undetected during surgery regardless of the lesion's nature, with patients experiencing symptoms like abdominal pain, peritonitis, or sepsis postoperatively [15]. In this case, bile in drainage was the only indication.…”

Section: Discussionmentioning

confidence: 94%

“…Alongside decompressing the biliary system, the implantation of a stent serves to seal the defect, functioning as a bridge at the site of extravasation. Endoscopic therapy encompasses procedures such as biliary sphincterotomy in isolation, the insertion of a biliary stent, or the use of nasobiliary drainage, either individually or in combination [15].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Biloma Post-Cholecystectomy: A Prudent “Wait-and-See” Approach

Idrissi,

Younes

2023

OJGas

View full text Add to dashboard Cite

Bile duct injury (BDI) is a well-known complication of cholecystectomy and can lead to the formation of a variety of complications, including biloma. Once diagnosed, the appropriate treatment depends on the severity of the condition and can range from minimally invasive procedures to more invasive procedures. We report the case of a 31-year-old woman who exhibited postoperative bile leakage after a cholecystectomy and a CT scan revealed a left hepatic subcapsular biloma. The patient was managed conservatively with close monitoring. The biloma resolved on its own without any intervention. Bilomas are rare complication of cholecystectomy that can be managed conservatively with a wait and see approach, especially in asymptomatic patients. Close monitoring with imaging and laboratory parameters is crucial in the management of these patients.

show abstract

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Biloma Post-Cholecystectomy: A Prudent “Wait-and-See” Approach

Idrissi,

Younes

2023

OJGas

View full text Add to dashboard Cite

show abstract

“…Етіологія ходів Люшка є предметом дискусій: чи це вроджена аномалія, чи набутий стан [1,7]. Перша теорія припускає, що на ранніх стадіях розвитку плода АХ утворюються з протокової пластинки в атипових ділянках [7]. З іншого боку, щодо набутого стану існують дві різні теорії.…”

Section: рис 6а змінена гетерогенна пз з випотомunclassified

“…З іншого боку, щодо набутого стану існують дві різні теорії. В основному вважається, що підміхурові жовчні протоки є нормальними периферичними жовчними протоками, розташованими у зоні, де паренхіма печінки ревертована внаслідок ремоделювання печінки [7]. Друга теорія передбачає, що субміхурові жовчні протоки виникають внаслідок гіпертрофії паренхіматозних гілок внаслідок попереднього локального запалення [1].…”

Section: рис 6а змінена гетерогенна пз з випотомunclassified

A Case of Intraoperative Discovery of Aberent Subvesical Bile Duct During Laparoscopic Cholecystectomy

Filip¹,

Skrypynets²,

Voronych³

et al. 2023

Scientific and practical journal

View full text Add to dashboard Cite

Introduction. Subvesical bile ducts (Lyushka ducts) are tubular aberrant anatomical anomalies of the biliary tree, in which the intrahepatic bile ducts drain into the lumen of the gallbladder at different levels. According to various sources, this variant of the anatomical architecture of the bile ducts occurs in 1.7 - 3% of clinical cases. The relevance of knowing the anatomical features of the biliary tree is due to the fact that routine preoperative methods of examination in most cases do not allow to verify them, and unnoticed damage to such courses at the stage of extraction of the bile duct can lead to intraoperative and postoperative complications. Therefore, knowledge of the presence of such anatomical options is a condition for safe laparoscopic cholecystectomy (LC). Goal. To represent a clinical case of aberrant subvesical bile duct during LC. Presentation of a clinical case. The 41-year-old patient was hospitalized for acute biliary pancreatitis of mild severity according to the Ranson scale against the background of gallstone disease. In cooperation with related specialists, the patient underwent complex conservative treatment according to the updated recommendations for the management of acute pancreatitis (AP). After the normalization of basic laboratory indicators, exclusion of local parapancreatic complications, the patient was prepared for LC. Intraoperatively, a subvesical aberrant bile duct with a diameter of 1 mm was found, connecting the lumen of the gallbladder with the intrahepatic ducts of the IV segment of the liver. Coagulation of the bilious source was performed. A diagnostic tubular drainage was installed. No complications were observed in the early and late postoperative period. Discussion. Subvesical bile ducts, or "Lyushka's ducts" - anatomical variants of biliary tracts that flow directly into the gallbladder, perforating its wall at different levels. The etiology of Lyushka's movements is a subject of debate. The first theory describes them as an embryological abnormality of development in the early stages of embryogenesis. In our clinical case, it is quite likely that subvesical bile ducts could have arisen according to the second theory - hypertrophy of parenchymal branches as a result of previous local inflammation against the background of chronic cholecystitis and periodic exacerbation of cryptogenic hepatitis. Due to their small size, these movements can go unnoticed, causing various postoperative complications. Therefore, such ducts are of great clinical importance for surgeons. Their preoperative identification is often impossible, so they can be damaged intraoperatively. Bile leakage due to damage to aberrant ducts usually manifests itself clinically within the first postoperative week. In severe cases, the development of biliary peritonitis with subsequent sepsis is possible. In our case, cholelithiasis from the subvesical course was eliminated by coagulation. In cases of postoperative complications, according to the literature, endoscopic methods are the main method of treatment. A repeat laparotomy is very rarely necessary. Conclusions. Aberrant subvesical bile ducts are extremely rare and may be overlooked during hepatobiliary operations. Their damage occurs at the stage of separation of the ZHM from its bed and is therefore inevitable. Knowledge of their existence, intraoperative vigilance and delicate surgical technique allow to identify and timely prevent the development of complications.

show abstract

Analysis of reasons for reoperations in patients after cholecystectomy

Matveev,

Baradulin,

Dmitriev

et al. 2024

Ann. hir. gepatol.

View full text Add to dashboard Cite

Aim. To study reoperations after cholecystectomy in terms of their incidence, reasons, peculiarities and their significance when evaluating quality of medical care for patients with cholecystolithiasis. Materials and methods. Cholecystectomy was performed in 1272 cases, repeated interventions – in 18 (1.4 %). The study involved determination of their structure, peculiarities, terms, and outcomes, as well as stratification of their severity. The electronic database of the clinic for 2016–2022 was used for the study. Results. 1101 operations (86.6 %) were performed laparoscopically, 171 cases (13.4 %) involved open surgery. Repeated laparoscopic and open surgeries were performed in 10 (0.9 %) and 8 (4.8 %) cases. Following cholecystectomy, 11 patients (61.1 %) underwent surgery for chronic cholecystitis, 7 (38,9 %) – for acute cholecystitis; laparoscopy was used in 11 cases, traditional intervention – in 7. The reasons for repeated interventions included bleeding – in 11 cases (0.8 %), bile leakage – in 4 (0.31 %), and purulent-septic complications – 3 (0.23 %). In order to stop bleeding, theoperation was performed in 18 hours on average. No fatal outcomes reported. Conclusion. The sufficient experience of the clinic in providing medical care to patients with cholecystolithiasis was proven by the prevalence of laparoscopic cholecystectomy, acceptable incidence of reoperations, as well as their timely and adequate performance.

show abstract

Minimally invasive management of biliary leakage after cholecystectomy

Abstract: Complex application of minimally invasive surgical interventions for extrahepatic bile ducts injury after cholecystectomy reduces likelihood of redo biliary surgery and may be independent treatment in some cases.

Cited by 6 publications

References 6 publications

Biloma Post-Cholecystectomy: A Prudent “Wait-and-See” Approach

Biloma Post-Cholecystectomy: A Prudent “Wait-and-See” Approach

A Case of Intraoperative Discovery of Aberent Subvesical Bile Duct During Laparoscopic Cholecystectomy

Analysis of reasons for reoperations in patients after cholecystectomy

Contact Info

Product

Resources

About