Postcholecystectomy biliary leaks in the laparoscopic era: risk factors, presentation, and management

Barkun, Alan N.; Rezieg, M; Mehta, Saurabh; Pavone, E; Landry, Sharon; Barkun, Jeffrey; Fried, Gerald M.; Bret, Patrice M.; Cohen, Albert

doi:10.1016/s0016-5107(97)70270-0

Cited by 140 publications

(92 citation statements)

References 24 publications

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“…No minor leaks significantly affected postoperative hospital stay; in the 4 cases under clinical observation, the bile leak resolved spontaneously within 36-72 h. Exceeding accuracy in dissecting free the cystic duct has been advocated as the main reason for postoperative bile leaks [40]; the method of application of the ultrasonically activated shears for closure-division of cystic duct requires an extended cleaning of this structure and could explain the high incidence of such a complication in the surgeon-in-training series. Comparing overall results to those reported by others, use of ultrasonically activated shears does not seem to reduce the incidence of postoperative bile leaks [6,19,22,44,45].…”

Section: Discussionmentioning

confidence: 44%

Laparoscopic cholecystectomy by ultrasonic dissection without cystic duct and artery ligature

et al. 2003

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No significant difference was found in both patient groups regarding postoperative mortality and complications, biliary complications, and especially cystic duct leaks. A retrospective comparison of literature data showed that use of ultrasonic dissection during LC seems to reduce the risk of BDI. Nevertheless, a learning curve in the use of ultrasonic-activated devices is required: a significant differences in postoperative major complications and biliary complications between the expert and the surgeon-in-training subgroups was shown. Furthermore, ultrasonic scissors misuse may cause bowel injuries in patients with severe adhesions, and this could represent a possible limitation for surgical safety.

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Section: Discussionmentioning

confidence: 44%

Laparoscopic cholecystectomy by ultrasonic dissection without cystic duct and artery ligature

et al. 2003

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“…5 Bile leaks usually arise during the first week after surgery and present with abdominal pain, fever, and tenderness. 6 Subvesical duct leaks follow the cystic duct as the most common cause of postcholecystectomy bile leaks. 7 The duct of Luschka mostly drains into the right and common hepatic ducts, and less frequently drains into the subsegmental ducts, sectoral ducts, and left hepatic duct.…”

Section: Discussionmentioning

confidence: 99%

Temporary Placement of a Newly Designed, Fully Covered, Self-Expandable Metal Stent for Refractory Bile Leaks

Hwang¹,

Kim²,

Yoo³

et al. 2011

Gut Liver

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Bile leaks remain a signifi cant cause of morbidity for patients undergoing laparoscopic cholecystectomy. Leakage from an injured duct of Luschka (subvesical duct) follows the cystic duct as the most common cause of postcholecystectomy bile leaks. Although endoscopic sphincterotomy, plastic-stent placement, or nasobiliary-drain placement are effective in healing biliary leaks, in patients in whom leakage persists and the symptoms worsen despite conventional endoscopic treatment, re-exploration with laparoscopy and ligation of the injured subvesical duct should be considered. We present herein the case of a 31-year-old woman with refractory bile leakage from a disrupted subvesical duct after cholecystectomy that could not be managed with endoscopic sphincterotomy and plastic-stent placement. A newly designed, fully covered, self-expandable metal stent (FC-SEMS) was successfully placed for the treatment of refractory bile leaks in this patient. It appears that temporary placement of an FC-SEMS is technically feasible and provides an effective alternative to surgical therapy for refractory bile leaks after cholecystectomy. (Gut Liver 2011;5:96-99)

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“…The rate of clinically relevant bile leaks after conventional open cholecystectomy ranges between 0.1 and 0.5% [3][4][5][6]. In contrast, biliary leakages have increased in the era of laparoscopic cholecystectomy (LC) by up to 3% [7][8][9][10]. A variety of injuries can occur.…”

Section: Introductionmentioning

confidence: 99%

Bile Duct Injury after Cholecystectomy: Surgical Therapy

Renz¹,

Bösch²,

Angele³

2017

Visc Med

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Background: Iatrogenic bile duct injuries (IBDI) after laparoscopic cholecystectomy (LC), being one of the most common performed surgical procedures, remain a substantial problem in gastrointestinal surgery. The most important aspect regarding this issue is the prevention of IBDI during index cholecystectomy. Once it occurs, early and accurate diagnosis of IBDI is very important for surgeons and gastroenterologists, because unidentified IBDI may result in severe complications such as hepatic failure and death. Laboratory tests, radiological imaging, and endoscopy play an important role in the diagnosis of biliary injuries. Methods: This review summarizes and discusses the current literature on the management of IBDI after LC from a surgical point of view. Results and Conclusion: In general, endoscopic techniques are recommended for the initial diagnosis and treatment of IBDI and are important to classify them correctly. In patients with complete dissection or obstruction of the bile duct, surgical management remains the only feasible option. Different surgical reconstructions are performed in patients with IBDI. According to the available literature, Roux-en-Y hepaticojejunostomy is the most frequent surgical reconstruction and is recommended by most authors. Long-term results are most important in the assessment of effectiveness of IBDI treatment. Apart from that, adequate diagnosis and treatment of IBDI may avoid many serious complications and improve the quality of life of our patients.

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Postcholecystectomy biliary leaks in the laparoscopic era: risk factors, presentation, and management

Cited by 140 publications

References 24 publications

Laparoscopic cholecystectomy by ultrasonic dissection without cystic duct and artery ligature

Laparoscopic cholecystectomy by ultrasonic dissection without cystic duct and artery ligature

Temporary Placement of a Newly Designed, Fully Covered, Self-Expandable Metal Stent for Refractory Bile Leaks

Bile Duct Injury after Cholecystectomy: Surgical Therapy

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