Specialist Early and Immediate Repair of Post-laparoscopic Cholecystectomy Bile Duct Injuries Is Associated With an Improved Long-term Outcome

Perera, M Thamara P R; Silva, Michael A.; Hegab, Bassem; Muralidharan, Vijayaragavan; Bramhall, Simon R.; Mayer, A. D.; Buckels, J. A. C.; Mirza, Darius F.

doi:10.1097/sla.0b013e318208fad3

Cited by 101 publications

(104 citation statements)

References 29 publications

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“…In one study, only 17 % of the repair was successful in the hands of primary surgeons compared to 94 % when performed by tertiary care surgeons [5]. Similar results have also been reported by other authors [6]. We managed six patients (group A) in whom the injury was detected during cholecystectomy.…”

Section: Discussionsupporting

confidence: 65%

“…Notwithstanding the conventional practice, some recent studies have highlighted the role of early repair of BDI in a select group of patients [6,24,25]. The result of early repair was comparable to the delayed approach in a stable patient in whom intra-abdominal sepsis, vascular and cautery injury could be excluded and more importantly when the surgery was performed by 'specialist hepatobiliary surgeon'.…”

Section: Discussionmentioning

confidence: 99%

“…Proper identification of the injury, appropriate timing, technique of repair and experience of the surgeon are paramount in the management of these patients. Some of the recent studies have laid much emphasis on repair by specialist hepatobiliary surgeons and considered this to be one of the most important factors in the successful outcome of BDI [5][6][7]. The present study is a retrospective analysis of all patients with BDI who presented to us during or at a variable period after the index cholecystectomy.…”

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confidence: 99%

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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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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

et al. 2012

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“…12,14,15 In this series, early repair within 3 weeks was associated with the lowest incidence of major complications, as reported in some other series also. 16 Patients with late repairs and repeat surgeries were associated with significantly higher incidence of major complications though timing of repair was not an independent predictor of outcome.…”

Section: Discussionmentioning

confidence: 99%

Predictors of outcome after reconstructive hepaticojejunostomy for post cholecystectomy bile duct injuries

Gomes¹

2015

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“…If this confirms the diagnosis, immediate repair may be performed in specialist hepatobiliary centers 1 See comment in PubMed Commons below (54). Strasberg type E injuries should be treated with hepaticojejunostomy (55)(56)(57)(58)(59).…”

Section: C) What Is the Management Of Biliary Injuries Diagnosed Intrmentioning

confidence: 99%

Prevention and acute management of biliary injuries during laparoscopic cholecystectomy: Expert consensus statement

Abbasoğlu¹,

Tekant²,

Alper³

et al. 2016

UCD

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Gallstone disease is very common and laparoscopic cholecystectomy is one of the most common surgical procedures all over the world. Parallel to the increase in the number of laparoscopic cholecystectomies, bile duct injuries also increased. The reported incidence of bile duct injuries ranges from 0.3% to 1.4%. Many of the bile duct injuries during laparoscopic cholecystectomy are not due to inexperience, but are the result of basic technical failures and misinterpretations. A working group of expert hepatopancreatobiliary surgeons, an endoscopist, and a specialist of forensic medicine study searched and analyzed the publications on safe cholecystectomy and biliary injuries complicating laparoscopic cholecystectomy under the organization of Turkish Hepatopancreatobiliary Surgery Association. After a series of e-mail communications and two conferences, the expert panel developed consensus statements for safe cholecystectomy, management of biliary injuries and medicolegal issues. The panel concluded that iatrogenic biliary injury is an overwhelming complication of laparoscopic cholecystectomy and an important issue in malpractice claims. Misidentification of the biliary system is the major cause of biliary injuries. To avoid this, the "critical view of safety" technique should be employed in all the cases. If biliary injury is identified intraoperatively, reconstruction should only be performed by experienced hepatobiliary surgeons. In the postoperative period, any deviation from the expected clinical course of recovery should alert the surgeon about the possibility of biliary injury.

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Specialist Early and Immediate Repair of Post-laparoscopic Cholecystectomy Bile Duct Injuries Is Associated With an Improved Long-term Outcome

Abstract: Immediate and early repair after BDI results in comparable, if not better long-term outcomes compared to late repair when performed by specialists.

Cited by 101 publications

References 29 publications

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

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

Predictors of outcome after reconstructive hepaticojejunostomy for post cholecystectomy bile duct injuries

Prevention and acute management of biliary injuries during laparoscopic cholecystectomy: Expert consensus statement

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