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Ahmad H, Zia HH, Salih M, Naseer M, Khan NY, Bhatti ABH. Outcomes of hepaticojejunostomy for post-cholecystectomy bile duct injury. J Int Med Res 2023; 51:3000605231162444. [PMID: 36974893 PMCID: PMC10052492 DOI: 10.1177/03000605231162444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 02/21/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVES Long-term results of hepaticojejunostomy (HJ) for complex bile duct injury (BDI) remain under-reported. The objective of this study was to assess short-term and long-term outcomes of HJ for post-cholecystectomy BDI. METHODS This was a retrospective cohort study and included patients who underwent Roux-en-Y HJ for BDI (n = 87). Short-term (90-day) and long-term morbidity and mortality were assessed. RESULTS At presentation, 42 (48.2%) patients had E3 or E4 BDI, 27 (31%) patients had vascular injury, and liver resection was performed in 12 (13.7%) patients. The 90-day morbidity was 51.7% (n = 45), and the 90-day mortality was 2.3% (n = 2). The long-term mortality was 3.4% (n = 3). The 10-year estimated stricture-free survival was 95%. The 10-year estimated overall survival rate was 100% in patients who underwent major hepatectomy and 91% in patients who did not. The 10-year estimated overall survival rate was 100% in patients with vasculobiliary injury and was not reached in patients without vascular injury. CONCLUSIONS Vascular injury with proximal BDI is not uncommon. Excellent long-term outcomes might be achieved with Roux-en-Y HJ for BDI with vascular injury and in patients requiring liver resection.
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Affiliation(s)
- Humaid Ahmad
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan
| | - Haseeb Haider Zia
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan
| | - Mohammad Salih
- Department of Gastroenterology and Hepatology, Shifa International Hospital, Islamabad, Pakistan
| | - Muhammad Naseer
- Department of Gastroenterology and Hepatology, Shifa International Hospital, Islamabad, Pakistan
| | - Nusrat Yar Khan
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan
| | - Abu Bakar Hafeez Bhatti
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital, Islamabad, Pakistan
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2
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Starkov YG, Zamolodchikov RD, Dzhantukhanova SV, Kontorshchikov PK. [Laparoscopic reconstructive Roux-en-Y hepaticojejunostomy]. Khirurgiia (Mosk) 2022:86-90. [PMID: 35477206 DOI: 10.17116/hirurgia202204186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Intraoperative damage to the bile ducts following laparoscopic cholecystectomy is still one of the urgent problems of modern minimally invasive surgery. In some cases, these complications lead to patient disability, deterioration in their quality of life and need for redo surgery including technically difficult procedures. Modern endoscopic technologies are essential in the treatment of postoperative benign strictures of the common bile duct. These approaches can heal some patients after intraoperative bile duct trauma. Nevertheless, endoscopic treatment is ineffective or impossible in some clinical situations. Reconstructive Roux-en-Y hepaticojejunostomy through laparotomy is a preferable procedure in these patients for many years. However, we report successful laparoscopic reconstructive Roux-en-Y hepaticojejunostomy in a patient with postoperative stricture of the common bile duct Halperin type 0.
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Affiliation(s)
- Yu G Starkov
- Vishnevsky National Medical Research Center for Surgery, Moscow, Russia
| | - R D Zamolodchikov
- Vishnevsky National Medical Research Center for Surgery, Moscow, Russia
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Ida Bagus B, Ida Bagus M, Ida Ayu S. Bismuth Classification of Bile Duct Injury and Its Association with Increasing 30 Days Mortality after Revision Surgery. Open Access Maced J Med Sci 2021; 9:272-275. [DOI: 10.3889/oamjms.2021.6008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: The incidence rate of bile duct injury has not been changed for many years for both open or laparoscopic technique. Open cholecystectomy has risen from 0.5% to 1.4% when gallbladder removal is performed laparoscopically. Injuries of the bile duct system after laparoscopic cholecystectomy are more complex than that after an open approach, causing significant morbidity and even death. From initial classification published by Bismuth, there have been many classifications of common bile duct injury. We would reported the 30 days mortality rate following reconstruction after bile duct injury according to type of Bismuth classification.
Case Report: 7 cases of common bile duct injury were reported from 2016 until 2018 following cholecystectomy (both open and laparoscopic), all cases were diagnosed as early complication and without intra operative cholangiography performed. The most common bile duct injury was Bismuth type II and IV (2 patients in each type). Reconstruction has been done by hepatico jejunostomy for type III and IV. Choledoco Duodenostomy bypass was done for type I and II. 2 patients with bismuth type IV have long standing cholangitis and cannot survive during 30 days of follow up. 4 others patients could survive with no intra abdominal complication nor other morbidity.
Conclusion: Bismuth classification was the simpliest type to described the bile duct injury, Bismuth type IV was associated with the high risk of 30 days mortality rate.
Keywords: bismuth classification, bile duct injury, cholecystectomy, mortality
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PEREK S, DURGUN V, AKINCI O, PEREK A, CANTAŞDEMIR M. Successful treatment of a high-level bile duct injury with a collaboration of a surgeon and an interventional radiologist: an unusual case. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.20.05117-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Li L, Li Q, Xie M, Zuo W, Song B. Anatomic Variation of the Cystic Artery: New Findings and Potential Implications. J INVEST SURG 2021; 34:276-283. [PMID: 31238741 DOI: 10.1080/08941939.2019.1631917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Purpose: To determine the anatomy of the cystic artery by dual-source CT, and correlate imaging findings with those patients who had laparoscopic cholecystectomy (LC). Materials and Methods: Following institutional review board approval, a total of 289 consecutive patients (204 men and 85 women) were evaluated with CT for abdominal pain, including 55 patients subsequently underwent LC. Location of the cystic artery termination, distance between the cystic artery origin and the gallbladder, and angle between the cystic artery and its parent artery were evaluated by two radiologists. The laparoscopic surgical video record (gold standard) was similarly evaluated by a surgeon. Results: A total of 256 cystic arteries in the 247 patients were included. Cystic artery terminations are predominately found in ventral Calot triangle plane (50.8%, type II). Cystic artery origin immediately adjacent to the gallbladder surface was seen in 11/256 (4.3%). Zero angle between the cystic artery and its parent artery was found in 17 of 256 cystic arteries (6.6%). The cystic arteries and the Calot triangle were depicted in 49 patients (95% confidence interval: 85%, 97%). For all 49 patients, CT imaging findings were consistent with surgical video records. No case involved vascular and biliary injury occurred. Conclusions: Given the large number of LC performed each year, better knowledge of anatomic variation of the cystic artery could potentially prevent arterial injury and bile duct injury, particularly for patients with unusual anatomy.
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Affiliation(s)
- Li Li
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| | - Qiang Li
- College of Ophthalmology, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| | - Mingguo Xie
- Department of Radiology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| | - Wenwei Zuo
- Department of General Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, People's Republic of China
| | - Bin Song
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, People's Republic of China
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6
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Kang KA, Kwon HJ, Ham SY, Park HJ, Shin JH, Lee SR, Kim MS. Impacts on outcomes and management of preoperative magnetic resonance cholangiopancreatography in patients scheduled for laparoscopic cholecystectomy: for whom it should be considered? Ann Surg Treat Res 2020; 99:221-229. [PMID: 33029481 PMCID: PMC7520229 DOI: 10.4174/astr.2020.99.4.221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/05/2020] [Accepted: 07/16/2020] [Indexed: 01/04/2023] Open
Abstract
Purpose We evaluated the impact of preoperative magnetic resonance cholangiopancreatography (MRCP) on patient outcomes, and found which patients should be considered for MRCP before cholecystectomy. Methods We performed retrospective analysis of 2,072 patients that underwent cholecystectomy for benign gallbladder disease from January 2014 to June 2017. Patients were grouped as CT only group (n = 737) and MRCP group (n = 1,335), including both CT and MRCP (n = 1,292) or MRCP only (n = 43). The main outcome measure was associated with complications after cholecystectomy, and the secondary outcomes were hospital stay, readmission, and events that could impact patient management due to addition of MRCP. Results There were no statistical differences in occurrence of intraoperative or postoperative complications or readmission rate between the 2 groups. Hospital stay was about 0.6 days longer in the MRCP group. However, MRCP group was more susceptible to complications due to underlying patient demographics (older age, higher frequency of diabetes, and higher level of the inflammatory markers). MRCP diagnosed common bile duct (CBD) stones in 6.5% of patients (84/1,292) without CBD stones in CT, and bile duct anomalies were identified in 41 patients (3.2%). Elevated γ-GT was the only independent factor for additional detection of CBD stones (adjusted odds ratio [OR], 2.89; P = 0.029) and subsequent biliary procedures (adjusted OR, 3.34; P = 0.018) when additional MRCP was performed. Conclusion MRCP is valuable for identification of bile duct variation and CBD stones. Preoperative MRCP can be considered, particularly in patients with elevated γ-GT, for proper preoperative management and avoidance of complications.
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Affiliation(s)
- Kyung A Kang
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heon-Ju Kwon
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Youn Ham
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Ho Shin
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Ryol Lee
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Sung Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
Every year approximately 750,000 cholecystectomies are performed in the United States, most of those are performed laparoscopically. Postcholecystectomy complications are not uncommon and lead to increased morbidity and financial burden. Some of the most commonly encountered complications with laparoscopic cholecystectomy include biliary injury (0.08%-0.5%), bile leak (0.42%-1.1%), retained common bile duct stones (0.8%-5.7%), postcholecystectomy syndrome (10%-15%), and postcholecystectomy diarrhea (5%-12%). Endoscopy has an important role in the diagnosis and management of biliary complications and in many cases can provide definitive management. There is no consensus on the best therapeutic approach for biliary complications. Therefore, biliary complications should be approached by an experienced multidisciplinary team. It is important for the gastroenterologist to be familiar with the management of such complications (Visual Abstract, Supplemental Digital content 1, http://links.lww.com/AJG/B544).
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Irigoyen JA, Cortes HH, Trujillo AT, Morales HL, Abarca JS, Barrientos LA, Rovira OA, Rivillo SZ. ROUND LIGAMENT REPAIR OF THE BILE DUCT AS TREATMENT OF BILE DUCT INJURIES: CASE REPORT. ACTA ACUST UNITED AC 2019; 32:e1443. [PMID: 31460603 PMCID: PMC6713056 DOI: 10.1590/0102-672020180001e1443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/15/2019] [Indexed: 11/22/2022]
Affiliation(s)
- Juan Alvarado Irigoyen
- Departamento de Cirugía, Universidad de la Frontera.,Servicio de Cirugía, Universidad de La Frontera
| | - Hernán Herrera Cortes
- Servicio de Cirugía, Universidad de La Frontera.,Servicio de Cirugía, Clinica Alemana Temuco, Chile
| | - Andrés Troncoso Trujillo
- Departamento de Cirugía, Universidad de la Frontera.,Servicio de Cirugía, Universidad de La Frontera.,Servicio de Cirugía, Clinica Alemana Temuco, Chile
| | - Héctor Losada Morales
- Departamento de Cirugía, Universidad de la Frontera.,Servicio de Cirugía, Universidad de La Frontera.,Servicio de Cirugía, Clinica Alemana Temuco, Chile
| | - Jorge Silva Abarca
- Servicio de Cirugía, Universidad de La Frontera.,Servicio de Cirugía, Clinica Alemana Temuco, Chile
| | - Luis Acencio Barrientos
- Servicio de Cirugía, Universidad de La Frontera.,Servicio de Cirugía, Clinica Alemana Temuco, Chile
| | - Oriel Arias Rovira
- Servicio de Cirugía, Universidad de La Frontera.,Servicio de Cirugía, Clinica Alemana Temuco, Chile
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9
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Laparoscopic to Open Cholecystectomy: The Risk Factors and the Reasons; A Retrospective Analysis of 1950 Cases of a Single Tertiary Center. Surg Laparosc Endosc Percutan Tech 2019; 30:192-195. [DOI: 10.1097/sle.0000000000000716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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10
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Chai LF, Xiao GS. Choledochoplasty with Gallbladder Wall Free Flap: A Novel Technique for Large Bile Duct Defects from Mirizzi Syndrome in High-Risk Patients-A Case Report and Literature Review. Case Rep Surg 2019; 2019:4615484. [PMID: 31467763 PMCID: PMC6701271 DOI: 10.1155/2019/4615484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 06/20/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Cholecystectomies are almost universally performed laparoscopically with complication rates similar to open surgery. Possible complications include bleeding and damage to surrounding structures. These often require intervention to repair the damage immediately when recognized intraoperatively or postoperatively. These injuries can cause significant morbidity and mortality, and additional interventions further compound this, especially for high-risk patients. All attempts should be made to a lower risk while performing the safest operation and addressing complications appropriately. We present a case of a surgically high-risk patient who underwent an attempted laparoscopic, converted to open, cholecystectomy for Mirizzi syndrome, during which a biliary defect was found and repaired with a novel technique of choledochoplasty with a gallbladder wall free flap. CASE An 82-year-old female with abdominal pain was diagnosed with a cholecystocholedochal fistula from chronic cholecystitis and Mirizzi syndrome. During cholecystectomy, a large common bile duct defect was noted, and given intraoperative instability, the repair was completed using a gallbladder wall free flap. Postoperatively, the patient recovered well through a 4.5-year follow-up. CONCLUSION Complications from laparoscopic cholecystectomy are rare but may result in additional interventions. For patients who are high-risk surgical candidates, gallbladder wall free flap choledochoplasty should be considered to avoid additional morbidity and mortality.
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Affiliation(s)
- Louis F. Chai
- Division of Multi-Organ Transplantation and Hepato-Pancreatic-Biliary Surgery, Department of Surgery, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia PA 19102, USA
| | - Gary S. Xiao
- Division of Multi-Organ Transplantation and Hepato-Pancreatic-Biliary Surgery, Department of Surgery, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia PA 19102, USA
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11
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Cohen JT, Charpentier KP, Beard RE. An Update on Iatrogenic Biliary Injuries: Identification, Classification, and Management. Surg Clin North Am 2019; 99:283-299. [PMID: 30846035 DOI: 10.1016/j.suc.2018.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Common bile duct injury is a feared complication of cholecystectomy, with an incidence of 0.1% to 0.6%. A majority of injuries go unnoticed at index operation, and postoperative diagnosis can be difficult. Patient presentation can vary from vague abdominal pain to uncontrolled sepsis and peritonitis. Diagnostic evaluation typically begins with ultrasound or CT scan in the acute setting, and source control is paramount at time of presentation. In a stable patient, hepatobiliary iminodiacetic acid scan can be useful in identifying an ongoing bile leak, which requires intervention. A variety of diagnostic techniques define biliary anatomy. Treatment often requires a multidisciplinary approach.
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Affiliation(s)
- Joshua T Cohen
- Department of Surgery, Rhode Island Hospital, 2 Dudley Street, Suite 370, Providence, RI 02905, USA
| | - Kevin P Charpentier
- Department of Surgery, Rhode Island Hospital, 2 Dudley Street, Suite 370, Providence, RI 02905, USA
| | - Rachel E Beard
- Department of Surgery, Rhode Island Hospital, 2 Dudley Street, Suite 370, Providence, RI 02905, USA.
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12
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Day versus night laparoscopic cholecystectomy for acute cholecystitis: A comparison of outcomes and cost. Am J Surg 2017; 214:1024-1027. [DOI: 10.1016/j.amjsurg.2017.08.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/25/2017] [Accepted: 08/05/2017] [Indexed: 02/07/2023]
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13
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Ng JJ, Kow AWC. Pedicled omental patch as a bridging procedure for iatrogenic bile duct injury. World J Gastroenterol 2017; 23:6741-6746. [PMID: 29085219 PMCID: PMC5643295 DOI: 10.3748/wjg.v23.i36.6741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/22/2017] [Accepted: 08/25/2017] [Indexed: 02/06/2023] Open
Abstract
Iatrogenic bile duct injuries during cholecystectomy can present as fulminant intra-abdominal sepsis which precludes immediate repair or biliary reconstruction. We report the case of a 29-year-old female patient who sustained a bile duct injury after an open cholecystectomy in a neighboring country. She presented to our institution 22 d after initial surgery with septic shock and multiple intra-abdominal collections. Endoscopic retrograde cholangiography revealed a large common hepatic duct defect corresponding to a Strasberg type D bile duct injury. Definitive reconstruction such as a hepaticojejunostomy cannot be performed due to the presence of dense adhesions with infected and friable tissues. She underwent a combination of endoscopic biliary stenting and pedicled omental patch repair of the bile duct to control bile leak and sepsis as a bridging procedure to definite hepaticojejunostomy three months later.
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Affiliation(s)
- Jun Jie Ng
- Department of Surgery, National University Hospital, Singapore 119074, Singapore
| | - Alfred Wei Chieh Kow
- Department of Surgery, National University Hospital, Singapore 119074, Singapore
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14
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Vachhani PG, Copelan A, Remer EM, Kapoor B. Iatrogenic hepatopancreaticobiliary injuries: a review. Semin Intervent Radiol 2015; 32:182-94. [PMID: 26038625 DOI: 10.1055/s-0035-1549377] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Iatrogenic hepatopancreaticobiliary injuries occur after various types of surgical and nonsurgical procedures. Symptomatically, these injuries may lead to a variety of clinical presentations, including tachycardia and hypotension from hemobilia or hemorrhage. Iatrogenic injuries may be identified during the intervention, immediately afterwards, or have a delayed presentation. These injuries are categorized into nonvascular and vascular injuries. Nonvascular injuries include biliary injuries such as biliary leak or stricture, pancreatic injury, and the development of fluid collections such as abscesses. Vascular injuries include pseudoaneurysms, arteriovenous fistulas, dissection, and perforation. Imaging studies such as ultrasound, computed tomography, magnetic resonance imaging, and digital subtraction angiography are critical for proper diagnosis of these conditions. In this article, we describe the clinical and imaging presentations of these iatrogenic injuries and the armamentarium of minimally invasive procedures (percutaneous drainage catheter placement, balloon dilatation, stenting, and coil embolization) that are useful in their management.
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Affiliation(s)
| | - Alexander Copelan
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Erick M Remer
- Department of Abdominal Radiology, Cleveland Clinic, Cleveland, Ohio
| | - Baljendra Kapoor
- Department of Interventional Radiology, Cleveland Clinic, Cleveland, Ohio
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15
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Endoscopic treatment of patients with bile duct stricture after cholecystectomy: factors predicting recurrence in the long term. Dig Dis Sci 2015; 60:1778-86. [PMID: 25577270 DOI: 10.1007/s10620-014-3515-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 12/29/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Endoscopic treatment is effective in the treatment of patients with bile duct injury after cholecystectomy. We aimed to investigate the long-term results of endoscopic treatment, factors predicting the recurrence of the stricture, and to determine the optimal endoscopic treatment. METHODS The study was a retrospective cohort analysis and conducted at a tertiary referral center in patients with major bile duct injury (Strasberg E1-4 and E5 patients with main bile duct injury). Patients with minor injury (Luschka and cystic duct leakage), complete transection, and isolated aberrant bile duct injuries were excluded. RESULTS The study group included 156 patients. The median follow-up period after stent removal was 6.5 years (range 1-16.5). Recurrence was seen in 18 patients (11 %) after a median duration of 9 months (range 2-96). Multivariate regression analysis revealed that the most important factors predicting the success of endoscopic treatment were: Rome type of treatment (inserting increasing number of stents every 3-4 months) (odds ratio 23.8, 95 % CI 1.46-390.7, p = 0.026) instead of Amsterdam-type treatment (replacing two 10F biliary stents every 3-4 months) and dilation of the stricture diameter to at least 76 % of the common bile duct diameter at the end of stent treatment (odds ratio 25.9, 95 % CI 2.46-272.7, p = 0.007). CONCLUSIONS Endoscopic treatment is an effective method in the treatment of patients with bile duct stricture after cholecystectomy. Inserting multiple stents as much as possible without leaving a scar in the bile ducts should be aimed.
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16
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Butte JM, Hameed M, Ball CG. Hepato-pancreato-biliary emergencies for the acute care surgeon: etiology, diagnosis and treatment. World J Emerg Surg 2015; 10:13. [PMID: 25767562 PMCID: PMC4357088 DOI: 10.1186/s13017-015-0004-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 02/02/2015] [Indexed: 12/19/2022] Open
Abstract
Hepatopancreatobiliary (HPB) emergencies include an ample range of conditions with overlapping clinical presentations and diverse therapeutic options. The most common etiologies are related to cholelithiasis (acute cholecystitis, pancreatitis, and cholangitis) and non-traumatic injuries (common bile duct or duodenal). Although the true incidence of HPB emergencies is difficult to determine due to selection and reporting biases, a population-based report showed a decline in the global incidence of all severe complications of cholelithiasis, primarily based on a reduction in acute cholecystitis. Even though patients may present with overlapping symptoms, treatment options can be varied. The treatment of these conditions continues to evolve and patients may require endoscopic, surgical, and/or percutaneous techniques. Thus, it is essential that a multidisciplinary team of HPB surgeons, interventional gastroenterologists and radiologists are available on an as needed basis to the Acute Care Surgeon. This focused manuscript is a contemporary review of the literature surrounding HPB emergencies in the context of the acute care surgeon. The main aim of this review is to offer an update of the diagnosis and management of HPB issues in the acute care setting to improve the care of patients with potential HPB emergencies.
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Affiliation(s)
- Jean M Butte
- Department of Surgery, Foothills Medical Center, University of Calgary, Calgary, AB Canada
| | - Morad Hameed
- University of British Columbia, Vancouver, BC Canada
| | - Chad G Ball
- Department of Surgery, Foothills Medical Center, University of Calgary, Calgary, AB Canada
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17
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Results of endoscopic treatment for the management of stenotic end-to-side hepaticoduodenostomy. Surg Laparosc Endosc Percutan Tech 2014; 24:502-5. [PMID: 24710249 DOI: 10.1097/sle.0b013e3182937bb2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The outcome of endoscopic treatment for the management of surgical end-to-side hepaticoduodenostomy (HD) has not been extensively studied. The aim of this study was to evaluate the results of endoscopic management of HD. METHODS The medical records of 17 patients with HD stenosis who were referred to the ERCP unit between August 2003 and June 2012 for endoscopic intervention were retrospectively analyzed. RESULTS Fourteen patients presented with cholangitis, of whom, jaundice was the presenting complaint in 3 patients. Eight patients (47.1%) who had stents placed for a median of 2 (min, 1; max, 3) ERCP periods remained asymptomatic for a median stent-free period of 19.5 months (min, 7; max, 96 mo). Five patients (29.4%) who had stents placed for a median of 2 (min, 1; max, 5) ERCP periods presented with an episode of stone-related cholangitis for a mean of 41.8±28.9 months after stent removal. These 5 patients remained asymptomatic for a median of 9.5 months (min, 5; max, 40 mo) after endoscopic stone extraction. Three patients with HD (17.6%) were followed up with stents for 4 to 19 ERC periods. One HD patient (5.9%) who had cholangitis associated with secondary biliary cirrhosis died of cholangitis-related complications, despite the treatment with stents for 4 ERC periods. CONCLUSION Endoscopic management is also a realistic treatment option for stenotic HD anastomosis, although success rates may vary.
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18
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Karabulut M, Gönenç M, Alış H. The chain of postoperative complications after laparoscopic cholecystectomy. ULUSAL CERRAHI DERGISI 2014; 30:173-5. [PMID: 25931907 DOI: 10.5152/ucd.2013.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 11/09/2012] [Indexed: 11/22/2022]
Abstract
Bile duct injuries are among the most dreadful complications of cholecystectomy. As laparoscopic cholecystectomy has become increasingly popular, the incidence of this complication increased and has remained unchanged in spite the learning curve being completed. A 50-year-old female underwent elective laparoscopic cholecystectomy for gallstone disease. A complicated bile duct injury occurred during the procedure. As the injury was immediately recognized, it was treated with concomitant hepaticojejunostomy. In the postoperative period, biliary fistula, which was assumed to be the result of an anastomotic leak, was encountered. Diagnostic and therapeutic percutaneous transhepatic biliary drainage was considered. It revealed that the anastomosis was intact and the source of biliary leak was an aberrant right posterior sectorial branch. A severe bleeding through the biliary catheter occurred due to transmigration of the catheter into the portal vein. Bleeding was controlled with embolization by the interventional radiologist. The patient thereafter was re-operated, and the leakage was sealed by ligation of the aberrant right posterior sectorial branch. The postoperative period was uneventful. As long as cholecystectomy is performed, bile duct injuries will always exist. Therefore, every abdominal surgeon should be aware of possible consequences of complications related to this procedure.
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Affiliation(s)
- Mehmet Karabulut
- Clinic of General Surgery, Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Murat Gönenç
- Clinic of General Surgery, Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Halil Alış
- Clinic of General Surgery, Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
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Wigham A, Alexander Grant L. Radiologic assessment of hepatobiliary surgical complications. Semin Ultrasound CT MR 2013; 34:18-31. [PMID: 23395315 DOI: 10.1053/j.sult.2012.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The complexity of hepatobiliary procedures continues to evolve at a rapid rate, with an increasing number of living donor liver transplants and extensive cancer resections being performed. The associated complications are a significant cause of morbidity and mortality, and are often complex injuries, involving both vascular and biliary structures. In this paper we describe the complications associated with laparoscopic cholecystectomy, liver transplant surgery, and hepatic resection. Focus is on the classical imaging appearances, imaging modality options, and varying management strategies for these injuries, to show how the radiologist's role is vital in ensuring the correct diagnosis is made and the appropriate treatment is instigated.
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Affiliation(s)
- Andrew Wigham
- Department of Radiology, Royal Free Hospital, London, UK
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Navarrete C, Gobelet JM. Treatment of common bile duct injuries after surgery. Gastrointest Endosc Clin N Am 2012; 22:539-53. [PMID: 22748247 DOI: 10.1016/j.giec.2012.04.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The treatment of common biliary duct injuries after surgery is a permanent challenge for physicians, and management by a multidisciplinary team is often required. The endoscopic approach is a valuable tool because it is able to assess the problem and also provide a therapeutic option for both fistulas and stenosis of the biliary tree. This article discusses the endoscopic management of postsurgical injuries of the common bile duct and discusses the application of practical tools.
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Affiliation(s)
- Claudio Navarrete
- The Latin American Gastrointestinal Endoscopy Training Center, Endoscopy Division, Clinica Alemana Santiago, Universidad del Desarrollo, Santiago de Chile 7630000, Chile
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Development of an animal model for assessment of primary end-to-end biliary reconstruction. Eur Surg 2012. [DOI: 10.1007/s10353-011-0047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Jayasundara JASB, de Silva WMM, Pathirana AA. Changing clinical profile, management strategies and outcome of patients with biliary tract injuries at a tertiary care center in Sri Lanka. Hepatobiliary Pancreat Dis Int 2011; 10:526-32. [PMID: 21947728 DOI: 10.1016/s1499-3872(11)60089-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Biliary tract injuries are mostly iatrogenic. Related data are limited in developing countries. There are lessons to be learned by revisiting the clinical profiles, management issues and outcome of patients referred to a tertiary care center in Sri Lanka, compared with the previous data from the same center published in 2006. Such a review is particularly relevant at a time of changing global perceptions of iatrogenic biliary injuries. This study aimed to analyze and compare the changes in the injury pattern, management and outcome following biliary tract injury in a Sri Lankan study population treated at a tertiary care center. METHODS A retrospective analysis was made of 67 patients treated between May 2002 and February 2011. The profiles of the last 38 patients treated from October 2006 to February 2011 were compared with those of the first 29 patients treated from May 2002 to September 2006. Definitive management options included endoscopic biliary stenting, reconstructive hepaticojejunostomy with creation of gastric access loops, and biliary stricture dilation. Post-treatment jaundice, cholangitis and abdominal pain needing intervention were considered as treatment failures. RESULTS In the 67 patients, 55 were women and 12 men. Their mean age was 40.6 (range 19-80) years. Five patients had traumatic injuries. Thirty-seven injuries (23 during the second study period) were due to laparoscopic cholecystectomy and 25 (10 during the second study period) to open cholecystectomy. The identification rate of intra-operative injury was 19% in the laparoscopic group and 8% in the open group. Bismuth type I, II, III and IV injuries were seen in 18, 18, 15 and 12 patients, respectively. Endoscopic stenting was the definitive treatment in 20 patients. In 35 patients who had hepaticojejunostomy, 33 underwent creation of the gastric access loop. Twenty-two reconstructions were performed during the second study period. A gastric access loop was used for endotherapy in three patients with anastomotic occlusion at the site of hepaticojejunostomy. The overall outcome was satisfactory in the majority of patients. There were four injury-related deaths. CONCLUSIONS Biliary tract injuries associated with laparoscopic cholecystectomy have become the most frequent cause of biliary injury management at our center. Although endotherapy was useful in selected patients, in the majority, surgical reconstruction with hepaticojejunostomy was required as the definitive treatment. Creation of the gastric access loop was found to be a useful adjunct in the management of hepaticojejunostomy strictures.
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Ruiz Gómez F, Ramia Ángel JM, García-Parreño Jofré J, Figueras J. Lesiones iatrogénicas de la vía biliar. Cir Esp 2010; 88:211-21. [DOI: 10.1016/j.ciresp.2010.03.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 02/21/2010] [Accepted: 03/12/2010] [Indexed: 12/20/2022]
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Roberts-Thomson IC, Teo E, Maddern GJ. Bile duct injuries associated with cholecystectomy. J Gastroenterol Hepatol 2009; 24:706-8. [PMID: 19646011 DOI: 10.1111/j.1440-1746.2009.05825.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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