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Robles-Campos R. Surgical Teaching From Hippocrates, Through Halsted and Ending in the Global Academy. Ann Surg 2023; 278:639-641. [PMID: 37459176 DOI: 10.1097/sla.0000000000006016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Affiliation(s)
- Ricardo Robles-Campos
- Regional Coordinator of Transplants, Virgen de la Arrixaca Clinic and University Hospital, IMIB Pascual Parrilla, Servicio de Cirugía General, El Palmar (Murcia - Spain)
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2
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Beckermann J, Harmsen WS, Lorenz TA, Wendt RC, Ramachandran M, Stewart SA, Swartz HJ, Linnaus ME. Implications of routine cholangiography during laparoscopic cholecystectomy on postoperative testing: Review of more than 2,300 cases in a community-based practice. Am J Surg 2023; 226:251-255. [PMID: 37031042 DOI: 10.1016/j.amjsurg.2023.03.024] [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: 11/23/2022] [Revised: 03/09/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND We hypothesized that routine cholangiography during laparoscopic cholecystectomy may increase use of postoperative imaging and invasive testing. METHODS A retrospective review was performed of laparoscopic cholecystectomy cases at 6 community hospitals from 2017 through 2020. For surgeons performing routine vs selective cholangiography, we compared primary outcomes of operative time, 30-day complications, and postoperative imaging or procedures. RESULTS In total, 2359 laparoscopic cholecystectomy procedures were performed. Eighteen surgeons performed routine cholangiography (1125 cases), and 13 performed selective (1234 cases). Mean operative time was longer in the routine group (125.3 vs 98.7 min, P < .001). Between groups, 30-day complications were similar. Two common bile duct injuries were identified in the routine group. Postoperatively, the routine group underwent 2.5 times more imaging and invasive testing (P < .001). CONCLUSIONS In community hospitals, laparoscopic cholecystectomy can be performed safely by surgeons using cholangiography routinely or selectively. Routine cholangiography resulted in more postoperative imaging and invasive testing.
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Affiliation(s)
- Jason Beckermann
- Department of Surgery, Mayo Clinic Health System - Northwest Wisconsin Region, Eau Claire, WI, USA.
| | - William S Harmsen
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Talya A Lorenz
- Department of Surgery, Mayo Clinic Health System - Northwest Wisconsin Region, Eau Claire, WI, USA
| | - Robert C Wendt
- Department of Surgery, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Mokhshan Ramachandran
- Research & Innovation, Mayo Clinic Health System - Northwest Wisconsin Region, Eau Claire, WI, USA
| | - Shelby A Stewart
- Medical Education, Mayo Clinic Health System - Northwest Wisconsin Region, Menomonie, WI, USA
| | - Hayden J Swartz
- Medical Education, Mayo Clinic Health System - Northwest Wisconsin Region, Menomonie, WI, USA
| | - Maria E Linnaus
- Department of Surgery, Mayo Clinic Health System - Northwest Wisconsin Region, Eau Claire, WI, USA
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3
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Symeonidis D, Paraskeua I, Samara AA, Bompou E, Valaroutsos A, Ntalouka MP, Zacharoulis D. Averting an Unnecessary Revision of a Roux-en-Y Hepaticojejunostomy by Surgically Creating an Access Point for the Endoscopic Assessment of the Anastomosis: A Report of a Case. MEDICINES (BASEL, SWITZERLAND) 2023; 10:medicines10050031. [PMID: 37233607 DOI: 10.3390/medicines10050031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/24/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023]
Abstract
Introduction: Primary sclerosing cholangitis sets the scene for several pathologies of both the intrahepatic and the extrahepatic biliary tree. Surgical treatment, when needed, is almost unanimously summarized in the creation of a Roux-en-Y hepaticojejunostomy, a procedure with a relatively high associated failure rate. Presentation of case: A 70-year-old male, diagnosed with primary sclerosing cholangitis, was submitted to a Roux-en-Y hepaticojejunostomy due to a dominant stricture of the extrahepatic biliary tree. Recurrent episodes of acute cholangitis dictated a workup in the direction of a possible stenosis at the level of the anastomosis. The imaging studies were inconclusive while both the endoscopic and the transhepatic approach failed to assess the status of the anastomosis. A laparotomy, with the intent to revise a high suspicion for stenosis hepaticojejunostomy, was decided. Intraoperatively, a decision to assess the hepaticojejunostomy prior to the scheduled surgical revision, via endoscopy, was made. In this direction, an enterotomy was made on the short jejunal blind loop in order to gain luminal access and an endoscope was propelled through the enterotomy towards the biliary enteric anastomosis. Results: The inspection of the anastomosis under direct endoscopic vision showed no evidences of stenosis and averted an unnecessary, under these circumstances, revision of the anastomosis. Conclusions: The surgical revision of a Roux-en-Y hepaticojejunostomy is a highly demanding operation with an increased associated morbidity, and it should be reserved as the final resort in the treatment algorithm. An approach of utilizing surgery to facilitate the endoscopic assessment prior to proceeding to the surgical revision of the anastomosis appears justified.
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Affiliation(s)
| | - Ismini Paraskeua
- Department of Surgery, University Hospital of Larissa, 41100 Larisa, Greece
| | - Athina A Samara
- Department of Surgery, University Hospital of Larissa, 41100 Larisa, Greece
| | - Effrosyni Bompou
- Department of Surgery, University Hospital of Larissa, 41100 Larisa, Greece
| | | | - Maria P Ntalouka
- Department of Anesthesiology, University Hospital of Larissa, 41100 Larisa, Greece
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4
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Sarcoidosis of the Bile Duct. ACG Case Rep J 2023; 10:e00964. [PMID: 36743331 PMCID: PMC9894337 DOI: 10.14309/crj.0000000000000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 12/14/2022] [Indexed: 02/04/2023] Open
Abstract
Sarcoidosis is an inflammatory disease that affects multiple organs. The lungs are the most commonly involved organs. Although a large proportion of patients with sarcoidosis have liver involvement, bile duct involvement is rare. Here, we present a case of a 56-year-old African American patient presented with painless jaundice because of extrahepatic bile duct sarcoidosis. Our diagnostic approach using endoscopic cholangioscopy with targeted biopsies confirmed the diagnosis. Multiple bile duct stent exchanges were performed to manage the bile duct stricture in addition to medical therapy.
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5
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Machine Learning-Based Analysis in the Management of Iatrogenic Bile Duct Injury During Cholecystectomy: a Nationwide Multicenter Study. J Gastrointest Surg 2022; 26:1713-1723. [PMID: 35790677 PMCID: PMC9439981 DOI: 10.1007/s11605-022-05398-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/17/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Iatrogenic bile duct injury (IBDI) is a challenging surgical complication. IBDI management can be guided by artificial intelligence models. Our study identified the factors associated with successful initial repair of IBDI and predicted the success of definitive repair based on patient risk levels. METHODS This is a retrospective multi-institution cohort of patients with IBDI after cholecystectomy conducted between 1990 and 2020. We implemented a decision tree analysis to determine the factors that contribute to successful initial repair and developed a risk-scoring model based on the Comprehensive Complication Index. RESULTS We analyzed 748 patients across 22 hospitals. Our decision tree model was 82.8% accurate in predicting the success of the initial repair. Non-type E (p < 0.01), treatment in specialized centers (p < 0.01), and surgical repair (p < 0.001) were associated with better prognosis. The risk-scoring model was 82.3% (79.0-85.3%, 95% confidence interval [CI]) and 71.7% (63.8-78.7%, 95% CI) accurate in predicting success in the development and validation cohorts, respectively. Surgical repair, successful initial repair, and repair between 2 and 6 weeks were associated with better outcomes. DISCUSSION Machine learning algorithms for IBDI are a novel tool may help to improve the decision-making process and guide management of these patients.
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6
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Moldovan C, Cochior D, Gorecki G, Rusu E, Ungureanu FD. Clinical and surgical algorithm for managing iatrogenic bile duct injuries during laparoscopic cholecystectomy: A multicenter study. Exp Ther Med 2021; 22:1385. [PMID: 34650633 PMCID: PMC8506945 DOI: 10.3892/etm.2021.10821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/11/2021] [Indexed: 12/15/2022] Open
Abstract
The present study was a multicenter, analytical, nonrandomized research on 108 cases of intraoperative vascular and bile duct lesions during laparoscopic cholecystectomies. We selected these cases from 16,559 cholecystectomies performed entirely laparoscopically or debuted laparoscopically and converted to an open approach. The study included two surgical centers labeled as primary, with extensive experience in hepato-biliary reconstructive surgery, and four other centers labeled as secondary that referred cases to the previous two. Our study analyzed several key parameters such as the percentage of iatrogenic lesions recorded, the variability of the main biliary pathway and conformation as well as its relationship to the adjacent critical anatomical landmarks, the anatomical and physiopathological characteristics of pathology requiring surgical intervention, factors related to laparoscopic surgical technique, the surgical technique used to repair the recorded lesions, the duration of survivability and the rate of the occurring complications. Based on the analysis of these parameters, we developed a descriptive algorithm with visual representation relying on several decisional points to guide the surgeons in choosing the optimal treatment method so that patients will benefit from a favorable clinical path.
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Affiliation(s)
- Cosmin Moldovan
- Faculty of Medicine, 'Titu Maiorescu' University, 040441 Bucharest, Romania.,General Surgery Ward, 'Witting' Clinical Hospital, 010243 Bucharest, Romania
| | - Daniel Cochior
- Faculty of Medicine, 'Titu Maiorescu' University, 040441 Bucharest, Romania.,General Surgery, 'Sanador' Clinical Hospital, 010991 Bucharest, Romania.,General Surgery, 'Monza' Clinical Hospital, 021967 Bucharest, Romania
| | - Gabriel Gorecki
- Medicine Doctoral School, 'Titu Maiorescu' University, 040317 Bucharest, Romania
| | - Elena Rusu
- Faculty of Medicine, 'Titu Maiorescu' University, 040441 Bucharest, Romania
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Keyur B, Pankaj D, Dhaval M, Daxa K. Bile Duct Injury: Surgical Use of Endobiliary Stents for the Management in Emergency Situations. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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8
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Rao PP, Singh A, Singh KJ. Bile Duct Injuries: Outcome of Early and Delayed Repair at a Tertiary Care Centre. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02393-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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9
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Revisional surgery for recurrent benign bile duct strictures. Eur Surg 2020. [DOI: 10.1007/s10353-020-00667-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Sghair YM, Elhoucein M, Kane A, Adda E, Sidahmed M, Abdi MYM, Naji SM. [A case study of post-traumatic common bile duct injury: an unusual lesion]. Pan Afr Med J 2020; 35:77. [PMID: 32537080 PMCID: PMC7250220 DOI: 10.11604/pamj.2020.35.77.16703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/13/2019] [Indexed: 11/22/2022] Open
Abstract
La section traumatique du cholédoque est un phénomène extrêmement rare surtout lorsqu'elle est isolée. Habituellement, elle survient suite à une chirurgie des voies biliaires notamment laparoscopique. Cette lésion est souvent associée à une ou plusieurs lésions des organes de voisinage. Nous rapportons un cas de section isolée du cholédoque suite à un traumatisme abdominal chez un enfant âgé de 5 ans pris en charge dans notre service au Centre Hospitalier Mère et Enfant de Nouakchott. L'exploration radiologique n'était concluante. Une laparotomie exploratrice faite devant un tableau chirurgical a révélé une péritonite généralisée d'origine biliaire secondaire à une plaie du bas cholédoque. Le traitement d'urgence était une toilette avec une dérivation biliaire externe suivie à un mois après par une dérivation bilio-digestive. La complication la plus redoutable de section de cholédoque est la péritonite biliaire. La morbidité postopératoire précoce est de l'ordre de 20 à 30% dans la littérature alors que la mortalité est de 0 à 2%. La section traumatique isolée du cholédoque chez l'enfant est une lésion dont le tableau clinique et la conduite thérapeutique doivent être connus afin de diminuer la morbi-mortalité. La prise charge doit être multidisciplinaire impliquant le chirurgien pédiatre, le radiologue et le réanimateur anesthésiste.
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Affiliation(s)
- Yacoub Mohamed Sghair
- Service de Chirurgie Pédiatrique, Centre Hospitalier Mère et Enfant, Faculté de Médecine de Nouakchott, Nouakchott, Mauritanie
| | - Mohamedou Elhoucein
- Service de Chirurgie Pédiatrique, Centre Hospitalier Mère et Enfant, Nouakchott, Mauritanie
| | - Ahmed Kane
- Service de Chirurgie Pédiatrique, Centre Hospitalier Mère et Enfant, Faculté de Médecine de Nouakchott, Nouakchott, Mauritanie
| | - Elhaj Adda
- Service de Chirurgie Pédiatrique, Centre Hospitalier Mère et Enfant, Nouakchott, Mauritanie
| | - Mohamed Sidahmed
- Service de Réanimation Anesthésie, Centre Hospitalier Mère et Enfant, Faculté de Médecine de Nouakchott, Nouakchott, Mauritanie
| | | | - Sidi Med Naji
- Service de Chirurgie Pédiatrique, Centre Hospitalier Mère et Enfant, Nouakchott, Mauritanie
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A Al-Omari M, Smadi S. Novel surgical technique for the management of biliary-enteric anastomotic strictures. INTERNATIONAL JOURNAL OF HEPATOBILIARY AND PANCREATIC DISEASES 2020. [DOI: 10.5348/100089z04ta2020ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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12
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Battal M, Yazici P, Bostanci O, Karatepe O. Early Surgical Repair of Bile Duct Injuries following Laparoscopic Cholecystectomy: The Sooner the Better. Surg J (N Y) 2019; 5:e154-e158. [PMID: 31637286 PMCID: PMC6800276 DOI: 10.1055/s-0039-1697633] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 07/26/2019] [Indexed: 12/13/2022] Open
Abstract
Background We aimed to investigate the outcomes of the immediate surgical repair of bile duct injuries (BDIs) following laparoscopic cholecystectomy. Materials and Methods Between January 2012 and May 2017, patients, who underwent immediate surgical repair (within 72 hours) for postcholecystectomy BDI, by the same surgical team expert in hepatobiliary surgery, were enrolled into the study. Data collection included demographics, type of BDI according to the Strasberg classification, time to diagnosis, surgical procedures, and outcome. Results There were 13 patients with a mean age of 43 ± 12 years. Classification of BDIs were as follows: type E in six patients (46%), type D in three patients (23%), type C in two (15%), and types B and A in one patient each (7.6%). Mean time to diagnosis was 22 ± 15 hours. Surgical procedures included Roux-en-Y hepaticojejunostomy for all six patients with type-E injury, primary repair of common bile duct for three patients with type-D injury, and primary suturing of the fistula orifice was performed in two cases with type-C injury. Other two patients with type-B and -A injury underwent removal of clips which were placed on common bile duct during index operation and replacing of clips on cystic duct where stump bile leakage was observed probably due to dislodging of clips, respectively. Mean hospital stay was 6.6 ± 3 days. Morbidity with a rate of 30% ( n = 4) was observed during a median follow-up period of 35 months (range: 6-56 months). Mortality was nil. Conclusion Immediate surgical repair of postcholecystectomy BDIs in selected patients leads to promising outcome.
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Affiliation(s)
- Muharrem Battal
- Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, General Surgery Clinic, Sisli, Istanbul, Turkey
| | - Pinar Yazici
- Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, General Surgery Clinic, Sisli, Istanbul, Turkey
| | - Ozgur Bostanci
- Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, General Surgery Clinic, Sisli, Istanbul, Turkey
| | - Oguzhan Karatepe
- Department of General Surgery, Memorial Hospital, General Surgery Clinic, Sisli, Istanbul, Turkey
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AYDIN MESUT. LAPAROSKOPİK KOLESİSTEKTOMİNİN NADİR BİR KOMPLİKASYONU; KOLEDOK BAĞLANMASI. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2019. [DOI: 10.17944/mkutfd.508895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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14
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Ray S, Sanyal S, Das S, Jana K, Das AK, Khamrui S. Outcomes of surgery for post-cholecystectomy bile duct injuries: An audit from a tertiary referral center. J Visc Surg 2019; 157:3-11. [PMID: 31427102 DOI: 10.1016/j.jviscsurg.2019.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM OF THE STUDY Bile duct injury (BDI) after cholecystectomy is a serious complication. It often requires surgical repair. The aim of this study was to report on the short and long-term outcomes of surgery for post-cholecystectomy BDI. PATIENTS AND METHODS All the patients, who underwent surgery for post-cholecystectomy BDI between August 2007 and September 2017, were retrospectively reviewed. McDonald grading system was used to assess the long-term outcome. The risk factors for unsatisfactory long-term outcome were analyzed by univariate and multivatiate logistic regression analysis. RESULTS In total, 228 patients had a Roux-en-Y hepaticojejunostomy. Open cholecystectomy was the major cause of BDI (61%). The median time from injury to definitive repair was 6 months. The types of BDI were as follows: E1 in 13 (5.7%), E2 in 68 (29.82%), E3 in 108 (47.36%), E4 in 28 (12.28%), and E5 in 11 (4.82%) patients respectively. Postoperative morbidity and mortality were 25% and 1.31% respectively. After a median follow-up of 58 months, 90% patients had excellent to good outcome. Recurrent stricture developed in 6 (3%) patients. On multivariate analysis, long injury-repair interval and previous attempt at repair were independent predictors for unsatisfactory long-term outcome. CONCLUSION Surgical reconstruction affords excellent to good results for majority of the patients with post-cholecystectomy BDI. As longer delay in definitive repair and previous attempt at repair were associated with unsatisfactory long-term outcome, early referral to a specialized hepatobiliary surgery unit is recommended.
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Affiliation(s)
- S Ray
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244, A.J.C. Bose Road, Kolkata, 700020 West Bengal, India.
| | - S Sanyal
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244, A.J.C. Bose Road, Kolkata, 700020 West Bengal, India
| | - S Das
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244, A.J.C. Bose Road, Kolkata, 700020 West Bengal, India
| | - K Jana
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244, A.J.C. Bose Road, Kolkata, 700020 West Bengal, India
| | - A K Das
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244, A.J.C. Bose Road, Kolkata, 700020 West Bengal, India
| | - S Khamrui
- Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244, A.J.C. Bose Road, Kolkata, 700020 West Bengal, India
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15
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Cuendis-Velázquez A, Trejo-Ávila M, Bada-Yllán O, Cárdenas-Lailson E, Morales-Chávez C, Fernández-Álvarez L, Romero-Loera S, Rojano-Rodríguez M, Valenzuela-Salazar C, Moreno-Portillo M. A New Era of Bile Duct Repair: Robotic-Assisted Versus Laparoscopic Hepaticojejunostomy. J Gastrointest Surg 2019; 23:451-459. [PMID: 30402722 DOI: 10.1007/s11605-018-4018-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/18/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite scientific evidence of the safety, efficacy, and in some cases superiority of minimally invasive surgery in hepato-pancreato-biliary procedures, there are scarce publications about bile duct repairs. The aim of this study was to compare the outcomes of robotic-assisted surgery versus laparoscopic surgery on bile duct repair in patients with post-cholecystectomy bile duct injury. METHODS This is a retrospective comparative study of our prospectively collected database of patients with bile duct injury who underwent robotic or laparoscopic hepaticojejunostomy. RESULTS Seventy-five bile duct repairs (40 by laparoscopic and 35 by robotic-assisted surgery) were treated from 2012 to 2018. Injury types were as follows: E1 (7.5% vs. 14.3%), E2 (22.5% vs. 14.3%), E3 (40% vs. 42.9%), E4 (22.5% vs. 28.6%), and E5 (7.5% vs. 0), for laparoscopic hepaticojejunostomy (LHJ) and robotic-assisted hepaticojejunostomy (RHJ) respectively. The overall morbidity rate was similar (LHJ 27.5% vs. RHJ 22.8%, P = 0.644), during an overall median follow-up of 28 (14-50) months. In the LHJ group, the actuarial primary patency rate was 92.5% during a median follow-up of 49 (43.2-56.8) months. While in the RHJ group, the actuarial primary patency rate was 100%, during a median follow-up of 16 (12-22) months. The overall primary patency rate was 96% (LHJ 92.5% vs. RHJ 100%, log-rank P = 0.617). CONCLUSION Our results showed that the robotic approach is similar to the laparoscopic regarding safety and efficacy in attaining primary patency for bile duct repair.
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Affiliation(s)
- Adolfo Cuendis-Velázquez
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, 14090, Mexico City, Mexico
| | - Mario Trejo-Ávila
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, 14090, Mexico City, Mexico.
| | - Orlando Bada-Yllán
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, 14090, Mexico City, Mexico
| | - Eduardo Cárdenas-Lailson
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, 14090, Mexico City, Mexico
| | | | | | - Sujey Romero-Loera
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, 14090, Mexico City, Mexico
| | - Martin Rojano-Rodríguez
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, 14090, Mexico City, Mexico
| | - Carlos Valenzuela-Salazar
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, 14090, Mexico City, Mexico
| | - Mucio Moreno-Portillo
- Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, 14090, Mexico City, Mexico
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16
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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: 21] [Impact Index Per Article: 4.2] [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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17
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Schizas D, Papaconstantinou D, Moris D, Koliakos N, Tsilimigras DI, Bakopoulos A, Karaolanis G, Spartalis E, Dimitroulis D, Felekouras E. Management of Segmental Bile Duct Injuries After Cholecystectomy: a Systematic Review. J Gastrointest Surg 2019; 23:408-416. [PMID: 30402723 DOI: 10.1007/s11605-018-4027-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/22/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Injuries to segmental or aberrant bile ducts are encountered less commonly than their major bile duct counterparts and present a unique diagnostic and therapeutic challenge, since the nature of this injury involves a transected bile duct that loses its communication with the main ductal system. In this systematic review, we aim to pool available data on this particular type of biliary injury in an effort to outline available diagnostic and therapeutic modalities and evaluate their efficacy. MATERIALS AND METHODS An extensive literature search was performed on MEDLINE, Scopus, and Web of Science to identify isolated segmental or aberrant bile duct injuries. RESULTS A total of 21 studies were included in this systematic report. Ten studies reported non-operative management of patients, while 12 reported operative management of included patients. Outcomes of interest were the choice of treatment interventions and their success. Overall, 23 patients were managed non-operatively with a 91% success rate and 30 patients were managed operatively with a 90% success rate. CONCLUSION Non-operative management might be a viable alternative to surgery. Hepatobiliary surgeons should be encouraged to publish their results in treating these rare injuries to further elucidate the role and efficacy of such an approach.
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Affiliation(s)
- Dimitrios Schizas
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Papaconstantinou
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Moris
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Nikolaos Koliakos
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Diamantis I Tsilimigras
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anargyros Bakopoulos
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Karaolanis
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Spartalis
- 2nd Propedeutic Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Dimitroulis
- 2nd Propedeutic Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Felekouras
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Rifatbegovic Z, Kovacevic M, Nikic B. Treatment of late identified iatrogenic injuries of the right and left hepatic duct after laparoscopic cholecystectomy without transhepatic stent and Witzel drainage: Case report. Int J Surg Case Rep 2018; 48:72-75. [PMID: 29883919 PMCID: PMC6041202 DOI: 10.1016/j.ijscr.2018.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 05/06/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Most of the case reports about high type iatrogenic hepatic duct injuries reports how to treat and make Roux-en-Y hepaticojejunostomy below the junction of the liver immediately after this condition is recognised during surgical procedure when the injury was made. Hereby we present a case where we made Roux-en-Y hepaticojejunostomy without transhepatic billiary stent and also without Witzel drainage one month after the iatrogenic injury. PRESENTATION OF CASE A 21-year-old woman suffered from iatrogenic high transectional lesion of both hepatic ducts during laparoscopic cholecystectomy in a local hospital. Iatrogenic injury was not immediately recognized. Ten days later due to patient complaints and large amount of bile in abdominal drain sac, second surgery was performed to evacuate biloma. Symptoms reappeared again, together with bile in abdominal sac, and then patient was sent to our Clinical Center. After performing additional diagnostics, high type (Class E) of iatrogenic hepatic duct injury was diagnosed. A revision surgical procedure was performed. During the exploration we found high transection lesion of right and left hepatic duct, and we decided to do Roux-en-Y hepaticojejunostomy. We created a part of anastomosis between the jejunum and liver capsule with polydioxanone suture (PDS) 4-0 because of poor quality of the remaining parts of the hepatic ducts. We made two separate hepaticojejunal anastomoses (left and right) that we partly connected to the liver capsule, where we had a defect of hepatic ducts, without Witzel enterostomy and transhepatic biliary stent. There were no significant postoperative complications. Magnetic resonance cholangiopancreatography (MRCP) was made one year after the surgical procedure, which showed the proper width of the intrahepatic bile ducts, with no signs of stenosis of anastomoses. DISCUSSION In most cases, treatment iatrogenic BDI is based on primary repair of the duct, ductal repair with a stent or creating duct-enteric anastomosis, often used and drainage by Witzel (Witzel enterostomy). Reconstructive hepaticojejunostomy is recommended for major BDIs during cholecystectomy. Considering that the biliary reconstruction with Roux-en-Y hepatojejunostomy is usually made with transhepatic biliary stent or Witzel enterostomy. What is interesting about this case is that these types of drainages were not made. We tried and managed to avoid such types of drainage and proved that in this way, without those types of drainage, we can successfully do duplex hepaticojejunal anastomoses and that they can survive without complications. CONCLUSION Our case indicates that this approach can be successfully used for surgical repair of iatrogenic lesion of both hepatic ducts.
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Affiliation(s)
- Zijah Rifatbegovic
- Department of Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
| | - Maja Kovacevic
- Department of Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
| | - Branka Nikic
- Department of Surgery, Clinical Hospital Tesanj, Tesanj, Bosnia and Herzegovina.
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Diminished Survival in Patients with Bile Leak and Ductal Injury: Management Strategy and Outcomes. J Am Coll Surg 2018; 226:568-576.e1. [PMID: 29307612 DOI: 10.1016/j.jamcollsurg.2017.12.023] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/18/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The increased incidence of bile duct injuries (BDIs) after the adoption of laparoscopic cholecystectomy has been well documented. However, the longitudinal impact of bile leaks and BDIs on survival and healthcare use have not been studied adequately. The aims of this analysis were to determine the incidence, long-term outcomes, and costs of bile leaks and ductal injuries in a large population. STUDY DESIGN The California Office of Statewide Health Planning and Development database was queried from 2005 to 2014. Bile leaks, BDIs, and their management strategy were defined. Survival was calculated by Kaplan-Meier failure estimates with multivariable regression and propensity analyses. Cost analyses used inflation adjustments and institution-specific cost-to-charge ratios. RESULTS Of 711,454 cholecystecomies, bile leaks occurred in 3,551 patients (0.50%) and were managed almost exclusively by endoscopists. Bile duct injuries occurred in 1,584 patients (0.22%) with 84% managed surgically. Patients with a bile leak were more likely to die at 1 year (2.4% vs 1.4%; odds ratio 1.85; p < 0.001). Similarly, BDI patients had an increased 1-year mortality (7.2% vs 1.3%; odds ratio 2.04; p < 0.0001). Survival of BDI patients was better with an operative approach (odds ratio 0.19; p < 0.001) when compared with endoscopic management. Operatively managed BDIs were also associated with fewer emergency department visits and readmissions, as well as lower cumulative costs at 1 year ($60,539 vs $118,245; p < 0.001). CONCLUSIONS The 0.22% incidence of BDIs observed in California is lower than reported in the first decade after the introduction of laparoscopic cholecystectomy. Bile leaks are 2.3 times more common than BDIs. Patients with a bile leak or BDI have diminished survival. Surgical repair of a BDI leads to enhanced survival and reduced cumulative cost compared with endoscopic management.
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Hepatobiliary Hands of Hopkins. Ann Surg 2017; 267:S34-S39. [PMID: 29206676 DOI: 10.1097/sla.0000000000002606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This historical perspective documents the role that John L. Cameron played in advancing hepatobiliary research, education, and surgery at Johns Hopkins in the 1970s, 1980s, and 1990s. SUMMARY OF BACKGROUND DATA Dating back to William S. Halsted in the 19th century, leaders of the Department of Surgery at Johns Hopkins have been interested in hepatobiliary disease and surgery. John L. Cameron had broad hepato-pancreato-biliary (HPB) interests when he completed his surgical training. Over the next 3 decades, he focused on the pancreas. As a result, many faculty and trainee hepatobiliary careers were launched. METHODS This perspective is based on 18 years of service as a surgical resident and faculty member at Johns Hopkins. An extensive literature search on the hepatobiliary publications of Halsted, Trimble, Blalock, Longmire, Zuidema, and Cameron was undertaken for this manuscript. Numerous hepatobiliary publications from Johns Hopkins from the 1970s, 1980s, 1990s, and early 2000s were also reviewed. RESULTS John L. Cameron's early biliary interests included stones, infections, malignancies, and strictures. He was innovative with respect to portal hypertension and Budd-Chiari surgery and supportive when liver transplantation emerged in the 1980s. Volume-outcome studies in the 1990s included hepatic and complex biliary surgery. He supported and encouraged studies of biliary lithotripsy, laparoscopic cholecystectomy, clinical pathways, hepatobiliary cysts, and gallstone pathogenesis. CONCLUSION Lessons learned by many who worked with John L. Cameron included the importance of mentorship, innovation, friendship, and collaboration. He taught leadership and change management by example. He fostered a multidisciplinary approach and encouraged randomized controlled trials.
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Intraoperative cholangiography during cholecystectomy among hospitalized medicare beneficiaries with non-neoplastic biliary disease. Am J Surg 2017; 214:682-686. [PMID: 28669532 DOI: 10.1016/j.amjsurg.2017.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/21/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Prior studies of Medicare beneficiaries with both neoplastic and non-neoplastic indications for cholecystectomy demonstrated a reduced risk of common bile duct (CBD) injury when intraoperative cholangiography (IOC) was used. We sought to determine the association between IOC and CBD injury during inpatient cholecystectomy for non-neoplastic biliary disease and compare survival among those with or without CBD injury. METHODS Retrospective study of patients ≥66 who underwent inpatient cholecystectomy (2005-2010) for gallstones, cholecystitis, cholangitis, or gallbladder obstruction. The association between IOC and CBD injury was analyzed using multivariable logistic regression and survival after cholecystectomy was analyzed using multivariable Cox regression. RESULTS Among 472,367 patients who underwent cholecystectomy, 0.3% had a CBD injury. IOC was associated with increased CBD injury (adjusted OR 1.41[1.27-1.57]). CBD injury was associated with increased hazards of death (adjusted HR 1.37[1.25-1.51]). CONCLUSIONS IOC in patients with non-neoplastic biliary disease was associated with increased odds of CBD injury. This likely reflects its selective use in patients at higher risk of CBD injury or as a confirmatory test when an injury is suspected.
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Malkov IS, Shaimardanov RS, Korobkov VN, Filippov VA, Khisamiev IG. [The factors affecting the results of mechanical jaundice management]. Khirurgiia (Mosk) 2016:48-51. [PMID: 27804934 DOI: 10.17116/hirurgia20161048-51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIM To improve the results of obstructive jaundice management by rational diagnostic and treatment strategies. MATERIAL AND METHODS Outcomes of 820 patients with obstructive jaundice syndrome were analyzed. RESULTS Diagnostic and tactical mistakes were made at pre-hospital stage in 143 (17.4%) patients and in 105 (12.8%) at hospital stage. Herewith, in 53 (6.5%) cases the errors were observed at all stages. Retrospective analysis of severe postoperative complications and lethal outcomes in patients with obstructive jaundice showed that in 23.8% of cases they were explained by diagnostic and tactical mistakes at various stages of examination and treatment. CONCLUSION We developed an algorithm for obstructive jaundice management to reduce the number of diagnostic and tactical errors, a reduction in the frequency of diagnostic and tactical errors. It reduced the number of postoperative complications up to 16.5% and mortality rate to 3.0%.
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Affiliation(s)
- I S Malkov
- Kazan State Medical Academy, Health Ministry of the Russian Federation
| | - R Sh Shaimardanov
- Kazan State Medical Academy, Health Ministry of the Russian Federation
| | - V N Korobkov
- Kazan State Medical Academy, Health Ministry of the Russian Federation
| | - V A Filippov
- Kazan State Medical Academy, Health Ministry of the Russian Federation
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Tokumura H, Iida A, Sasaki A, Nakamura Y, Yasuda I. Gastroenterological surgery: The gallbladder and common bile duct. Asian J Endosc Surg 2016; 9:237-249. [PMID: 27790872 DOI: 10.1111/ases.12315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Hiromi Tokumura
- Department of Surgery, Tohoku Rosai Hospital, Sendai, Japan.
| | - Atsushi Iida
- First Department of Surgery, University of Fukui, Fukui, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan
| | - Yoshiharu Nakamura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Ichiro Yasuda
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
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Karanikas M, Bozali F, Vamvakerou V, Markou M, Memet Chasan ZT, Efraimidou E, Papavramidis TS. Biliary tract injuries after lap cholecystectomy-types, surgical intervention and timing. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:163. [PMID: 27275476 DOI: 10.21037/atm.2016.05.07] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
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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Affiliation(s)
- Michail Karanikas
- 1 1st Department of Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, Alexandroupolis, 68100 Thrace, Greece ; 2 1st Propedeutic Surgical Clinic, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, 54655 Macedonia, Greece
| | - Ferdi Bozali
- 1 1st Department of Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, Alexandroupolis, 68100 Thrace, Greece ; 2 1st Propedeutic Surgical Clinic, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, 54655 Macedonia, Greece
| | - Vasileia Vamvakerou
- 1 1st Department of Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, Alexandroupolis, 68100 Thrace, Greece ; 2 1st Propedeutic Surgical Clinic, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, 54655 Macedonia, Greece
| | - Markos Markou
- 1 1st Department of Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, Alexandroupolis, 68100 Thrace, Greece ; 2 1st Propedeutic Surgical Clinic, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, 54655 Macedonia, Greece
| | - Zeinep Tzoutze Memet Chasan
- 1 1st Department of Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, Alexandroupolis, 68100 Thrace, Greece ; 2 1st Propedeutic Surgical Clinic, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, 54655 Macedonia, Greece
| | - Eleni Efraimidou
- 1 1st Department of Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, Alexandroupolis, 68100 Thrace, Greece ; 2 1st Propedeutic Surgical Clinic, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, 54655 Macedonia, Greece
| | - Theodossis S Papavramidis
- 1 1st Department of Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Dragana, Alexandroupolis, 68100 Thrace, Greece ; 2 1st Propedeutic Surgical Clinic, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, 54655 Macedonia, Greece
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The Hepaticojejunostomy Technique with Intra-Anastomotic Stent in Biliary Diseases and Its Evolution throughout the Years: A Technical Analysis. Gastroenterol Res Pract 2016; 2016:3692096. [PMID: 27190504 PMCID: PMC4846744 DOI: 10.1155/2016/3692096] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/28/2016] [Indexed: 12/16/2022] Open
Abstract
Roux-en-Y hepaticojejunostomy (RYHJ) is currently considered as the definitive treatment for iatrogenic bile duct injuries and the principal representative of biliary diversion procedures. This technique has met many milestones of extensive evolution, particularly the last years of concomitant technological evolution (laparoscopic/robotic approach). Anastomotic strictures and leaks, which may have deleterious effects on the survival and quality of life of a patient with biliary obstruction of any cause, made the need of the development of a safe and efficient RYHJ compulsory. The aim of this technical analysis and the juxtaposed discussions is to elucidate with the most important milestones and technical tips and tricks all aspects of a feasible and reliable RYHJ technique that is performed in our center for the last 25 years in around 400 patients.
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Suliman E, Palade RȘ, Suliman E. Importance of cystic pedicle dissection in laparoscopic cholecystectomy in order to avoid the common bile duct injuries. J Med Life 2016; 9:44-48. [PMID: 27974912 PMCID: PMC5152603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/02/2015] [Indexed: 11/03/2022] Open
Abstract
The dissection of the cystic pedicle represents the "main" issue in performing the cholecystectomy, as well as the surgical moment when many accidents may happen. The paper analyzes the most frequent causes, which can generate iatrogenic injuries of the common bile duct (CBD) during the dissection of the cystic pedicle, such as the ductal and vascular anatomical variants, the local pathological transformation, human errors, etc.
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Affiliation(s)
- E Suliman
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; First Surgery Clinic, University Emergency Hospital, Bucharest, Romania
| | - R Ș Palade
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - E Suliman
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Surgical management of post-cholecystectomy bile duct injuries: referral patterns and factors influencing early and long-term outcome. Updates Surg 2015; 67:283-91. [DOI: 10.1007/s13304-015-0311-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 06/11/2015] [Indexed: 12/30/2022]
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DePietro DM, Shlansky-Goldberg RD, Soulen MC, Stavropoulos SW, Mondschein JI, Dagli MS, Itkin M, Clark TWI, Trerotola SO. Long-term outcomes of a benign biliary stricture protocol. J Vasc Interv Radiol 2015; 26:1032-9. [PMID: 25890686 DOI: 10.1016/j.jvir.2015.03.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 03/07/2015] [Accepted: 03/09/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate long-term outcomes of a structured protocol for percutaneous treatment of benign biliary stricture. MATERIALS AND METHODS Seventy-one patients (37 men, 34 women; mean age, 54 y; age range, 23-84 y) entered the protocol, which consisted of staged upsizing of internal/external biliary catheters, balloon dilation (nominally 8 mm), and prolonged stent treatment (6 mo) at maximal catheter size (nominally 18 F). It concluded with a capping trial and catheter removal if the stricture remained patent. Fifty-three patients completed the protocol and 18 did not (6 died, 6 underwent alternative treatment, 4 were lost to follow-up, and 2 underwent repeat transplantation). Stricture features, treatment parameters, complications, and outcomes were reviewed, and Kaplan-Meier analysis was conducted. RESULTS Strictures were anastomotic in 45 patients (64%), intrahepatic in 14 (20%), extrahepatic in 7 (10%), and multiple (intra- and extrahepatic) in 5 (7%). A right-sided approach was used in 47 patients (66%) patients, a left-sided approach in 18 (25%), and a bilateral approach in 6 (9%). Forty-six patients who entered the protocol (65%) and 46 patients who completed the protocol (87%) showed stricture patency. Four of 7 patients in whom a capping trial failed underwent surgical revision, 2 required chronic biliary drainage, and 1 received a metal stent. Follow-up (range, 0-12 y; mean, 4.7 y) was obtained for 42 of 53 patients who completed the protocol (79%). Kaplan-Meier analysis showed stricture patency probabilities of 84% at 1 year after treatment, 78% at 2 years, 74% at 5 years, and 67% at 10 years. CONCLUSIONS Use of a structured protocol for the percutaneous treatment of benign biliary strictures yields durable long-term results, suggesting that percutaneous treatment is an effective therapy.
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Affiliation(s)
- Daniel M DePietro
- Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine of the University of Pennsylvania, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104
| | - Richard D Shlansky-Goldberg
- Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine of the University of Pennsylvania, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104
| | - Michael C Soulen
- Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine of the University of Pennsylvania, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104
| | - S William Stavropoulos
- Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine of the University of Pennsylvania, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104
| | - Jeffrey I Mondschein
- Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine of the University of Pennsylvania, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104
| | - Mandeep S Dagli
- Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine of the University of Pennsylvania, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104
| | - Maxim Itkin
- Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine of the University of Pennsylvania, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104
| | - Timothy W I Clark
- Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine of the University of Pennsylvania, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104
| | - Scott O Trerotola
- Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine of the University of Pennsylvania, 1 Silverstein, 3400 Spruce St., Philadelphia, PA 19104.
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Early or Delayed Intervention for Bile Duct Injuries following Laparoscopic Cholecystectomy? A Dilemma Looking for an Answer. Gastroenterol Res Pract 2015; 2015:104235. [PMID: 25722718 PMCID: PMC4333332 DOI: 10.1155/2015/104235] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/16/2015] [Indexed: 12/27/2022] Open
Abstract
Background. To evaluate the effect of timing of management and intervention on outcomes of bile duct injury. Materials and Methods. We retrospectively analyzed 92 patients between 1991 and 2011. Data concerned patient's demographic characteristics, type of injury (according to Strasberg classification), time to referral, diagnostic procedures, timing of surgical management, and final outcome. The endpoint was the comparison of postoperative morbidity (stricture, recurrent cholangitis, required interventions/dilations, and redo reconstruction) and mortality between early (less than 2 weeks) and late (over 12 weeks) surgical reconstruction. Results. Three patients were treated conservatively, two patients were treated with percutaneous drainage, and 13 patients underwent PTC or ERCP. In total 74 patients were operated on in our unit. 58 of them underwent surgical reconstruction by end-to-side Roux-en-Y hepaticojejunostomy, 11 underwent primary bile duct repair, and the remaining 5 underwent more complex procedures. Of the 56 patients, 34 patients were submitted to early reconstruction, while 22 patients were submitted to late reconstruction. After a median follow-up of 93 months, there were two deaths associated with BDI after LC. Outcomes after early repairs were equal to outcomes after late repairs when performed by specialists. Conclusions. Early repair after BDI results in equal outcomes compared with late repair. BDI patients should be referred to centers of expertise and experience.
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Major Liver Resection as Definitive Treatment in Post-cholecystectomy Common Bile Duct Injuries. World J Surg 2015; 39:1216-23. [DOI: 10.1007/s00268-014-2933-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Abstract
Late complications arising after bile duct injury (BDI) include biliary strictures, hepatic atrophy, cholangitis and intra-hepatic lithiasis. Later, fibrosis or even secondary biliary cirrhosis and portal hypertension can develop, enhanced by prolonged biliary obstruction associated with recurrent cholangitis. Secondary biliary cirrhosis resulting in associated hepatic failure or digestive tract bleeding due to portal hypertension is a substantial risk factor for morbidity and mortality after bile duct repair. Parameters that determine the management of late complications of BDI include the type of biliary injury, associated vascular injury, hepatic atrophy, the presence of intra-hepatic strictures or lithiasis, repetitive infectious complications, the quality of underlying parenchyma (fibrosis, secondary biliary cirrhosis) and the presence of portal hypertension. Endoscopic drainage is indicated for patients with uncontrolled acute sepsis, patients at high operative risk, patients with cirrhosis who are not eligible for liver transplantation and patients who have previously undergone several attempts at repair. Roux-en-Y hepaticojejunostomy, whether de novo or as an iterative repair, is the technique of reference for post-cholecystectomy BDI. Hepatic resection is indicated in only rare instances, mainly in case of extended hilar stricture, multiple stone retention in one sector of the liver or in patients for whom the repair is deemed technically difficult. Liver transplantation is indicated only in exceptional circumstances, when secondary biliary cirrhosis is associated with liver failure and portal hypertension.
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Affiliation(s)
- L Barbier
- Chirurgie Digestive et Transplantation Hépatique, Hôpital La Conception, Assistance publique-Hôpitaux de Marseille, Aix-Marseille Université, 147, boulevard Baille, 13385 Marseille cedex 5, France.
| | - R Souche
- Chirurgie Digestive A, Hôpital Saint-Éloi, Centre Hospitalo-Universitaire, Montpellier, France
| | - K Slim
- Service de Chirurgie Digestive, Unité de Chirurgie Ambulatoire, CHU Estaing, Clermont-Ferrand, France
| | - P Ah-Soune
- Gastro-Entérologie et Hépatologie, Centre Hospitalier Régional de Toulon, Toulon, France
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Stewart L. Iatrogenic biliary injuries: identification, classification, and management. Surg Clin North Am 2014; 94:297-310. [PMID: 24679422 DOI: 10.1016/j.suc.2014.01.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Because it offers several advantages over open cholecystectomy, laparoscopic cholecystectomy has largely replaced open cholecystectomy for the management of symptomatic gallstone disease. The only potential disadvantage is a higher incidence of major bile duct injury. Although prevention of these biliary injuries is ideal, when they do occur, early identification and appropriate treatment are critical to improving the outcomes of patients suffering a major bile duct injury. This report delineates the key factors in classification (and its relationship to mechanism and management), identification (intraoperative and postoperative), and management principles of these bile duct injuries.
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Affiliation(s)
- Lygia Stewart
- Department of Surgery (112), University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA 94121, USA.
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Bharathy KGS, Negi SS. Postcholecystectomy bile duct injury and its sequelae: pathogenesis, classification, and management. Indian J Gastroenterol 2014; 33:201-15. [PMID: 23999681 DOI: 10.1007/s12664-013-0359-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 07/21/2013] [Indexed: 02/06/2023]
Abstract
A bile duct injury sustained during cholecystectomy can change the life of patients who submit themselves to a seemingly innocuous surgery. It has far-reaching medical, socioeconomic, and legal ramifications. Attention to detail, proper interpretation of variant anatomy, use of intraoperative cholangiography, and conversion to an open procedure in cases of difficulty can avoid/lessen the impact of some of these injuries. Once suspected, the aims of investigation are to establish the type and extent of injury and to plan the timing and mode of intervention. The principles of treatment are to control sepsis and to establish drainage of all liver segments with minimum chances of restricturing. Availability of expertise, morbidity, mortality, and quality of life issues dictate the modality of treatment chosen. Endoscopic intervention is the treatment of choice for minor leaks and provides outcomes comparable to surgery in selected patients with lateral injuries and partial strictures. A Roux-en-Y hepaticojejunostomy (HJ) by a specialist surgeon is the gold standard for high strictures, complete bile duct transection and has been shown to provide excellent long-term outcomes. Percutaneous intervention is invaluable in draining bile collections and is useful in treating post-HJ strictures. Combined biliovascular injuries, segmental atrophy, and secondary biliary cirrhosis with portal hypertension are special circumstances which are best managed by a multidisciplinary team at an experienced center for optimal outcomes.
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Affiliation(s)
- Kishore G S Bharathy
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110 070, India
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Abstract
OBJECTIVE The objectives of this analysis were to compare the outcomes of bile duct injuries by specialist over time and the role of management timing and biliary stents. BACKGROUND Postoperative bile duct injuries require multidisciplinary management. In recent years, advancements have occurred in patient evaluation and in timing and type of therapy. METHODS A multidisciplinary team managed 528 patients over 18 years. Mean age was 52 years; 69% were women and 95% had a cholecystectomy and/or bile duct exploration. Patients were classified by the Strasberg system as having bile leaks (type A, n = 239, 45%) or bile duct injuries (types B-E, n = 289, 55%). Injury outcomes from 1993 to 2003 (n = 132) were compared with those from 2004 to 2010 (n = 157). A successful outcome was defined as no need for further intervention after the initial 12 months of therapy. Standard statistical methods were employed. RESULTS Patients with bile leaks were managed almost exclusively by endoscopists (96%) with a 96% success rate. Patients with bile duct injuries were managed most often by endoscopists (N = 115, 40%) followed by surgeons (N = 104, 36%) and interventional radiologists (N = 70, 24%). Overall success rates were best for surgery (88%, P < 0.05) followed by endoscopy (76%) and interventional radiology (50%) and improved over time (78% vs 69%). Outcomes were best for surgery in recent years (95% vs 80%, P < 0.05) and for patients stented for more than 6 months (P < 0.01). CONCLUSIONS Almost all bile leaks and many bile duct injuries can be managed successfully by endoscopists. Selected proximal injuries can be treated by interventional radiologists with modest success. Outcomes of bile duct injuries are best with surgical management and in patients who are stented for more than 6 months.
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Iimuro Y, Okada T, Ohashi K, Uda Y, Suzumura K, Fujimoto J. Salvage treatment of laparoscopic cholecystectomy-associated bile duct stenosis combining laparoscopic and endoscopic procedures: a case report. Asian J Endosc Surg 2013; 6:322-6. [PMID: 24308595 DOI: 10.1111/ases.12053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 05/31/2013] [Accepted: 06/20/2013] [Indexed: 11/30/2022]
Abstract
The incidence of laparoscopic cholecystectomy (LC)-associated bile duct injury has reached a steady state despite learning curve effect. Herein we report the case of a 74-year-old Japanese man who suffered from bile duct stenosis and stones after LC. The stenosis was due to stricture caused by surgical clips used inappropriately during LC. We planned a salvage treatment combining laparoscopic and endoscopic approaches. At laparoscopic observation, the clips had already invaded the right side of the bile duct; minimal absorbable suture was performed after all the clips were removed. The bile duct stenosis was then endoscopically dilated and the biliary stones were successfully removed. For the recurrent biliary stenosis after discharge, endoscopic balloon dilation was performed and multiple plastic stent tubes were placed. The stent tubes were removed 4 months later, and the patient has had no symptoms for 1 year. A combined laparoscopic and endoscopic approach was useful for the salvage treatment of LC-associated bile duct stenosis.
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Affiliation(s)
- Yuji Iimuro
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
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Lee KY. Acute cholecystitis at ER—We can remove it! GASTROINTESTINAL INTERVENTION 2013. [DOI: 10.1016/j.gii.2013.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bile Duct Injury-from Injury to Repair: an Analysis of Management and Outcome. Indian J Surg 2013; 77:536-42. [PMID: 26730060 DOI: 10.1007/s12262-013-0915-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 04/08/2013] [Indexed: 12/28/2022] Open
Abstract
Despite advances in speciality care, mortality and morbidity remain the most important issues in the management of post-cholecystectomy bile duct injuries. We analysed the peri-operative management of post-cholecystectomy bile duct injuries to assess their outcomes. Of 150 patients with post-cholecystectomy bile duct injuries, 13 patients who presented with strictured hepaticojejunostomy were excluded from the analysis. The records of the remaining 137 patients were analysed for type of presentation, management and follow-up. Of 137 injuries, 88 were open and 49 were laparoscopic. Various presentations include acute bile duct injury (n = 5), bile collection (n = 45), external biliary fistula (n = 46) and stricture (n = 41). After initial management, three patients died (sepsis, n = 2; pseudoaneurysmal bleed, n = 1). Of 107 patients who underwent definitive repair, three died (portal hypertension, n = 2; sepsis, n = 1). At median follow-up of 30 months, 100 patients had good outcome (grade A, B), and only 4 had bad outcome (grade C, D) as per McDonald grading. Peritonitis and sepsis in the early phase and portal hypertension and cirrhosis in the late phase are the main causes of mortality in patients sustaining bile duct injury during cholecystectomy. Successful management in a specialist hepatobiliary centre can limit the morbidity in more than 90 % cases.
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Pekolj J, Alvarez FA, Palavecino M, Sánchez Clariá R, Mazza O, de Santibañes E. Intraoperative management and repair of bile duct injuries sustained during 10,123 laparoscopic cholecystectomies in a high-volume referral center. J Am Coll Surg 2013; 216:894-901. [PMID: 23518251 DOI: 10.1016/j.jamcollsurg.2013.01.051] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 01/13/2013] [Accepted: 01/16/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Bile duct injury (BDI) remains the most serious complication of laparoscopic cholecystectomy (LC). The best strategy in terms of timing of repair is still controversial. The purpose of the current study is to review the experience in the intraoperative repair of bile duct injuries sustained during LC at a high-volume referral center. STUDY DESIGN Single-institution retrospective analysis of a prospectively collected database. Patients with diagnosis of BDI sustained during LC between October 1991 and November 2010 were extracted. RESULTS Among 10,123 LC performed during the study period, 19 patients had a BDI sustained during the procedure. Intraoperative cholangiography was routinely used. Bile duct injury was diagnosed intraoperatively in 17 patients (89.4%). Mean age was 56.4 years (range 18 to 81 years) and 15 patients were women (88%). According to the Strasberg classification of BDI, there were 3 type C lesions, 12 type D lesions, and 2 type E2 lesions. There were no associated vascular injuries. Twelve cases (71%) were converted to open surgery. The repairs included 10 primary biliary closures, 4 Roux-en-Y hepaticojejunostomies, 2 end to end anastomosis, and 1 laparoscopic transpapillary drainage. Postoperative complications occurred in 5 patients (29.4%). During the follow-up period, early biliary strictures developed in 2 patients (11.7%) and were treated by percutaneous dilation and a Roux-en-Y hepaticojejunostomy with satisfactory long-term results. CONCLUSIONS The current series represents one of the largest single-center experiences in terms of intraoperative repair of BDI sustained during LC. The results suggest that a high level of intraoperative diagnosis is possible, where intraoperative cholangiography is a useful tool. The intraoperative repair of BDI sustained during LC by experienced hepatobiliary surgeons either by open or laparoscopic approach appears of paramount importance to assure optimal results.
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Affiliation(s)
- Juan Pekolj
- Hepato-Pancreato-Biliary and Liver Transplant Sections, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
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Goessmann H, Lang SA, Fichtner-Feigl S, Scherer MN, Schlitt HJ, Stroszczynski C, Schreyer AG, Schnitzbauer AA. [Biliodigestive anastomosis: indications, complications and interdisciplinary management]. Chirurg 2012. [PMID: 23179515 DOI: 10.1007/s00104-012-2365-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Techniques for biliodigestive anastomoses are a frequent indication in primary surgical interventions. Moreover, they are required to manage secondary complications of hepatobiliary surgery. Evidence for the management of complications following biliodigestive anastomoses is low. Biliodigestive anastomoses can be performed as hepaticojejunostomy, hepatojejunostomy/portoenterostomy and hepaticoduodenostomy using running or single stitch suture techniques. Complication management in the hands of experienced hepatopancreatobiliary surgeons should consider a time delay to the primary operation and an interdisciplinary surgical and/or endoscopic or radiologic interventional approach. The therapy may be protracted and requires repeated critical reflection of the particular complication.
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Affiliation(s)
- H Goessmann
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Deutschland
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Törnqvist B, Strömberg C, Persson G, Nilsson M. Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study. BMJ 2012; 345:e6457. [PMID: 23060654 PMCID: PMC3469410 DOI: 10.1136/bmj.e6457] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To determine whether the routine use of intraoperative cholangiography can improve survival from complications related to bile duct injuries. DESIGN Population based cohort study. SETTING Prospectively collected data from the Swedish national registry of gallstone surgery and endoscopic retrograde cholangiopancreatography, GallRiks. Multivariate analysis done by Cox regression. POPULATION All cholecystectomies recorded in GallRiks between 1 May 2005 and 31 December 2010. MAIN OUTCOME MEASURES Evidence of bile duct injury, rate of intended use of intraoperative cholangiography, and rate of survival after cholecytectomy. RESULTS During the study, 51,041 cholecystectomies were registered in GallRiks and 747 (1.5%) iatrogenic bile duct injuries identified. Patients with bile duct injuries had an impaired survival compared with those without injury (mortality at one year 3.9% v 1.1%). Kaplan-Meier analysis showed that early detection of a bile duct injury, during the primary operation, improved survival. The intention to use intraoperative cholangiography reduced the risk of death after cholecystectomy by 62% (hazard ratio 0.38 (95% confidence interval 0.31 to 0.46)). CONCLUSIONS The high incidence of bile duct injury recorded is probably from GallRiks' ability to detect the entire range of injury severities, from minor ductal lesions to complete transections of major ducts. Patients with bile duct injury during cholecystectomy had impaired survival, and early detection of the injury improved survival. The intention to perform an intraoperative cholangiography reduced the risk of death after cholecystectomy.
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Affiliation(s)
- Björn Törnqvist
- Division of Surgery, CLINTEC, Karolinska Institutet and Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
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Cui Y, Zhang H, Cui N, Li Z. Surgical treatment for benign biliary strictures: single-center experience on 64 cases. EXCLI JOURNAL 2012; 11:390-8. [PMID: 27418914 PMCID: PMC4942806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 07/18/2012] [Indexed: 11/29/2022]
Abstract
Objectives: In order to describe treatment options for postoperative benign biliary strictures and find a proper approach for treatment, we describe the presentation and management of postoperative biliary stricture in 64 patients. Methods: Demographical and clinical data from 64 patients undergoing surgical reconstructions by retrospective methods during the past 6 years were analyzed. Clinical features of Grade I and II group versus Grade III and IV group and bile duct plasty versus biliojejunostomy were compared. Results: Of the 64 patients, 21 received bile duct plasty and the other 43 underwent biliojejunostomy. Patients with bigger bile duct dilatation had better outcomes than those with smaller one, P=0.0372. Hepaticojejunostomy was correlated to better outcomes than other surgical procedures, P=0.0483. Bile duct plasty was related to Bismuth classification Type I, P=0.0001. But biliojejunostomy was related to Bismuth classification Type II, P=0.0001 and Type III, P=0.0059. Patients with bigger bile duct dilatation had more biliojejunostomy than those with smaller one, P=0.0001. Conclusion: Both biliojejunostomy and bile duct plasty had good treatment outcomes. Bile duct plasty should be confined to patients with a degree of bile duct dilatation less than 1.5 cm and Bismuth classification (Type I). The degree of dilatation, hepaticojejunostomy and postoperative morbidity were factors statistically correlated to long term outcomes.
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Affiliation(s)
- Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, 122 Sanwei Road Nankai District, Tianjin 300100, China
| | - Hongtao Zhang
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, 122 Sanwei Road Nankai District, Tianjin 300100, China
| | - Naiqiang Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, 122 Sanwei Road Nankai District, Tianjin 300100, China
| | - Zhonglian Li
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, 122 Sanwei Road Nankai District, Tianjin 300100, China
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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: 1.1] [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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Dageforde LA, Landman MP, Feurer ID, Poulose B, Pinson CW, Moore DE. A Cost-Effectiveness Analysis of Early vs Late Reconstruction of Iatrogenic Bile Duct Injuries. J Am Coll Surg 2012; 214:919-27. [PMID: 22495064 DOI: 10.1016/j.jamcollsurg.2012.01.054] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 01/23/2012] [Accepted: 01/23/2012] [Indexed: 01/07/2023]
Affiliation(s)
- Leigh Anne Dageforde
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232-4753, USA
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Robles Campos R, Marín Hernández C, Fernández Hernández JA, Sanchez Bueno F, Ramirez Romero P, Pastor Perez P, Parrilla Paricio P. Hemorragia diferida de la arteria hepática derecha tras iatrogenia biliar por colecistectomía laparoscópica que precisó trasplante hepático por insuficiencia hepática aguda: caso clínico y revisión de la literatura. Cir Esp 2011; 89:670-6. [DOI: 10.1016/j.ciresp.2011.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 06/14/2011] [Accepted: 07/01/2011] [Indexed: 01/14/2023]
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Choledochoscopic light-guided method for redo biliary reconstruction in patients with biliary stricture after living donor liver transplantation. J Am Coll Surg 2011; 213:e1-4. [PMID: 21680203 DOI: 10.1016/j.jamcollsurg.2011.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 05/13/2011] [Accepted: 05/13/2011] [Indexed: 11/21/2022]
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Mercado MA, Domínguez I. Classification and management of bile duct injuries. World J Gastrointest Surg 2011; 3:43-8. [PMID: 21528093 PMCID: PMC3083499 DOI: 10.4240/wjgs.v3.i4.43] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 03/25/2011] [Accepted: 04/01/2011] [Indexed: 02/06/2023] Open
Abstract
To review the classification and general guidelines for treatment of bile duct injury patients and their long term results. In a 20-year period, 510 complex circumferential injuries have been referred to our team for repair at the Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán” hospital in Mexico City and 198 elsewhere (private practice). The records at the third level Academic University Hospital were analyzed and divided into three periods of time: GI-1990-99 (33 cases), GII- 2000-2004 (139 cases) and GIII- 2004-2008 (140 cases). All patients were treated with a Roux en Y hepatojejunostomy. A decrease in using transanastomotic stents was observed (78% vs 2%, P = 0.0001). Partial segment IV and V resection was more frequently carried out (45% vs 75%, P = 0.2) (to obtain a high bilioenteric anastomosis). Operative mortality (3% vs 0.7%, P = 0.09), postoperative cholangitis (54% vs 13%, P = 0.0001), anastomosis strictures (30% vs 5%, P = 0.0001), short and long term complications and need for reoperation (surgical or radiological) (45% vs 11%, P = 0.0001) were significantly less in the last period. The authors concluded that transition to a high volume center has improved long term results for bile duct injury repair. Even interested and tertiary care centers have a learning curve.
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Affiliation(s)
- Miguel Angel Mercado
- Miguel Angel Mercado, Ismael Domínguez, Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", P.C.14000 México, DF, Mexico
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Specialist Early and Immediate Repair of Post-laparoscopic Cholecystectomy Bile Duct Injuries Is Associated With an Improved Long-term Outcome. Ann Surg 2011; 253:553-60. [DOI: 10.1097/sla.0b013e318208fad3] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Surgical management and outcome of bile duct injuries following cholecystectomy: a single-center experience. Langenbecks Arch Surg 2011; 396:699-707. [PMID: 21336816 DOI: 10.1007/s00423-011-0745-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 01/26/2011] [Indexed: 01/29/2023]
Abstract
PURPOSE Biliary injury is a severe complication of cholecystectomy. The Hepp-Couinaud reconstruction with the hepatic duct confluence and the left duct may offer best long-term outcome as long as the confluence remains intact (Bismuth I-III). Complex liver surgery is usually indicated in most proximal (Bismuth IV) injuries in non-cirrhotic patients. The aim of this study was to evaluate the surgical treatment and outcome of bile duct injuries managed in a referral hepatobiliary unit. METHODS We retrospectively analyzed surgical management and outcome of biliary injuries following cholecystectomy in 35 patients (27 laparoscopic) referred to our center between June 2001 and December 2009. There was no liver cirrhosis diagnosed in any patient. High injuries (Bismuth III-IV) were found in 14 patients. Management after referral included the Hepp-Couinaud hepaticojejunostomy in 32 patients with Bismuth I-III injuries, which in four cases with biliary peritonitis was preceded by abdominal lavage and prolonged external biliary drainage. Liver transplantation was performed in two patients with Bismuth IV injuries. RESULTS After median follow-up of 59 months (range, 6-102), 34 (97%) patients are alive and 32 (92%) remain in good general condition with normal liver function. One patient who had combined biliary and colonic injury died of sepsis before repair. Recurrent strictures following the Hepp-Couinaud repair developed in two (6%) patients with high injuries combined with right hepatic arterial injury. CONCLUSION The Hepp-Couinaud hepaticojejunostomy offers durable results, even after previous interventions have failed. In case of diffuse biliary peritonitis, delayed biliary reconstruction following external biliary drainage may be the best option.
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Sampaio JA, Kruse CK, Passarin TL, Waechter FL, Nectoux M, Fontes PRO, Pereira-Lima L. Estenoses biliares benignas: reparação e resultados com o uso de silastic transhepático transanastomótico. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2010. [DOI: 10.1590/s0102-67202010000400011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
RACIONAL: Os avanços da medicina nem sempre estão relacionados a bons resultados homogêneos para todos os pacientes. Este é o caso de colecistectomia laparoscópica, cujas vantagens são amplamente reconhecidos na literatura médica. No entanto, ela pode trazer consigo temida e grave complicação que é lesão iatrogênica da via biliar extra-hepática. Ela vem aumentando nos últimos anos, apesar da curva de aprendizagem já estar ultrapassada na maioria dos centros. Está estabilizada em nível mais elevado do que o registrado nas colecistectomias laparotômicas. Na reparação das grandes lesões bom resultado pode ser alcançado com a utilização de tubos transanastomóticos em associação à hepaticojejunostomias. OBJETIVOS: Relatar 20 anos de experiência na reconstrução das vias biliares por lesão ductal com o uso de tubos transanastomóticos. MÉTODOS: Foram analisados os dados de 338 pacientes que se submeteram à operação para as principais lesões do ducto biliar entre janeiro de 1988 e dezembro de 2009. RESULTADOS: Todos os 338 pacientes foram submetidos à hepaticojejunostomias com anastomoses em Y-de-Roux (Hepp-Couinaud) ou colangiojejunostomias, todos com o uso de tubos de silastic transanastomóticos. A longo prazo, bom resultado foi obtido em 240 (92,9%) dos 338 pacientes, incluindo aqueles que necessitaram de procedimentos subsequentes. CONCLUSÃO: Estenoses biliares benignas próximas à confluência dos ductos hepáticos permanece sendo desafio cirúrgico. O uso de tubos de silastic transhepáticos transanastomóticos na reconstrução biliar alta é opção que pode proporcionar boa reparação biliar com baixos índices de complicações.
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Affiliation(s)
- José Artur Sampaio
- Universidade Federal de Ciências da Saúde de Porto Alegre; Santa Casa de Porto Alegre, Brasil
| | - Cristine Kist Kruse
- Universidade Federal de Ciências da Saúde de Porto Alegre; Santa Casa de Porto Alegre, Brasil
| | - Thiago Luciano Passarin
- Universidade Federal de Ciências da Saúde de Porto Alegre; Santa Casa de Porto Alegre, Brasil
| | - Fábio Luiz Waechter
- Universidade Federal de Ciências da Saúde de Porto Alegre; Santa Casa de Porto Alegre, Brasil
| | - Mauro Nectoux
- Universidade Federal de Ciências da Saúde de Porto Alegre; Santa Casa de Porto Alegre, Brasil
| | | | - Luiz Pereira-Lima
- Universidade Federal de Ciências da Saúde de Porto Alegre; Santa Casa de Porto Alegre, Brasil
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