Value of routine intraoperative cholangiography in detecting aberrant bile ducts and bile duct injuries during laparoscopic cholecystectomy

1996 ◽  
Vol 83 (2) ◽  
pp. 171-175 ◽  
Author(s):  
E Kullman ◽  
K Borch ◽  
E Lindstrom ◽  
J Svanvik ◽  
B Anderberg
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Ducts ◽  
Intraoperative Cholangiography ◽  
Bile Duct Injuries

scholarly journals Tulžies latakų sužalojimai atliekant laparoskopinę cholecistektomiją

2007 ◽  
Vol 5 (2) ◽  
pp. 0-0
Author(s):  
Donatas Venskutonis ◽  
Linas Urbanavičius ◽  
Juozas Juočas ◽  
Saulius Bradulskis ◽  
Virmantas Daubaras ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
General Surgery ◽  
Bile Ducts ◽  
Diffuse Peritonitis ◽  
Clinical Hospital ◽  
Bile Duct Injuries ◽  
Extrahepatic Bile Ducts ◽  
Iatrogenic Bile Duct Injury

Donatas Venskutonis, Linas Urbanavičius, Juozas Juočas, Saulius Bradulskis, Virmantas Daubaras, Juozas KutkevičiusKauno medicinos universiteto Bendrosios chirurgijos klinika,VšĮ Kauno II klinikinė ligoninė, Josvainių g. 2, LT-47133 KaunasEl paštas: [email protected] Įvadas / tikslas Manoma, kad atliekant laparoskopinę cholecistektomiją ekstrahepatiniai tulžies latakai sužalojami dažniau nei atvirąją. Įvykus tulžies latakų sužalojimui, svarbu jį kuo skubiau diagnozuoti ir tinkamai gydyti. Siūlomos įvairios sužalojimų prevencijos priemonės. Šio darbo tikslas – išanalizuoti KMU Bendrosios chirurgijos klinikoje 1994–2006 metais laparoskopinės cholecistektomijos metu įvykusių ekstrahepatinių tulžies latakų jatrogeninių sužalojimų dažnį, priežastis, gydymo metodus, padarinius ir prevencijos priemones, apžvelgti literatūros duomenis. Ligoniai ir metodai Analizavome 1994–2006 m. KMU Bendrosios chirurgijos klinikoje (VšĮ II KKL) dėl tulžies latakų jatrogeninių sužalojimų, įvykusių laparoskopinės cholecistektomijos metu, gydytų pacientų ligos istorijas. Rezultatai Per minėtą laikotarpį atliktos 5396 laparoskopinės cholecistektomijos: 1681 (31,2%) pacientui – dėl ūminio ir 3715 (68,8%) – dėl lėtinio cholecistito. Po operacijos 7 ligoniai mirė. Vienas ligonis mirė nuo bendrojo tulžies latako sužalojimo ir pankreatito. Kitos mirties priežastys: trims ligoniams buvo plaučių arterijos embolija, vienam – dvylikapirštės žarnos perforacija ir peritonitas, dviem – gangreninis cholecistitas ir lokalus peritonitas. Bendras mirštamumas 0,13%. Ekstrahepatiniai tulžies latakai sužaloti 10 ligonių (0,19%). Vienas ligonis gydytas nuo tulžies latakų sužalojimo kitoje ligoninėje. Išvados Apibendrinus rezultatus galima tvirtinti, kad tulžies latakų sužalojimo ir mirties atvejai operuojant laparoskopiškai yra reti, o laparoskopinė cholecistektomija mūsų klinikoje – saugi operacija. Atvira cholecistektomija pranašesnė tik sunkiais, komplikuotais atvejais (neaiški anatomija, tulžies pūslės-žarnyno fistulės) ir nesant galimybės išgydyti tulžies latakų akmenligės endoskopiškai. Pagrindiniai žodžiai: cholecistitas, laparoskopinė cholecistektomija, ekstrahepatiniai tulžies latakai, sužalojimai Bile duct injuries during laparoscopic cholecystectomy donatas venskutonis, linas urbanavičius, juozas juočas, saulius bradulskis, virmantas daubaras, juozas kutkevičiusKaunas University of Medicine Clinic of General Surgery, Kaunas 2nd Clinical Hospital,Josvainių str. 2, LT-47133, Kaunas, LithuaniaE-mail: [email protected] Background / objective Laparoscopic cholecystectomy is associated with a higher risk of extrahepatic bile duct injuries. Timely diagnosis and proper management of bile duct injury are very important. Various preventive measures are widely discussed. Our aim was to analyze iatrogenic injuries of extrahepatic bile ducts sustained during laparoscopic cholecystectomy over the period 1994–2006 at the Clinic of General Surgery of Kaunas University of Medicine and to review the relevant pub-lished reports. Patients and methods Analysis of the case histories of patients treated for iatrogenic bile duct injuries sustained during laparoscopic cholecystectomy over the period 1994–2006 at the Clinic of General Surgery of Kaunas University of Medicine (2nd Clinical Hospital), Lithuania. Results During the period 1994–2006, 5396 patients underwent laparoscopic cholecystectomy for acute cholecystitis (n = 1681, 31.2%) and chronic gallstone disease (n = 3715, 68.8%). Seven patients died after surgery: one patient died of bile duct injury, 3 patients of pulmonary artery embolism; there were one case of duodenum perforation and diffuse peritonitis, one case of severe acute pancreatitis, and 2 cases of gangrenous cholecystitis with peritonitis. The overall mortality rate was 0.13%. Iatrogenic bile duct injury occurred in 10 cases (0.19%). One patient was referred from another hospital and was treated for a iatrogenic bile duct injury. Conclusions The incidence of bile duct injuries and the death rate were low. Laparoscopic cholecystectomy was performed with acceptable safety in our clinic. Conventional cholecystectomy was preferred to laparoscopic cholecystectomy in difficult, complicated cases (unclear anatomy, biliary enteric fistulas) and in cases of unsuccessful endoscopic treatment of choledocholithiasis and obstructive jaundice. Keywords: cholecystitis, laparoscopic cholecystectomy, extrahepatic bile ducts, injuries

DAMAGE TO THE BILE DUCTS AFTER LAPAROSCOPIC CHOLECYSTECTOMY. REVIEW.

2021 ◽  
pp. 17-25
Author(s):  
Maxat Doskhanov
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Ducts ◽  
Gallstone Disease ◽  
Abdominal Cavity ◽  
Bile Leakage ◽  
Treatment And Prevention ◽  
Technical Errors ◽  
Bile Duct Injuries ◽  
Good Cosmetic

This article provides a review of the literature on bile duct injuries after laparoscopic cholecystectomy. Laparascopy is considered the gold standard in the treatment of gallstone disease. This technique has a number of positive advantages: minimally invasiveness, quick rehabilitation, a shorter hospital stay, a good cosmetic effect, and a low lethal outcome. Along with these advantages, the number of complications also increased: damage to the bile ducts, hepatic vessels, bile leakage, formation of strictures, defects in drainage of the biliary tract and improper treatment of the cystic duct, insufficient drainage of the abdominal cavity. Today, many aspects of surgical treatment and prevention of bile duct injuries remain controversial and are still considered relevant. The main reasons for this complication are: lack of experience of the surgeon, inattention, ignorance of the main options and possible anomalies of important anatomical structures in the area of the hepatic hilum and hepato-duodenal ligament, technical errors.

Does A Surgeon as First Assistant Reduce the Incidence of Common Bile Duct Injuries during Laparoscopic Cholecystectomy?

2010 ◽  
Vol 76 (3) ◽  
pp. 287-291
Author(s):  
Matt B. Martin ◽  
Kristen R. Earle
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
General Surgery ◽  
Retrospective Review ◽  
Intraoperative Cholangiography ◽  
Surgical Endoscopy ◽  
Bile Duct Injuries ◽  
Surgery Group

This retrospective review supports the hypothesis that a surgeon acting as first assistant during laparoscopic cholecystectomy will reduce the incidence of significant common bile duct (CBD) injuries (BDIs). Central Carolina Surgery, P.A., is a single-specialty general surgery group of 19 surgeons that have performed 8767 laparoscopic cholecystectomies from October 1999 to December 2007. In those cases, 89 per cent of the cases had surgeons as first assistants and 66 per cent of the cases were performed with intraoperative cholangiography. Five cases of BDI occurred during this period for an incidence of 0.0570 per cent. Only three of these injuries required bilioenteric anastomotic reconstruction. When this same group of surgeons learned to perform laparoscopic cholecystectomy in 1990, their published series (Surgical Endoscopy: [1993] 7:300 to 303] of 762 cases had 98 per cent of cases performed with a surgeon as first assistant and no CBD injuries. Only 27 per cent of those 762 cases had intraoperative cholangiograms. This single-practice general surgery experience supports the use of a surgeon as first assistant to lower the incidence of CBD injures.

Postcholecystectomy bile duct injuries: evolution of surgical treatment

2019 ◽  
Vol 91 (1) ◽  
pp. 14-21
Author(s):  
Audrius Šileikis ◽  
Rūta Žulpaitė ◽  
Auksė Šileikytė ◽  
Martynas Lukšta
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Treatment ◽  
Bile Duct ◽  
Bile Ducts ◽  
Late Complications ◽  
Bile Duct Injuries ◽  
Appropriate Treatment ◽  
The Mean ◽  
End To End

Introduction Bile duct injuries (BDIs) still occur during laparoscopic cholecystectomy. Although management of such complications is challenging, collaboration of a multidisciplinary team and development of treatment methods and materials often lead to the successful treatment. Materials and methods Medical records of 67 patients who have experienced bile duct injures after laparoscopic cholecystectomy were retrospectively reviewed. All injures were classified according to the European Association for Endoscopic Surgery ATOM classification and investigated by manifestation of the injury, surgical repair technique, early and late complications. Results In 28 (41.8 %) patients with partial divisions, the surgical treatment of BDI was completed with endoscopic retrograde cholangiopancreatography (ERCP) and stenting while in 14 (20.1%) cases, the defect of bile duct was closed by suture. End-to-end ductal anastomosis was performed for 6 (13.4%) patients with complete division while 19 (28.3%) patients underwent hepaticojejunostomy. We followed up 58 (92.1%) of 63 patients. The mean follow-up duration was 25.7 (3 - 123) months. Twenty-three (39.7%) patients were found with strictures. Discussion Intraoperative detection and management of BDIs is crucial to achieve good results. The routine intraoperative cholangiography and possibilities of repair by initial surgeons in peripheral hospitals remain controversial. Stenting with a covered self-expanding metal stent is promising for the patients with partial divisions of bile ducts. Initial hepaticojejunostomy is often a preferred treatment for transected bile ducts because of lower rate of anastomosis strictures. However, as end-to-end anastomosis is more physiological, and endoscopy allows successful management of the strictures, we suggest choosing this treatment when possible Recommendation for paperwork content: Classifying bile duct injuries according to the new ATOM classification may be useful in the decision of the most appropriate treatment in each case.

scholarly journals The Critical View Of Safety : Une Attitude Pour Prévenir L’erreur D’identification Dans Les Cholécystectomies Laparoscopiques.

2021 ◽  
Author(s):  
Anisse Tidjane ◽  
Nabil Boudjenan-Serradj ◽  
Benali Tabeti
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Ducts ◽  
Voies Biliaires ◽  
Critical View ◽  
Critical View Of Safety ◽  
Bile Duct Injuries ◽  
Bonnes Pratiques ◽  
Voie Biliaire Principale ◽  
Haptic Sensation

Résumé: Avec la généralisation de la cholécystectomie laparoscopique, l’incidence des traumatismes opératoires des voies biliaires a augmentée de façon significative. La perte de la sensation haptique, la vision bidimensionnelle, et l’éclairage centré favorisent l’illusion aboutissant à des erreurs d’identifications, où le chirurgien confond voie biliaire principale et canal cystique. Ce phénomène explique l’augmentation des traumatismes biliaires à l’ère de la laparoscopie.Récemment, et grâce aux recommandations des sociétés savantes comme la SAGES sur les bonnes pratiques chirurgicales, l’incidence de ces traumatismes est en régression et tend a rejoindre celle décrite à l’ère de la chirurgie ouverte. Parmi ses recommandations, la SAGES met l’accent sur l’adoption par tous les chirurgiens de la « Critical View of Safety » durant la réalisation de la cholécystectomie par voie laparoscopique. L’objectif de cette mise au point est de décrire cette attitude, mais surtout analyser son efficacité et ses limites dans la prévention des traumatismes opératoires des voies biliaires.Abstract:With the generalization of laparoscopic cholecystectomy, the incidence of operative bile ducts injury has increased significantly, the loss of haptic sensation, the two-dimensional vision, and the centered lighting favor the illusion leading to misidentifications, as consequences the surgeon confuses the main bile duct and the cystic duct. This phenomenon explains this increase in the incidence of bile duct injuries in the era of laparoscopy.Recently, and thanks to the recommendations of some learned societies such as SAGES on good surgical practices, the incidence of these complications is declining and tends to join that described in the era of open surgery. Among its many recommendations, SAGES recommends the adoption by all surgeons of the “Critical View of Safety” during the performance of laparoscopic cholecystectomy, an attitude that we will describe, and analyze its effectiveness and its limits in prevention of operative bile ducts injury.

scholarly journals Role of Intraoperative Cholangiography in Laparoscopic Cholecystectomy in Higher Risk Patients of Bile Duct Injuries

2019 ◽  
Vol 87 (12) ◽  
pp. 4137-4140
Author(s):  
SAMIR E. SHNEASHEN, M.Sc.; MOHAMED ELSHEIKH, M.D. ◽  
MOHAMED A. HABLUS, M.D.; HAMDY ABDELHADY, M.D.
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Intraoperative Cholangiography ◽  
Bile Duct Injuries ◽  
Risk Patients
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