scholarly journals Difficult iatrogenic bile duct injuries following different types of upper abdominal surgery: report of three cases and review of literature

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jerzy Lubikowski ◽  
Bernard Piotuch ◽  
Anna Stadnik ◽  
Marta Przedniczek ◽  
Piotr Remiszewski ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Abdominal Surgery ◽  
Delayed Diagnosis ◽  
Biliary Leak ◽  
Bile Duct Injuries ◽  
Upper Abdominal Surgery ◽  
Different Types ◽  
Upper Abdominal ◽  
Type Of Injury

Abstract Background Iatrogenic bile duct injuries (BDIs) are mostly associated with laparoscopic cholecystectomy but may also occur following gastroduodenal surgery or liver resection. Delayed diagnosis of type of injury with an ongoing biliary leak as well as the management in a non-specialized general surgical units are still the main factors affecting the outcome. Case presentation Herein we present three types of BDIs (Bismuth type I, IV and V) following three different types of upper abdominal surgery, ie. Billroth II gastric resection, laparoscopic cholecystectomy and left hepatectomy. All of them were complex injuries with complete bile duct transections necessitating surgical treatment. All were also very difficult to treat mainly because of a delayed diagnosis of type of injury, associated biliary leak and as a consequence severe inflammatory changes within the liver hilum. The treatment was carried out in our specialist hepatobiliary unit and first focused on infection and inflammation control with adequate biliary drainage. This was followed by a delayed surgical repair with the technique which had to be tailored to the type of injury in each case. Conclusion We emphasize that staged and individualized treatment strategy is often necessary in case of a delayed diagnosis of complex BDIs presenting with a biliary leak, inflammatory intraabdominal changes and infection. Referral of such patients to expert hepatobiliary centres is crucial for the outcome.

Laparoscopic common bile duct exploration in patients with previous upper abdominal surgery

2018 ◽  
Vol 32 (12) ◽  
pp. 4893-4899 ◽  
Author(s):  
Jisheng Zhu ◽  
Gen Sun ◽  
Le Hong ◽  
Xiaohua Li ◽  
Yong Li ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Abdominal Surgery ◽  
Common Bile Duct Exploration ◽  
Upper Abdominal Surgery ◽  
Upper Abdominal

scholarly journals Bile Duct Injuries in Connection With 2500 Laparoscopic Cholecystectomies

1997 ◽  
Vol 4 (2) ◽  
pp. 55-60
Author(s):  
P. Schmidt ◽  
P. Ezer ◽  
A. Antal
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Complication Rate ◽  
Open Surgery ◽  
Biliodigestive Anastomosis ◽  
T Tube ◽  
The Past ◽  
Bile Duct Injuries ◽  
Type Of Injury ◽  
Methods Of Treatment

Background: Laparoscopic cholecystectomy (LC) is taking the place of an effective and tested procedure in surgery, therefore it must not be inferior to the standard modality in any aspect. Some complications specific to the technique, however, are severe and complication rate seem to be higher than in standard open surgery.Methods: In this paper the authors report their guiding principles in applying LC and methods of treatment, and describe the bile duct injuries of 2500 LCs accomplished during the past 4.5 years.Results: Seventeen ductal injuries occurred in the whole series, which means an overall incidence rate of 0.68%. Data obtained in the last period, however, show a decrease down to 0.14%. Following ductal injuries six ductal strictures became clinically apparent. The various complications of these injuries caused the death of two patients.Conclusions: The great number of intraoperatively undetected injuries, many of them arising not due to technical difficulties, suggest the possibility of an injury caused by electric current. Depending on the type of injury direct suture, T-tube drainage or biliodigestive anastomosis can equally be effective. Long established practice and experience can help reduce the occurrence of complications to the level in standard open surgery.

scholarly journals Medicolegal claims following laparoscopic cholecystectomy in the UK and Ireland

2010 ◽  
Vol 92 (4) ◽  
pp. 286-291 ◽  
Author(s):  
James RH Scurr ◽  
Julian R Brigstocke ◽  
David A Shields ◽  
John H Scurr
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Vascular Injury ◽  
Expert Witness ◽  
Vascular Injuries ◽  
Biliary Leak ◽  
Delay In Diagnosis ◽  
Bile Duct Injuries ◽  
The Uk ◽  
Major Vascular Injury

INTRODUCTION The causes and outcomes of medicolegal claims following laparoscopic cholecystectomy were evaluated. SUBJECTS AND METHODS A retrospective analysis of the experience of a consultant surgeon acting as an expert witness within the UK and Ireland (1990–2007). RESULTS A total of 151 claims were referred for an opinion. Sixty-three related to bile duct injuries and four followed major vascular injury. Bowel injury resulted in 17 claims. A postoperative biliary leak not associated with a bile duct injury was responsible for 25 claims. Other reasons for claims included spilled gallstones, port-site herniae, haemorrhage and other recognised complications associated with laparoscopic cholecystectomy. Twelve of the claims are on-going, two went to trial, 79 (52%) were settled out of court and 58 (38%) were discontinued after the claimants were advised that they were unlikely to win their case. Disclosed settlement amounts are reported. CONCLUSIONS Bile duct and major vascular injuries are almost indefensible. The delay in diagnosis and (mis)management of other recognised complications following laparoscopic cholecystectomy have also led to a significant number of successful medicolegal claims.

scholarly journals Feasibility of Laparoscopic Cholecystectomy in Patients with Previous Upper Abdominal Surgery

2021 ◽  
Vol 3 (2) ◽  
pp. 1482-1493
Author(s):  
Hamdy Ahmed Mostafa salama ◽  
Salah Ayoub Soliman ◽  
Ayman Fahmy Elramah
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Surgery ◽  
Upper Abdominal Surgery ◽  
Upper Abdominal

scholarly journals Assessment of clinical, hematological, radiological parameters for prediction of difficult laparoscopic cholecystectomy at a tertiary health care centre

2018 ◽  
Vol 5 (9) ◽  
pp. 2984
Author(s):  
Abhishek Jina ◽  
Shailendra Kumar ◽  
Vineet Singh
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Surgery ◽  
Gall Bladder ◽  
Open Cholecystectomy ◽  
Total Leukocyte Count ◽  
Symptomatic Cholelithiasis ◽  
Upper Abdominal Surgery ◽  
Study Results ◽  
History Of ◽  
Upper Abdominal

Background: Since its introduction in the mid 1980’s, laparoscopic cholecystectomy (LC) has been widely used for symptomatic cholelithiasis. In recent years it has been considered as a gold standard for treatment of symptomatic cholelithiasis. Recent studies have reported that the rate of conversion of LC to open cholecystectomy (OC) is 1.5-19%. The aim of the present study was to predict the difficulties of performing laparoscopic cholecystectomy in symptomatic cholelithiasis. Further, the possibility of converting LC to open cholecystectomy was also investigated using various haematological, clinical, and radiological tool such as USG.Methods: The present prospective study was conducted in in Nehru Hospital of BRD Medical College, Gorakhpur, India over a period of 12 months on in-patients from various surgical wards undergoing LC. The patients were primarily divided into two groups consisting of those undergoing LC and those converted to OC respectively. Parameters like gender, age, body mass index, associated complains, total leukocyte count (TLC) and levels of alkaline phosphatase (ALP) were assessed as potential risk factors for conversion.Results: 50 patients were considered for this study. Results indicated that rate of conversion of LC to OC was found to be maximum for patients belonging to male gender, 31-40 years old, were obese, had previous history of upper abdominal surgery and had raised levels of TLC and ALP. Patients having multiple stones and contracted gall bladder also had a higher incidence of conversion to OC.Conclusions: From results obtained in this study, it could be concluded that parameters like age, gender, obesity, history of upper abdominal surgery, raised levels of TLC and ALP, incidences of multiple stones and contracted gall bladder posed significant risk for LC and acted as predictors for conversion to OC.

scholarly journals Laparoscopic Cholecystectomy after Upper Abdominal Surgery : Is It Feasible Even after Gastrectomy?

2017 ◽  
Vol 20 (1) ◽  
pp. 22-28
Author(s):  
Jungmin Lee ◽  
Jincheol Jeong ◽  
Doojin Kim ◽  
Jooseop Kim ◽  
Taesuk Ryu
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Surgery ◽  
Upper Abdominal Surgery ◽  
Upper Abdominal

scholarly journals Post-Operative Pulmonary Function : A Comparison between Upper Abdominal Open Cholecystectomy and Laparoscopic Cholecystectomy

2014 ◽  
pp. 12-16
Author(s):  
Shahnaz Afroza ◽  
MM Masum-Ul-Haque ◽  
Nibedita Nargis ◽  
Nezamuddin Ahmed ◽  
Lutful Aziz ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Abdominal Surgery ◽  
Pulmonary Function ◽  
Open Cholecystectomy ◽  
Patient Control Analgesia ◽  
Pulmonary Complications ◽  
Significant Alteration ◽  
Mortality And Morbidity ◽  
Upper Abdominal Surgery ◽  
Upper Abdominal

Postoperative Pulmonary Complications (PPCs) is one of the major cause of perioperative mortality and morbidity in thoracic and upper abdominal surgery. Preoperative risk assessment enables clinicians to reduce perioperative risk in high risk patients.. In upper abdominal surgery, there is a larger alteration in pulmonary functions. This study was performed in 30 patients scheduled for laparoscopic cholecystectomy and for upper abdominal open cholecystectomy. The study revealed that after both laparoscopic & open upper abdominal cholecystectomy there was significant alteration of pulmonary function. There was significant alteration at six hours and after operation which then gradually improved, but it took about 24 hours for its complete recovery. The alteration was more evident in open cholycystectomy. Nevertheless these alterations did not cause any clinical derangement as expressed by SpO2, HR, & BP. The study also showed a significant dose reduction of opioid in case of laparoscopic cholecystomy. The lung function at postoperative ward correlated well with the level of analgesia. But persistent alteration of pulmonary function indicated presence of other mechanical factors. Key Words: Surgery-Lap.Cholecystectomy, Surgery- Upper abdominal, Complication-post- Operative, complication-pulmonary, Patient control analgesia Journal of BSA, Vol. 17, No. 1 & 2, 2004 p.12-16DOI: http://dx.doi.org/10.3329/jbsa.v17i1.4045  

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