scholarly journals Reliable reconstruction of the complex high-location bile duct injury: a novel hepaticojejunostomy

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yuxin Zhang ◽  
Jianping Zhao ◽  
Songshan Chai ◽  
Zhanguo Zhang ◽  
Lei Zhang ◽  
...  
Keyword(s):  
Bile Duct ◽  
Bile Duct Injury ◽  
Biliary Fistula ◽  
Surgical Reconstruction ◽  
Reconstruction Technique ◽  
The Novel ◽  
Repair Operation ◽  
The Mean ◽  
Convenient Technique

Abstract Background This study aimed to propose a novel surgical reconstruction technique for complex high-location bile duct injury (CHBDI). Methods There were eight patients with CHBDI underwent the novel hepaticojejunostomy between Feb 2015 and Feb 2017. Seven patients underwent a primary operation and found CHBDI postoperatively in the inferior hospitals referred to our center. And four of them had received hepaticojejunostomy, but the results were not satisfying. One patient (No.8) with radiographically diagnosed hilar cholangiocarcinoma came to our center for surgical treatment and underwent the novel hepaticojejunostomy technique because CHBDI was found in operation. Perioperative and follow-up data of these patients were retrospectively reviewed. Results The mean age was 47.6 ± 10.7 years, and there was four female. The mean range of time between the injury and the repair operation in our center was 6.3 ± 4.8 months. All repair operations using the novel hepaticojejunostomy technique in our center were successfully performed. No postoperative complications, including biliary fistula, restenosis, peritonitis, and postoperative cholangitis was observed. Besides, no evidence of biliary stenosis or biliary complications happened during the follow-up (median 28 months). Conclusions The novel hepaticojejunostomy is a reliable and convenient technique for surgical repair of multiple biliary ductal openings like CHBDI.

scholarly journals Surgical management and follow up of patients with bile duct injuries in tertiary health care institute

2021 ◽  
Vol 8 (3) ◽  
pp. 954
Author(s):  
Shahnawaz Akram ◽  
Sadaf Ali ◽  
Omer Javid Shah ◽  
Anzar Santosh
Keyword(s):  
Bile Duct ◽  
Bile Duct Injury ◽  
Type D ◽  
Bile Duct Injuries ◽  
Definitive Repair ◽  
Type C ◽  
The Mean ◽  
Surgical Unit

Background: Bile duct injury is an iatrogenic catastrophe associated with significant mortality, morbidity, decrease quality of life and higher rates of subsequent litigation. We conducted a study to analyse the presentation and pattern of bile duct injury managed at our surgical unit. Operative details, type of surgery, complications associated with the repair and Follow up in terms of liver function tests.Methods: The study included evaluation of 56 patients who had suffered bile duct injuries and then were subsequently being managed surgically at our institute retrospectively from October-2009 to 2012 and prospectively onwards till October- 2014. The mean follow up period in case of our study was 26.8 months. The follow up LFTs were performed at regular intervals. MRCP was used as a gold standard investigation.Results: jaundice (64.2%) was the most common presentation. Injuries noted were, type E1 in 16 (28.5%),type E2 in 11(19.6%), type E3 in 1 (1.8%), type A in 2 (3.6%), type B in 3 (5.4%), type C in 5 (9%) and type D in 18 (32.1%) of patients. Roux-en-y Hepatico-jejunostomy was the common definitive repair performed (85.7%) with various modifications. The mean bilirubin levels and ALP levels showed a downward trend in follow up .5 patients were readmitted with features of cholangitis in which 2 patients were reoperated and 3 patients were managed conservatively, 2 patients died.Conclusions: The management of patients with BDI is a challenge for a surgeon and often requires the skills of experienced hepatobiliary surgeons at tertiary referral canters.  

Endoscopy-Assisted Achilles Tendon Reconstruction With a Central Turndown Flap and Semitendinosus Augmentation

2016 ◽  
Vol 37 (12) ◽  
pp. 1333-1342 ◽  
Author(s):  
Prashant N. Gedam ◽  
Faizaan M. Rushnaiwala
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Wound Complication ◽  
Reconstruction Technique ◽  
Level Of Evidence ◽  
Invasive Approach ◽  
Perioperative Morbidity ◽  
The Mean

Background: The objective of this study was to report the results of a new minimally invasive Achilles reconstruction technique and to assess the perioperative morbidity, medium- to long-term outcomes, and functional results. Methods: Our series was comprised 14 patients (11 men and 3 women), with a mean age of 45.6 years at surgery. Each patient had a chronic Achilles tendon rupture. The mean interval from rupture to surgery was 5.5 months (range, 2-10). The mean total follow-up was 30.1 months (range, 12-78). All patients were operated with a central turndown flap augmented with free semitendinosus tendon graft and percutaneous sutures in a minimally invasive approach assisted by endoscopy. The patients underwent retrospective assessment by clinical examination, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, and the Achilles Tendon Total Rupture Score (ATRS). Paired t tests were used to assess the preoperative and postoperative AOFAS scores, ATRS scores, and ankle range of motion. Results: The length of the defect ranged from 3 to 8 cm (mean, 5.1), while the length of the turndown flap ranged from 8 to 13 cm (mean, 10.1). The mean AOFAS score improved from 64.5 points preoperatively to 96.9 points at last follow-up. The mean ATRS score improved from 49.4 preoperatively to 91.4 points at last follow-up. None of the patients developed a wound complication. No patient had a rerupture or sural nerve damage. Conclusion: All patients in our study had a favorable outcome with no complications. We believe that with this triple-repair technique, one can achieve a strong and robust repair such as in open surgery while at the same time reducing the incidence of complications. Level of Evidence: Level III, retrospective comparative study.

Treatment of Major Laparoscopic Bile Duct Injury: A Long-Term Follow-up Result

2011 ◽  
Vol 77 (12) ◽  
pp. 1584-1588 ◽  
Author(s):  
Xiao Dong Xu ◽  
You Cheng Zhang ◽  
Pen Gao ◽  
Farah Bahrani-Mougeot ◽  
Ling Yi Zhang ◽  
...  
Keyword(s):  
Bile Duct ◽  
Bile Duct Injury ◽  
Tertiary Care ◽  
Secondary Operation ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B ◽  
Group D

The goal of this study is to present the multiple institutions experience comparing the outcome of management between initial laparoscopic cholecystectomy (LC) surgeon and specialist as well as the outcome of different operative procedures to major bile duct injury (BDI) after LC. We have retrospectively collected data of 77 cases of perioperatively detected major BDI in LC at 15 general surgical institutions from 1997 to 2007. We classified 42 cases treated by an experienced biliary surgeon as Group A and 35 cases treated by the initial LC surgeon as Group B. Forty-eight cases were treated with duct-to-duct anastomosis as Group C and 29 cases were treated with Roux-en-Y choledochojejunostomy as Group D. The median duration of follow-up was 62 months. The outcome of groups was compared. In Group A, 7 of 42 (16.7%) patients developed a failure. Two of seven (28.6%) patients were treated by a secondary operation. In Group B, 24 of 35 (68.6%) patients developed a failure. Seventeen of 24 (70.8%) patients were treated by a secondary operation. One of 35 (2.85%) patients died. The significant differences were observed in failure and secondary operations (16.7 vs 68.6%, P < 0.01 and 28.6 vs 70.8%, P < 0.01). There is no significant difference Group C and Group D in failure rate (28.5 vs 11.7%, P > 0.05). A multiple institutional cooperative methodology between the local surgical institution and tertiary care centers provided a good way to limit further operations, failure. The reconstructive strategy is important and should be selected according to the type of injury and the diagnosed status of major BDI.

493 Long-Term Follow-Up (4-9 Years) of 125 Patients Demonstrates Common Bile Duct Injury Is Associated With Significant Mortality

2015 ◽  
Vol 148 (4) ◽  
pp. S-1114
Author(s):  
Caitlin A. Halbert ◽  
Maria Altieri ◽  
Jie Yang ◽  
Ziqi Meng ◽  
Mark A. Talamini ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Duct Injury ◽  
Common Bile Duct Injury ◽  
Long Term Follow Up ◽  
Significant Mortality

scholarly journals Comparative analysis of iatrogenic injury of biliary tract in laparotomic and laparoscopic cholecystectomy

2014 ◽  
Vol 27 (4) ◽  
pp. 272-274 ◽  
Author(s):  
André Augusto FORTUNATO ◽  
João Kleber de Almeida GENTILE ◽  
Diogo Peral CAETANO ◽  
Marcus Aurélio Zaia GOMES ◽  
Marco Antônio BASSI
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Biliary Tract ◽  
Bile Duct Injury ◽  
Laparoscopic Approach ◽  
Epidemiological Data ◽  
Iatrogenic Injury ◽  
Exclusion Criteria ◽  
Causal Factors

BACKGROUND: Iatrogenic injury to the bile ducts is the most feared complication of cholecystectomy and several are the possibilities to occur. AIM: To compare the cases of iatrogenic lesions of the biliary tract occurring in conventional and laparoscopic cholecystectomy, assessing the likely causal factors, complications and postoperative follow-up. METHODS: Retrospective cohort study with analysis of records of patients undergoing conventional and laparoscopic cholecystectomy. All the patients were analyzed in two years. The only criterion for inclusion was to be operative bile duct injury, regardless of location or time of diagnosis. There were no exclusion criteria. Epidemiological data of patients, time of diagnosis of the lesion and its location were analyzed. RESULTS: Total of 515 patients with gallstones was operated, 320 (62.1 %) by laparotomy cholecystectomy and 195 by laparoscopic approach. The age of patients with bile duct injury ranged from 29-70 years. Among those who underwent laparotomy cholecystectomy, four cases were diagnosed (1.25 %) with lesions, corresponding to 0.77 % of the total patients. No patient had iatrogenic interventions with laparoscopic surgery. CONCLUSION: Laparoscopic cholecystectomy compared to laparotomy, had a lower rate of bile duct injury.

scholarly journals Optimal timing for surgical reconstruction of bile duct injury: meta‐analysis

BJS Open ◽  
2020 ◽  
Vol 4 (5) ◽  
pp. 776-786
Author(s):  
A. M. Schreuder ◽  
B. C. Nunez Vas ◽  
K. A. C. Booij ◽  
S. Dieren ◽  
M. G. Besselink ◽  
...  
Keyword(s):  
Bile Duct ◽  
Bile Duct Injury ◽  
Meta Analysis ◽  
Surgical Reconstruction ◽  
Optimal Timing

Differences in Post-Cholecystectomy Bile Duct Injury Care: A Comparative Analysis of 2 Different Health-Care Public Institutions in a Low- and Middle-Income Country: Southeast Mexico

2020 ◽  
Vol 37 (6) ◽  
pp. 472-479
Author(s):  
Gustavo Martínez-Mier ◽  
Pedro Ivan Moreno-Ley ◽  
Sergio Esquivel-Torres ◽  
José Luis Gonzalez-Grajeda ◽  
Daniel Mendez-Rico
Keyword(s):  
Bile Duct ◽  
Bile Duct Injury ◽  
Open Cholecystectomy ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Preoperative Assessment ◽  
Primary Patency ◽  
Public Institutions ◽  
System Structure ◽  
Biliary Stents

<b><i>Background:</i></b> Mexican health system structure allows us to study the differences in bile duct injury (BDI) management. The study aimed to assess the differences in patients with complex BDI in 2 different public sector institutions using a new proposed standard terminology. <b><i>Methods:</i></b> Retrospective review (2008–2019) in 2 public institutions (IMSS/SESVER). Bismuth-Strasberg E injuries with hepaticojejunostomy were included. Data are presented in a tabular reporting system. The outcomes were percent of patients attaining primary patency, loss of primary patency, and actuarial primary patency rate. <b><i>Results:</i></b> Seventy-eight patients (IMSS: <i>n</i> = 37; SESVER: <i>n</i> = 41) without differences in demographic and preoperative assessment were studied. BDI occurred mostly in outside hospitals. Open cholecystectomy was the most common index operation in SESVER (73%, <i>p</i> = 0.02). IMSS had more surgeries (<i>p</i> = 0.007) and repair attempts (<i>p</i> = 0.06) prior to referral. Magnetic resonance cholangiopancreatography was more commonly used in IMSS patients. Biliary stents (45%) and cholangitis (29%) were more common in IMSS (<i>p</i> &#x3c; 0.05). IMSS patients had longer follow-up than SESVER (<i>p</i> &#x3c; 0.05). No differences in primary patency rates (IMSS: 89%, SESVER: 97%) and actuarial patency rates were noted. <b><i>Discussion:</i></b> Despite differences in referral, preoperative, and operative events, good BDI repair outcomes can be achieved. Longer follow-up is needed to monitor these outcomes.

scholarly journals Technical feasibility and safety of transluminal antegrade dilation for hepaticojejunostomy stricture using a novel fine-gauge electrocautery dilator (with video)

2020 ◽  
Vol 08 (06) ◽  
pp. E733-E737 ◽  
Author(s):  
Takeshi Ogura ◽  
Nobu Nishioka ◽  
Masanori Yamada ◽  
Tadahiro Yamada ◽  
Saori Ueno ◽  
...  
Keyword(s):  
Bile Duct ◽  
Intrahepatic Bile Duct ◽  
The Novel ◽  
Technical Success ◽  
Long Term Follow Up ◽  
Secondary Endpoints ◽  
Patient Refusal ◽  
A Prospective Study

Abstract Background and study aims A novel fine-gauge electrocautery dilator (ED) has recently become available in Japan. The current study evaluated the safety and feasibility of transluminal antegrade dilation for hepaticojejunal stricture (HJS) using this novel ED. Patients and methods Patients who with complicated HJS were retrospectively enrolled. The primary and secondary endpoints of this study were rates of technical success defined as functional antegrade HJS dilation using the novel ED and types of adverse events, respectively. A total of 22 patients were enrolled. Among them, six were treated using an enteroscopic approach due to the absence of bile duct dilation or patient refusal to undergo EUS-HGS. Therefore, 16 patients underwent EUS-HGS. Results The procedure was successful in 15 of 16 patients (93.8 %). The contrast medium flowed from the intrahepatic bile duct to the intestine of 14 of 15 patients (93.3 %). The resolution rate of HJS was 13 of 14 (92.9 %) at 6 months. Conclusion Our technique might offer a new option with which to treat HJS, although a prospective study with long-term follow-up is needed.

Is the Age of Patients with Iatrogenic Bile Duct Injuries Increasing?

2015 ◽  
Vol 87 (3) ◽  
Author(s):  
Rafał Stankiewicz ◽  
Bogusław Najnigier ◽  
Marek Krawczyk
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Elderly Person ◽  
Reference Centre ◽  
Bile Duct Injuries ◽  
Gender And Age ◽  
Complications Of Laparoscopic Cholecystectomy ◽  
The Mean ◽  
Iatrogenic Bile Duct Injury

AbstractResection of the gall-bladder is still the most common surgical procedure performed at general surgery departments. The laparoscopic method used in the majority of cases offers considerable benefits but at the same time is associated with an increased rate of bile duct complications. So far, a slim female aged 25-50 years was a typical patient with a iatrogenic bile duct injury.The aim of the study was to identify the age of patients with iatrogenic bile duct injuries as well as the clinical course observed in recent years.Material and methods. Gender and age structure of patients admitted to the Department of General, Transplant and Liver Surgery between the beginning of 2011 and June 2014 and treated for iatrogenic bile duct injuries, complications of laparoscopic cholecystectomy, were analysed. The patients were referred to the department as a reference centre.Results. In the group of 186 patients, females predominated (69.4%) and the mean age was 52 years. A considerable increase in the mean age of patients treated in 2014 as compared with previous years was seen. This was related to an increased rate of bile duct injuries in patients aged over 70 years, who accounted for about 25% of the group. In previous years, bile duct injuries in patients of such an advanced age happened considerably less frequently.Conclusions. A iatrogenic bile duct injury in an elderly person may prove a fatal complication. A repair surgery, i.e. the biliary-enteric anastomosis, is a major and burdensome procedure, particularly in the case of patients aged over 70 years. Special caution during laparoscopic cholecystectomy is advised in this population, and the slightest doubts should lead to conversion.

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