scholarly journals Choledochodudenostomy for bile duct injuries: a less demanding option, in a demanding surgical situation

2019 ◽  
Vol 6 (5) ◽  
pp. 1817
Author(s):  
Amulya Aggarwal ◽  
Alok V. Mathur ◽  
Manmeet Kaur
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Hepatic Duct ◽  
Common Hepatic Duct ◽  
Significant Morbidity ◽  
Normal Anatomy ◽  
Fatal Complication ◽  
Common Cause ◽  
Bile Duct Injuries ◽  
Cbd Injury

Cholecystectomy is one of the most common surgical procedure performed worldwide and therefore a common cause for iatrogenic biliary tract injury. Bile duct injuries are associated with significant morbidity and are a potentially fatal complication. Choledochodudenostomy in patients of post cholecystectomy bile duct injury can be done safely by experienced surgeons in CBD injuries distal to the confluence of the cystic and common hepatic duct after eradication of sepsis. Choledochoduodenostomy has its own technical advantages and it maintains the normal anatomy. As compared with a routine Roux-en-Y hepaticojejunostomy, CDD is technically easier, faster, requires less manipulation of the CBD, and is more physiological. We present a case report of a patient of laparoscopic cholecystectomy with CBD injury managed with choledochoduodenostomy who did extremely well after procedure with no immediate and delayed postoperative complication. 

scholarly journals Right Hepatic Artery: A Cadaver Investigation and Its Clinical Significance

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Usha Dandekar ◽  
Kundankumar Dandekar ◽  
Sushama Chavan
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hepatic Artery ◽  
Hepatic Duct ◽  
Common Hepatic Duct ◽  
Normal Anatomy ◽  
Surgical Safety ◽  
Right Hepatic Artery ◽  
The Common ◽  
The Right

The right hepatic artery is an end artery and contributes sole arterial supply to right lobe of the liver. Misinterpretation of normal anatomy and anatomical variations of the right hepatic artery contribute to the major intraoperative mishaps and complications in hepatobiliary surgery. The frequency of inadvertent or iatrogenic hepatobiliary vascular injury rises with the event of an aberrant anatomy. This descriptive study was carried out to document the normal anatomy and different variations of right hepatic artery to contribute to existing knowledge of right hepatic artery to improve surgical safety. This study conducted on 60 cadavers revealed aberrant replaced right hepatic artery in 18.3% and aberrant accessory right hepatic artery in 3.4%. Considering the course, the right hepatic artery ran outside Calot’s triangle in 5% of cases and caterpillar hump right hepatic artery was seen in 13.3% of cases. The right hepatic artery (normal and aberrant) crossed anteriorly to the common hepatic duct in 8.3% and posteriorly to it in 71.6%. It has posterior relations with the common bile duct in 16.7% while in 3.4% it did not cross the common hepatic duct or common bile duct. The knowledge of such anomalies is important since their awareness will decrease morbidity and help to keep away from a number of surgical complications.

scholarly journals Application of near-infrared fluorescent cholangiography using indocyanine green in laparoscopic cholecystectomy

2020 ◽  
Vol 48 (12) ◽  
pp. 030006052097922
Author(s):  
Chusi Wang ◽  
Wenguang Peng ◽  
Jiarui Yang ◽  
Yuxuan Li ◽  
Jiawei Yang ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Near Infrared ◽  
Hepatic Duct ◽  
Operation Time ◽  
Common Hepatic Duct ◽  
Intraoperative Blood Loss ◽  
Real Time Identification

Objective Near-infrared fluorescence cholangiography (NIRF-C) can help to identify the bile duct during laparoscopic cholecystectomy. This retrospective study was performed to investigate the effect of NIRF-C in laparoscopic cholecystectomy. Methods Consecutive patients who underwent NIRF-C-assisted laparoscopic cholecystectomy (n = 34) or conventional laparoscopic cholecystectomy (n = 36) were enrolled in this study. Identification of biliary structures, the operation time, intraoperative blood loss, and postoperative complications were analyzed. Results Laparoscopic cholecystectomy was completed in all patients without conversion to laparotomy. The median operation time and intraoperative blood loss were not significantly different between the two groups. No intraoperative injuries or postoperative complications occurred in either group. In the NIRF-C group, the visualization rate of the cystic duct, common bile duct, and common hepatic duct prior to dissection was 91%, 79%, and 53%, respectively. The success rate of cholangiography was 100% in the NIRF-C group. NIRF-C was more effective for visualizing biliary structures in patients with a BMI of <25 than >25 kg/m2. Conclusions NIRF-C is a safe and effective technique that enables real-time identification of the biliary anatomy during laparoscopic cholecystectomy. NIRF-C helps to improve the efficiency of dissection.

scholarly journals Strategies for Management of Bile Duct Injury During Laparoscopic Cholecystectomy

2001 ◽  
Vol 7 (2) ◽  
pp. 55-61 ◽  
Author(s):  
Tatsuya Aoki ◽  
Akihiko Tsuchida ◽  
Hitoshi Saito ◽  
Yuichi Nagakawa ◽  
Keiichi Kitamura ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Duct Injury ◽  
Cystic Duct ◽  
Hepatic Duct ◽  
Common Hepatic Duct ◽  
Tube Drainage ◽  
T Tube ◽  
Aberrant Bile Duct

We encountered 10 patients with bile duct injuries during laparoscopic cholecystectomy. Their causes were electrocautery in 2 patients, misjudgment in 2, mechanical injury in 3, aberrant bile duct in 2, and weakness of the bile duct wall in one. The sites of injury were cystic duct in 4 patients, common bile duct in 2, aberrant bile duct in 2, common hepatic duct in one, and common bile duct plus right hepatic duct in one. Treatments for the injuries discovered intraoperatively consisted of T-tube drainage above in 2 patients, re-ligation of the cystic duct in one, ligation of an aberrant bile duct in one, simple suture and T-tube in one, and choledochojejunostomy in one. In the remaining 4 patients discovered postoperatively, 2 were conservatively treated by endoscopic retrograde biliary drainage. The duration of hospitalization was 9–12 days in the 4 patients with simple suture or ligation, 10–21 days in 2 cases of bile drainage, and 34–43 days in 3 with T-tube drainage. The patient with choledochojejunostomy suffered repeated cholangitis, resulting in hepatic abscess with hospitalization for 6 months. Since laparoscopic surgery should be minimally invasive, meticulous attention is necessary before and during surgery to avoid bile duct injury.

scholarly journals Fluorescent Cholangiography in Laparoscopic Cholecystectomy: An Updated Canadian Experience

2019 ◽  
Vol 27 (1) ◽  
pp. 38-43 ◽  
Author(s):  
Michael S. Bleszynski ◽  
Kristin M. DeGirolamo ◽  
Adam T. Meneghetti ◽  
C. Jack Chiu ◽  
Ormond Neely Panton
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Hepatic Duct ◽  
Case Series ◽  
Common Hepatic Duct ◽  
Fluorescent Cholangiography ◽  
Calot’S Triangle ◽  
Prospective Case Series ◽  
Real Time Identification ◽  
Indications For Operation

Background. Laparoscopic cholecystectomy (LC) is one of the most common general surgery procedures in Canada with approximately 100 000 cases performed per year. Bile duct injury remains a morbid complication with an incidence rate of 0.3% to 0.5%. Indocyanine green (ICG) fluorescent cholangiography is a noninvasive technology aiding in real-time identification of biliary structures for safe dissection within Calot’s triangle. The objectives were to provide an update to our initial experience with ICG aiding in the identification of biliary structures and ensuring that no adverse patient reactions occurred with ICG administration. Methods. Prospective case series from 2016 to 2018 for elective LC with ICG technology performed at a single academic teaching institution. Patient demographics, indications for operation, biliary structures visualized, amount of ICG used, operative times, and complications were recorded. Results. One hundred eight cases were included for review. The cystic duct, common hepatic duct, and common bile duct were identified with ICG in 90%, 48%, and 84% of cases, respectively. ICG simultaneously visualized at least 2 of 3 biliary structures 83.4% of the time. Only 1 biliary structure was identified in 10% of cases. No biliary structures were identified in 6% of cases. Mean initial ICG dose given was 1.65 mL. No adverse patient reactions to ICG were noted. Conclusions. This updated series illustrates that administration of ICG enhances visualization of the biliary system during outpatient LC. ICG is safe and its application should be further studied in early LC for acute cholecystitis.

scholarly journals Laparoscopic Cholecystectomy at Shree Birendra Hospital

2012 ◽  
Vol 10 (1) ◽  
pp. 15-19
Author(s):  
S Malla ◽  
SB Rawal ◽  
NK Giri
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Hepatic Duct ◽  
Tube Placement ◽  
Left Hepatic Duct ◽  
Type D ◽  
Calot’S Triangle ◽  
Bile Duct Injuries ◽  
A Prospective Study

Introduction: Since its introduction in Shree Birendra Hospital, laparoscopic cholecystectomy has gradually replaced its open counterpart. Along with its superior results, surgeons had to deal with the difficult challenges of managing bile duct injuries. Methods: A prospective study of all laparoscopic cholecystectomies performed in the General surgical unit of Shree Birendra Hospital from January 2003 to December 2010 was carried out from case records in a separate register kept for laparoscopic surgeries. Results: Out of the total number of 786 patients who underwent laparoscopic cholecystectomy during the study period, 21 (2.67%) required conversion to open procedure with the most common indication being unclear anatomy at Calot’s triangle. There were 14 major post operative complications (1.78%) with bile duct injuries occurring in 7 patients (0.89%). Among these injuries, 3 injuries were recognized during the primary operation. Laparotomy with t tube placement for 6 weeks was the mode of treatment in 2 patients with Strasberg type D injuries detected post operatively. Delayed repair after 3 months were carried out in 2 injuries- one hepaticojejunostomy (Type E2) and the other required anastamosis to the left hepatic duct (Type E3). In follow up, these patients have remained aniciteric and comfortable so far. Conclusion: Bile duct injuries continue to remain a major morbidity factor in laparoscopic cholecystectomy and its management a challenge to the surgeon. Though repair in a specialized hepatobiliary center is recommended, in the absence of such center in our country, it is being done in SBH with good results. DOI: http://dx.doi.org/10.3126/mjsbh.v10i1.6444 Medical Journal of Shree Birendra Hospital Jan-June 2011 10(1) 15-19

scholarly journals Extra hepatic bile duct injury after laparoscopic cholecystectomy: a retrospective study

2020 ◽  
Vol 7 (8) ◽  
pp. 2517
Author(s):  
Ankit Gupta ◽  
Saurabh Agrawal ◽  
Namrata Sharma ◽  
Nakum Parth
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Surgical Techniques ◽  
Uttar Pradesh ◽  
Major Complication ◽  
Moderate Degree ◽  
Hepatic Bile ◽  
Hepatic Bile Duct ◽  
Bile Duct Injuries ◽  
Cbd Injury

Background: Laparoscopic cholecystectomy (LC), being one of the most common performed surgical procedure among the basic surgeries. Incidence of common bile duct (CBD) injury as high as 1.4-3% has been reported in some studies. The aim of this study was to estimate the incidence and predictors of CBD injury who underwent elective laparoscopic cholecystectomy.Methods: A retrospective observational study conducted at Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh India. Data was collected for a period of 1 year between March 2019 till 2020.Results: In majority of laparoscopic cholecystectomy we encountered moderate degree of difficulty. Extra hepatic bile duct injuries occurred in 1.4% of cases and were classified according to Strasberg classification. Type A injury was most common followed by type E2. Most major bile duct injuries were recognized intraoperatively. No mortality was noted in our study.Conclusions: Bile duct injuries is a major complication of laparoscopic cholecystectomy with significant morbidity and mortality, reduced survival impaired quality of life and subsequent litigations. Majority of bile duct injuries, results mainly from the surgeon’s inexperience, misinterpretation of anatomy and poor surgical techniques.

scholarly journals Biliary Complications Post Laparoscopic Cholecystectomy: Mechanism, Preventive Measures, and Approach to Management: A Review

2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
Norman Oneil Machado
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Preventive Measures ◽  
Hepatic Duct ◽  
Biliary Complications ◽  
Common Hepatic Duct ◽  
Management Approach ◽  
Open Approach ◽  
Increased Risk

Laparoscopic cholecystectomy has emerged as a gold standard therapeutic option for the management of symptomatic cholelithiasis. However, adaptation of LC is associated with increased risk of complications, particularly bile duct injury ranging from 0.3 to 0.6%. Occurrence of BDI results in difficult reconstruction, prolonged hospitalization, and high risk of long-term complications. Therefore, more emphasis is placed on preventing these complications. In addition to adequate training, several techniques have been proposed to prevent bile duct injury including use of 30∘ scope, adequate delineation of structures in Calot's triangle (critical view), avoidance of diathermy close to common hepatic duct, and intraoperative cholangiogram, and to maintain a low threshold to conversion to open approach when uncertain. Management of Bile duct injury depends on the nature of injury, time of detection, and the expertise available, and would range from simple subhepatic drainage to Roux-en-Y hepaticojejunostomy particularly performed at specialised centers. This article based on the literature review aims to review the biliary complications following laparoscopic cholecystectomy with reference to its mechanism , preventive measures to be taken, and the management approach.

scholarly journals Iatrogenic Bile Duct Injuries: An Overview and A Review of Literature

2021 ◽  
Vol 07 (01) ◽  
pp. 037-043
Author(s):  
Vinoth M. ◽  
Abhijit Joshi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Surgical Procedures ◽  
Surgical Repair ◽  
Review Of Literature ◽  
Bile Duct Injuries ◽  
Iatrogenic Bile Duct Injury

Abstract​ Laparoscopic cholecystectomy (LC) is one of the most frequently performed surgical procedures worldwide. Iatrogenic bile duct injury (IBDI) is a serious complication of LC and has an incidence of 0.3 to 0.7%. Since it is associated with a significant and potentially lifelong morbidity as well as mortality, diagnosing IBDI as early as possible is of paramount importance. Management of bile duct injuries and prognosis of their surgical repair depend on the timing of its recognition, type and the extent of the injury. In this paper, we present a case of IBDI and attempt to discuss all its dimensions.

scholarly journals Erratum to: Age and Obesity are Independent Predictors of Bile Duct Injuries in Patients Undergoing Laparoscopic Cholecystectomy

2015 ◽  
Vol 39 (7) ◽  
pp. 1809-1809 ◽  
Author(s):  
Hassan Aziz ◽  
Viraj Pandit ◽  
Bellal Joseph ◽  
Tun Jie ◽  
Evan Ong
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injuries
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