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.  

scholarly journals Current Scenario of Postcholecystectomy Bile Leak and Bile Duct Injury at a Tertiary Care Referral Centre of Nepal

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Narendra Pandit ◽  
Tek Narayan Yadav ◽  
Laligen Awale ◽  
Kunal Bikram Deo ◽  
Yogesh Dhakal ◽  
...  
Keyword(s):  
Bile Duct ◽  
Bile Duct Injury ◽  
Tertiary Care ◽  
Bile Leak ◽  
Injury Rate ◽  
Excellent Outcome ◽  
Type D ◽  
Bile Duct Injuries ◽  
Current Scenario

Objective. With the adoption of safe cholecystectomy principles at an academic institute, the risk of major bile duct injury has decreased. This study aims at evaluating the present status of bile duct injury, compared to the study published in 2013 by index centre. Methods. This is a retrospective review of a prospectively maintained database of bile leak and bile duct injury from 2014 to 2019. Patients who completed postcholecystectomy bile leak or bile duct injury treatment and were on regular follow-up were included. Results. Eighteen patients (0.78%) among 2,300 consecutive cholecystectomies presented with bile duct injury, including 8 (0.35%) major bile duct injuries and 10 (0.43%) bile leaks compared to major bile duct injury rate of 0.68% (92/11,345 cholecystectomies) between 2001 and 2010. Injuries were classified as Strasberg’s type A (52.9%), type D (5.9%), and type E (41.1%). Eight patients (47%) of bile leak were managed conservatively with drains, while two required laparotomy and lavage. The mean time for spontaneous closure of bile leak was 11 days. Intraoperative repair was done in three cases: Roux en Y hepaticojejunostomy in 2 and end-to-end repair over T-tube in 1 for sharp transection of the duct. Delayed repair (Roux-en-Y hepaticojejunostomy) was done in five patients. The median postcholecystectomy hospital stay was 8 days, with no mortality. There was no restricture at a median follow-up of 13 months. Conclusion. With the adoption of a safe culture of cholecystectomy, the major bile duct injury rate has decreased currently. Repair of bile duct injury by experienced hepatobiliary surgeon results in excellent outcome.

scholarly journals Management of Bile Duct Injury Following Cholecystectomy

2020 ◽  
Vol 18 (2) ◽  
pp. 214-218
Author(s):  
Bala Ram Malla ◽  
Nripesh Rajbhandari ◽  
Robin Man Karmacharya
Keyword(s):  
Bile Duct ◽  
Bile Duct Injury ◽  
Open Cholecystectomy ◽  
Biliary Tree ◽  
Endoscopic Stenting ◽  
Bile Duct Injuries ◽  
Biliary Anastomosis ◽  
Classification Management

Background: Laparoscopic cholecystectomy is responsible for 80-85% of the bileduct injury, and twice as frequentcompared to open cholecystectomy.Injury affects the quality of life and overall survival of the patient. The management of these injuries is complex and challenging. There are few locally published reports regarding management of bile duct injury. The objective of this study is to evaluate the management of bile duct injury and its outcome Methods: This retrospective study includes patients bile duct injury following cholecystectomy who were managed at Dhulikhel Hospital, Nepal, during January 2014 to December 2016. The clinical features, type of injuries(Strasberg classification) management, outcome (as per McDonald and colleague grading system) and follow up were analyzed descriptively. Results: Out of 35 bile duct injuries,only 3 (8.57%)occurred following open cholecystectomy. Three (8.7%) cases of bile duct injury were diagnosed intraoperatively and had primary biliary anastomosis over T-tube. Five (14.28%) were diagnosed postoperatively and underwent Roux-en-y hepatojejunostomy 6 weeks after index surgery. And, 27(77.14%) with type A injuries were treated by endoscopic retrograde cholangio-pancreatography and stenting. After surgical repair, 1 (2.85%) had transient biliary leak. One patient had grade B outcome. During 18 months follow up, no stricture or cholangitis were observed. Conclusions: Bile duct injury with intact continuity of the duct can be successfully managed with endoscopic stenting of the biliary tree. Intraoperative diagnosis of bile duct injury and immediate surgical management has good outcome. Keywords: Bile duct injury; cholecystectomy; repair; strasberg classification

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.

scholarly journals Choledochoplasty by Vein Grafts in Iatrogenic Bile Duct Injuries

HPB Surgery ◽  
1992 ◽  
Vol 5 (3) ◽  
pp. 195-202 ◽  
Author(s):  
Aws S. Salim
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Balloon Catheter ◽  
Tissue Loss ◽  
Stricture Formation ◽  
Vein Grafts ◽  
Bile Duct Injuries ◽  
Considerable Morbidity

The quality of immediate repair of common bile duct injuries with or without tissue loss occurring during elective cholecystectomy is crucial and maybe the sole factor behind future stricture formation with its considerable morbidity and mortality. Successful repair of iatrogenic common bile duct injuries has been achieved by immediate saphenous vein grafts in two patients with cystic duct avulsion, in one patient whose duct was split by a balloon catheter, and in one patient where a segment of the duct was resected. Follow-up for 5 years demonstrated that the grafting remained sound and produced no complications. Consequently, the immediate repair of iatrogenic bile duct injuries using vein grafts deserves consideration.

scholarly journals Bile Duct Injury—Classification and Prevention

2020 ◽  
Vol 11 (03) ◽  
pp. 182-186
Author(s):  
Mukesh Nasa ◽  
Zubin Dev Sharma ◽  
Mahesh Gupta ◽  
Rajesh Puri
Keyword(s):  
Quality Of Life ◽  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Therapeutic Management ◽  
Optimal Management ◽  
Bile Duct Injuries ◽  
Injury Classification

AbstractIatrogenic bile duct injuries (BDI) are commonly encountered after laparoscopic cholecystectomy. Timely recognition of these injuries is important as the outcome depends on the optimal management and there is significant impact on the patient’s quality of life. Therapeutic management is guided by the type and extent of the bile duct injury and availability of expertise, and includes involvement of endoscopic, surgical, and radiological approaches.

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 Early Surgical Repair of Bile Duct Injuries following Laparoscopic Cholecystectomy: The Sooner the Better

2019 ◽  
Vol 05 (04) ◽  
pp. e154-e158 ◽  
Author(s):  
Muharrem Battal ◽  
Pinar Yazici ◽  
Ozgur Bostanci ◽  
Oguzhan Karatepe
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Surgical Procedures ◽  
Surgical Repair ◽  
Primary Repair ◽  
Type D ◽  
Bile Duct Injuries ◽  
Time To Diagnosis ◽  
Type C

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.

scholarly journals Specialist Outreach Service for On-Table Repair of Iatrogenic Bile Duct Injuries – A New Kind of ‘Travelling Surgeon’

2008 ◽  
Vol 90 (3) ◽  
pp. 243-246 ◽  
Author(s):  
MA Silva ◽  
C Coldham ◽  
AD Mayer ◽  
SR Bramhall ◽  
JAC Buckels ◽  
...  
Keyword(s):  
Bile Duct ◽  
Portal Vein ◽  
Bile Leak ◽  
Right Hepatic Artery ◽  
Outreach Service ◽  
Type D ◽  
Bile Duct Injuries ◽  
Vein Injury ◽  
Definitive Management

INTRODUCTION The objective of this study was to determine the outcome of on table repair of iatrogenic bile duct injuries (IBDIs) following laparoscopic cholecystectomy, by specialist hepatobiliary surgeons as an outreach service. PATIENTS AND METHODS Prospectively collected data on IBDI managed as an outreach service, was analysed retrospectively. The Strasberg classification was used to define types of injury. RESULTS There were 22 patients. Twenty (91%) had type E ‘classical’ excision injuries, two had types B and D. Two type E cases had co-existent vascular injury both with right hepatic artery injuries; one also had a co-existent portal vein injury. A Roux-en-Y hepaticojejunostomy was used to repair the IBDI in 21 (95%) patients. One type D injury had duct repair over a T-tube. No attempt was made to reconstruct the injured hepatic arteries, while the portal vein injury was primarily repaired. The median follow-up was 210 days (range, 47–1088 days). Two patients developed bile leak and cholangitis while another developed transient jaundice. There were no postoperative mortalities. All patients were followed up at our centre. CONCLUSIONS Repair of IBDI as an outreach service by specialist surgeons is feasible and safe, with minimal disruption to the patient pathway. Prompt recognition and definitive management may help reduce complaints and medicolegal litigation.

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 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.

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