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

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 Bile Duct Injuries Following Laparoscopic Cholecystectomy

2018 ◽  
Vol 15 (1) ◽  
pp. 14-19
Author(s):  
Mohammad Ibrahim Khalil ◽  
Haridas Saha ◽  
Azmal Kader Chowdhury ◽  
Imarat Hossain ◽  
AZM Mostaque Hossain
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Open Cholecystectomy ◽  
Standard Procedure ◽  
Gall Stone ◽  
Common Bile Duct Injury ◽  
Medical College ◽  
Bile Duct Injuries ◽  
Case Files

Background: Laparoscopic cholecystectomy (LC) is the gold standard procedure for the gall stone diseases.Objective: This study aimed to assess the outcome of laparoscopic cholecystectomy (LC) by determining the frequency of complications especially of bile duct injuries.Methodology: This retrospective study was conducted in the Department of surgery at Dhaka Medical College and Hospital, Dhaka, Bangladesh. The case files of all patients undergoing laparoscopic cholecystectomy (LC) from the year of 2013 to 2015 were retrospectively analyzed. The data were collected according to outcome measures, such as bile duct injury, morbidity, mortality and numbers of patients whose resections had to be converted from laparoscopic to open surgery.Results: During the three years a total number of 336 patients were underwent LC for chronic cholecystitis (CC) of which 22(6.5%) developed complications. Among those who developed complications, two patients had major bile duct injuries (0.4%); other 43(12.8%) patients had planned laparoscopic operations converted to open cholecystectomy intra-operatively. None of the patients in this study died as a result of LC.Conclusion: The two patients who had severe common bile duct injury in this study had major anatomical anomalies that were only recognized during surgery.Journal of Science Foundation 2017;15(1):14-19

Surgical Management of Complex Bile Duct Injuries in Specialized Hepatopancreatobiliary (HPB) Unit

2021 ◽  
Vol 15 (7) ◽  
pp. 1700-1702
Author(s):  
Muhammad Khawar Shahzad ◽  
Tariq Ali Bangash ◽  
Amer Latif ◽  
Hussam Ahmed ◽  
Muhammad Asif Naveed ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Retrospective Study ◽  
Bile Duct ◽  
Hospital Stay ◽  
Surgical Management ◽  
Bile Duct Injury ◽  
Surgical Repair ◽  
Open Cholecystectomy ◽  
Tube Placement ◽  
Bile Duct Injuries

Objective: To describe the surgical management of complex bile duct injuries in a specialized hepatopancreatobiliary unit. Design of the Study: It was a retrospective study. Study Settings: This study was carried out at Department of Anaesthesia and Hepatobiliary Unit, Sheikh Zayed Hospital Lahore from August 2017 to August 2019. Material and Methods: This retrospective study includes 80 patients of bile duct injury who underwent surgical correction of bile duct injury at specialized Hepatopancreatobiliary [HPB] and liver transplant department of Shaikh Zayed Hospital Lahore. All the subjects were evaluated by retrospectively. The information regarding primary operative procedure, drain placement, T-tube placement, presentation, hospital stay, Liver Function Tests [LFTs], level of biliary tract injury and type of surgical procedure obtained from patients records. Results of the Study: During the study period 80 patients – 65 females and 15 male were operated for bile duct injury. Mean age was 39.89 years range 21 to 65 years. Hospital stay ranges from 9 to 36 days with mean of 16.18 days. Patients underwent open cholecystectomy, 43.8% laparoscopic cholecystectomy and in 3 patients procedure was converted from laparoscopic to open. 52.5% patients underwent open cholecystectomy, 43.8 laparoscopic cholecystectomy and in 3 patient’s procedure was converted from laparoscopic to open. Conclusion: It is concluded that the correct long lasting and physiological method to treat injuries of bile duct is only surgical repair. Although, surgical repair of bile duct must be operated by skilled hepatopancreaticobiliary surgeons. A practical method which is selected appropriately and implemented successfully has surely improved surgical outcome without any problem faced during the operation. Keywords: Hepatopancreatobiliary, Bile Duct Injury, Surgical Management

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 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 INJURIES

2018 ◽  
Vol 21 (05) ◽  
pp. 841-844
Author(s):  
Sadia Sana ◽  
Muhammad Jawed ◽  
Ubedullah Shaikh ◽  
Shazia Ubed Shaikh
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Open Cholecystectomy ◽  
Female Ratio ◽  
Surgical Department ◽  
Bile Duct Injuries ◽  
Laparoscopic Cholecystectomy Group ◽  
Male Female Ratio ◽  
Group B

Objective: To find out frequency of bile duct injuries during cholecystectomyprocedures either open or laparoscopic. Study design: Prospective observational study. Placeand duration of study: This study was conducted at Surgical department, Liaquat UniversityHospital Jamshoro and Dow International Hospital Karachi, from July 2012 to December2013. Methodology: This study consisted of hundred patients. Patients were divided in twogroups. Group A for open cholecystectomy (OC) comprising of 50 patients who underwentelective open cholecystectomy. Group B for Laparoscopic cholecystectomy (LC) comprisingof 50 patients who underwent elective Laparoscopic cholecystectomy. Inclusion criteria wereall patients diagnosed case of gallstones on the basis of ultrasound abdomen, any age andboth gender. Exclusion criteria included not willing for surgery, General anesthesia problem,pregnant ladies due to risk of foetal loss, carcinoma of gall bladder, stone in CBD and obstructivejaundice. Results: Out of 100 cases of gallstone were operated for either laparoscopic / opencholecystectmy. In open cholecystectomy group 20(40 % ) were male and 30(60 %) female.Ratio male: female ratio of 1:1.5. In laparoscopic cholecystectomy group 11(22 % ) were maleand 39(78 %) female with male: female ratio of 1:3.5. There was wide variation of age rangingfrom a minimum of 10 year to 70 year in both group. The mean age was 41.28+12.30 yearsfor OC group and 38.44+13.50 years for LC group (p 0.02). Common bile duct injury wereoccurred 2(4%) patients in laparoscopic cholecystectomy group while 3(6%) patients observedin open cholecystectomy group. Conclusions: We conclude that found bile duct injury 2(4%)patients in laparoscopic cholecystectomy group while 3(6%) patients observed in opencholecystectomy group

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 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 Management of major bile duct injuries following laparoscopic and open cholecystectomy - single center experience

2019 ◽  
Vol 147 (7-8) ◽  
pp. 422-426
Author(s):  
Borislav Toskovic ◽  
Dragoljub Bilanovic ◽  
Aleksandar Resanovic ◽  
Slobodan Todorovic ◽  
Davor Mrda ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Open Cholecystectomy ◽  
Injury Incidence ◽  
Complication Rates ◽  
Open Approach ◽  
Single Center ◽  
Single Center Experience ◽  
Bile Duct Injuries

Introduction/Objective. Bile duct injuries represent a devastating and potentially life-threatening consequence of cholecystectomy. Although most cholecystectomies are currently performed laparoscopically, some complex cases require an open approach. The aim of this report is to present and analyze a single center experience regarding the management of these injuries. Methods. A retrospective study was conducted in a tertiary referral institution. During a 13-year period, we identified a total of 64 patients. Only patients requiring surgical reconstruction to repair bile duct injuries were included in the study. Patients were grouped according to the type of surgical approach, i.e. laparoscopic or open cholecystectomy. Results. Out of 64 patients with bile duct injuries, 38 (59.4%) incurred the injuries during open and 26 (40.6%) during laparoscopic cholecystectomy. No differences between the groups were observed concerning the time of bile duct injury diagnosis, type of injury, incidence of concomitant vascular and bile duct injuries, type of reconstruction procedure or complication rates after the primary intervention. The latency of bile duct injury management was found to differ between the study groups. In the open cholecystectomy group, bile duct injuries were managed significantly later than in the laparoscopic one. Conclusion. The results suggest that bile duct injuries occur with equal frequency after laparoscopic as well as open cholecystectomy. However, injuries are managed later after open than after laparoscopic cholecystectomy. Tertiary centers have satisfactory outcomes of major bile duct injury reconstruction, with low rates of both morbidity and mortality.

scholarly journals The first experience with the fully-covered self-expandable nitinol stents in the management of anastomotic biliary strictures after orthotopic liver transplantation

2020 ◽  
Vol 48 (3) ◽  
pp. 171-176
Author(s):  
A. V. Shabunin ◽  
I. Yu. Korzheva ◽  
G. M. Chechenin ◽  
S. S. Lebedev ◽  
P. A. Drozdov ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Graft Loss ◽  
Endoscopic Stenting ◽  
Biliary Strictures ◽  
Anastomotic Strictures ◽  
Nitinol Stents ◽  
Biliary Anastomosis

Background: Biliary anastomosis strictures after orthotopic liver transplantation (OLT) develop in 5–12% of patients. This complication significantly impairs the patients’ quality of life and can lead to graft loss.Aim: To analyze the first experience in the use of coated self-expanding nitinol stents in patients with biliary anastomosis strictures after OLT.Materials and methods: From December 2018 to January 2019, there were 5 patients with anastomotic strictures after OLT in the Department of Organ and/or Tissue Transplantation of the S.P. Botkin Municipal Clinical Hospital. All patients underwent endoscopic stenting of strictures with a self-expanding nitinol-coated stent. In all patients, the stent was removed at 3 months after its placement.Results: No complications and deaths were recorded in this patient group. The median duration of the follow-up after stent removal was 14.15 ± 2.35 (3–17) months, with no cases of restenosis identified.Conclusion: The use of coated nitinol stents in the management of patients with anastomotic strictures after liver transplantation is effective and safe. The possibility of their use in routine clinical practice requires confirmation in further studies.

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