DAMAGE TO THE BILE DUCTS AFTER LAPAROSCOPIC CHOLECYSTECTOMY. REVIEW.

2021 ◽  
pp. 17-25
Author(s):  
Maxat Doskhanov
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Ducts ◽  
Gallstone Disease ◽  
Abdominal Cavity ◽  
Bile Leakage ◽  
Treatment And Prevention ◽  
Technical Errors ◽  
Bile Duct Injuries ◽  
Good Cosmetic

This article provides a review of the literature on bile duct injuries after laparoscopic cholecystectomy. Laparascopy is considered the gold standard in the treatment of gallstone disease. This technique has a number of positive advantages: minimally invasiveness, quick rehabilitation, a shorter hospital stay, a good cosmetic effect, and a low lethal outcome. Along with these advantages, the number of complications also increased: damage to the bile ducts, hepatic vessels, bile leakage, formation of strictures, defects in drainage of the biliary tract and improper treatment of the cystic duct, insufficient drainage of the abdominal cavity. Today, many aspects of surgical treatment and prevention of bile duct injuries remain controversial and are still considered relevant. The main reasons for this complication are: lack of experience of the surgeon, inattention, ignorance of the main options and possible anomalies of important anatomical structures in the area of the hepatic hilum and hepato-duodenal ligament, technical errors.

scholarly journals Tulžies latakų sužalojimai atliekant laparoskopinę cholecistektomiją

2007 ◽  
Vol 5 (2) ◽  
pp. 0-0
Author(s):  
Donatas Venskutonis ◽  
Linas Urbanavičius ◽  
Juozas Juočas ◽  
Saulius Bradulskis ◽  
Virmantas Daubaras ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
General Surgery ◽  
Bile Ducts ◽  
Diffuse Peritonitis ◽  
Clinical Hospital ◽  
Bile Duct Injuries ◽  
Extrahepatic Bile Ducts ◽  
Iatrogenic Bile Duct Injury

Donatas Venskutonis, Linas Urbanavičius, Juozas Juočas, Saulius Bradulskis, Virmantas Daubaras, Juozas KutkevičiusKauno medicinos universiteto Bendrosios chirurgijos klinika,VšĮ Kauno II klinikinė ligoninė, Josvainių g. 2, LT-47133 KaunasEl paštas: [email protected] Įvadas / tikslas Manoma, kad atliekant laparoskopinę cholecistektomiją ekstrahepatiniai tulžies latakai sužalojami dažniau nei atvirąją. Įvykus tulžies latakų sužalojimui, svarbu jį kuo skubiau diagnozuoti ir tinkamai gydyti. Siūlomos įvairios sužalojimų prevencijos priemonės. Šio darbo tikslas – išanalizuoti KMU Bendrosios chirurgijos klinikoje 1994–2006 metais laparoskopinės cholecistektomijos metu įvykusių ekstrahepatinių tulžies latakų jatrogeninių sužalojimų dažnį, priežastis, gydymo metodus, padarinius ir prevencijos priemones, apžvelgti literatūros duomenis. Ligoniai ir metodai Analizavome 1994–2006 m. KMU Bendrosios chirurgijos klinikoje (VšĮ II KKL) dėl tulžies latakų jatrogeninių sužalojimų, įvykusių laparoskopinės cholecistektomijos metu, gydytų pacientų ligos istorijas. Rezultatai Per minėtą laikotarpį atliktos 5396 laparoskopinės cholecistektomijos: 1681 (31,2%) pacientui – dėl ūminio ir 3715 (68,8%) – dėl lėtinio cholecistito. Po operacijos 7 ligoniai mirė. Vienas ligonis mirė nuo bendrojo tulžies latako sužalojimo ir pankreatito. Kitos mirties priežastys: trims ligoniams buvo plaučių arterijos embolija, vienam – dvylikapirštės žarnos perforacija ir peritonitas, dviem – gangreninis cholecistitas ir lokalus peritonitas. Bendras mirštamumas 0,13%. Ekstrahepatiniai tulžies latakai sužaloti 10 ligonių (0,19%). Vienas ligonis gydytas nuo tulžies latakų sužalojimo kitoje ligoninėje. Išvados Apibendrinus rezultatus galima tvirtinti, kad tulžies latakų sužalojimo ir mirties atvejai operuojant laparoskopiškai yra reti, o laparoskopinė cholecistektomija mūsų klinikoje – saugi operacija. Atvira cholecistektomija pranašesnė tik sunkiais, komplikuotais atvejais (neaiški anatomija, tulžies pūslės-žarnyno fistulės) ir nesant galimybės išgydyti tulžies latakų akmenligės endoskopiškai. Pagrindiniai žodžiai: cholecistitas, laparoskopinė cholecistektomija, ekstrahepatiniai tulžies latakai, sužalojimai Bile duct injuries during laparoscopic cholecystectomy donatas venskutonis, linas urbanavičius, juozas juočas, saulius bradulskis, virmantas daubaras, juozas kutkevičiusKaunas University of Medicine Clinic of General Surgery, Kaunas 2nd Clinical Hospital,Josvainių str. 2, LT-47133, Kaunas, LithuaniaE-mail: [email protected] Background / objective Laparoscopic cholecystectomy is associated with a higher risk of extrahepatic bile duct injuries. Timely diagnosis and proper management of bile duct injury are very important. Various preventive measures are widely discussed. Our aim was to analyze iatrogenic injuries of extrahepatic bile ducts sustained during laparoscopic cholecystectomy over the period 1994–2006 at the Clinic of General Surgery of Kaunas University of Medicine and to review the relevant pub-lished reports. Patients and methods Analysis of the case histories of patients treated for iatrogenic bile duct injuries sustained during laparoscopic cholecystectomy over the period 1994–2006 at the Clinic of General Surgery of Kaunas University of Medicine (2nd Clinical Hospital), Lithuania. Results During the period 1994–2006, 5396 patients underwent laparoscopic cholecystectomy for acute cholecystitis (n = 1681, 31.2%) and chronic gallstone disease (n = 3715, 68.8%). Seven patients died after surgery: one patient died of bile duct injury, 3 patients of pulmonary artery embolism; there were one case of duodenum perforation and diffuse peritonitis, one case of severe acute pancreatitis, and 2 cases of gangrenous cholecystitis with peritonitis. The overall mortality rate was 0.13%. Iatrogenic bile duct injury occurred in 10 cases (0.19%). One patient was referred from another hospital and was treated for a iatrogenic bile duct injury. Conclusions The incidence of bile duct injuries and the death rate were low. Laparoscopic cholecystectomy was performed with acceptable safety in our clinic. Conventional cholecystectomy was preferred to laparoscopic cholecystectomy in difficult, complicated cases (unclear anatomy, biliary enteric fistulas) and in cases of unsuccessful endoscopic treatment of choledocholithiasis and obstructive jaundice. Keywords: cholecystitis, laparoscopic cholecystectomy, extrahepatic bile ducts, injuries

scholarly journals Results of surgical treatment of extrahepatic bile duct injuries

2020 ◽  
Vol 37 (1) ◽  
pp. 63-72
Author(s):  
L. P. Kotelnikova ◽  
I. G. Burnyshev ◽  
O. V. Bazhenova ◽  
D. V. Trushnikov
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Treatment ◽  
Bile Duct ◽  
Bile Ducts ◽  
Bile Leakage ◽  
Biliary Reconstruction ◽  
Long Term Outcomes ◽  
Endoscopic Retrograde ◽  
Extrahepatic Bile Ducts

Aim. To evaluate the short-and long-term outcomes after surgical repair of iatrogenic lesions of extrahepatic bile ducts depending on the timing of diagnosis in conditions of specialized clinic. Materials and methods. Our study involved a retrospective analysis of 159 patients who were treated for iatrogenic lesions of extrahepatic bile ducts during 1987-2017. These patients were divided into two groups depending on the timing of surgical treatments: early biliary reconstruction ( 5 days after bile duct transection) and late biliary reconstruction ( 5 days post-transection). These groups were compared on the basis of postoperative morbidity and long-term outcomes. Results. Following laparoscopic cholecystectomy, 2 patients received endoscopic retrograde stents due to bile leakage from the cystic ducts, and 14 patients underwent hepaticocholedochostomy using Ker drainage. The incidence of bile leakage was observed in 14. 3 % of cases during the early post-operative period, strictures appeared in 28.6 % of cases. Hepaticojejunostomy was performed in 91 cases: in 62 with stents and in 29 without stents. Bile leakage was observed in 17.6 % of cases, and strictures in 19.8 % of cases. Our statistical analyses revealed no significant differences between the two groups (i.e., early and late timing of surgical treatment) in the rates of bile leakage and strictures. The extent of surgeons experience in bile surgery significantly correlated with positive outcomes. Conclusions. Endoscopic retrograde stent proved to be an effective and fast solution in cases of bile leakage from cystic ducts following laparoscopic cholecystectomy. Although it is preferable to perform reconstructive surgeries within the first five days after bile duct injury, our results indicated that in the presence of external bile fistula without peritonitis and severe cholangitis, reconstructive surgery can be performed in specialized surgical departments later than 5 days with satisfactory results.

scholarly journals Bile leak syndrome after laparoscopic cholecystectomy

2019 ◽  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Treatment ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Minimally Invasive ◽  
Abdominal Cavity ◽  
Bile Leak ◽  
Bile Leakage ◽  
Early Postoperative Period ◽  
Type I

Aim of the study was the assasement of surgical treatment results of patients with cholelithiasis, who had external or internal bile leakage (BL), for the optimization and improvement of diagnostic programme and surgical tactic of minimally invasive techniques usage. Materials and methods. Results of surgical treatment during the early postoperative period of patients with cholelithiasis, who underwent laparoscopic cholecystectomy (LC) were analysed. Results. In early post-operative period 67 (0,6%) patients, mean aged 56,9 ± 7,4 had BL. 54 (81,0%) of them were women, 13 (19,0%) were men. 21 (31,3%) patients underwent LC due to chronic cholecystitis, 46 (68,7%) patients had acute cholecystitis. In 54 (81,0%) cases there was drainage bile leakage, in 13 (19,0%) cases bile collection in abdominal cavity was identified several days after drains ejection, due to clinical manifestation and ultrasonography data. 23 (34,3%) patients were treated conservatively. Minimally invasive endoscopic manipulations, ultrasonography controlled percutaneous drainage and relaparotomy were effective in 35 (52,2%) patients, 9 (13,4%) patients underwent laparotomy with following surgical correction of BL. These patients had dense perivesical infiltrates, Mirizzi’s syndrome type I. 6 (9,0%) patients underwent laparotomy, abdominal cavity sanation and drainage. In 1 (1,5%) case partial right bile duct injury was identified, defect suturing and Vishnevsky common bile duct drainage. In 2 (3,0%) cases the cause of BL was more than 2/3 diameter injury of common bile duct. These patients underwent Roux-en-Y hepaticojejunostomy. Conclusion. Installation of drainage into the hepatic space and the right flank provide early diagnosis of postoperative complications, one of which is bile flow syndrome. Ultrasound examination of abdominal organs and endoscopic retrograde cholangiopancretography are performed to determine the cause and localization of the syndrome of the BL syndrome, depending on the volume of the BL. Repeated laparoscopy is indicated for the phenomena of bile peritonitis, significant accumulation of bile in the abdominal cavity. The complex usage of relaparoscopy, transduodenal endoscopic interventions and puncture techniques can significantly reduce the number of laparotomy operations to correct complications.

scholarly journals Bile duct injuries and systemic approach to the treatment

2019 ◽  
Vol 24 (1) ◽  
pp. 71-82 ◽  
Author(s):  
P. N. Romashchenko ◽  
N. A. Maystrenko ◽  
A. S. Pryadko ◽  
A. K. Aliev
Keyword(s):  
Bile Duct ◽  
Bile Ducts ◽  
Abdominal Cavity ◽  
Surgical Care ◽  
Rational Approach ◽  
Biliary Duct ◽  
Negative Consequences ◽  
Surgical Interventions ◽  
Bile Duct Injuries ◽  
Reconstructive Operations

Aim.Present a program of examination and treatment of patients with biliary duct injury, corresponding to the level of the international protocol and modern requirements for the quality of medical care.Material and methods.The results of examination and treatment of 77 patients with bile ducts injuries are analyzed. The analysis of the main surgical interventions for the elimination of bile ducts injuries is given: reconstructive operations in 44.3% of patients, recovery operations – in 36.7% and external drainage – in 19%.Results.A program approach has been developed to assist patients with bile duct injuries in civil health care at various levels of surgical care.Conclusions.The implementation of this program provides timely diagnosis of damage to the bile duct and minimizing the number of postoperative complications at the second and third levels of surgical care. It was determined that a rational approach to reduce the number of injuries of the bile ducts is their prevention by perfect adherence to the technique of surgical intervention on the organs of the upper floor of the abdominal cavity, and to reduce the number of negative consequences, the proposed algorithm for diagnosis and treatment.

scholarly journals Laparoscopic choledochoduodenal anastomosis after bile duct injury in a patient with previous laparoscopic gastric bypass

2021 ◽  
Vol 8 (10) ◽  
pp. 3157
Author(s):  
Adolfo Cuendis-Velázquez ◽  
Francisco Pérez-López ◽  
Erika Barlandas-Quintana ◽  
Orlando Bada-Yllán ◽  
Braulio Ríos-Muñoz
Keyword(s):  
Gastric Bypass ◽  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Laparoscopic Gastric Bypass ◽  
Gallstone Disease ◽  
Gastrointestinal Surgery ◽  
Biliary Duct ◽  
Bile Duct Injuries ◽  
Successful Case ◽  
Bariatric Patients

Bile duct injuries after laparoscopic cholecystectomy remain a major problem in gastrointestinal surgery. Twenty five to thirty percent of bariatric patients could develop gallstone disease. However, laparoscopic cholecystectomy in this group may result challenging due to the presence of a previous Roux-en-Y reconstruction. We documented the successful case of 66 year old female with story of non-supplemented laparoscopic gastric bypass, with subsequent injury of bile duct during laparoscopic cholecystectomy treated with a laparoscopic choledochoduodenal anastomosis. This technique offers an excellent alternative to solve highly complex cases in a single surgical time, allowing the patient to restore his original functionality prior to the biliary duct lesion.

scholarly journals Early-stage T1b adenocarcinoma arising in the remnant cystic duct after laparoscopic cholecystectomy: a case report and literature review

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Pankaj Prasoon ◽  
Yuki Hirose ◽  
Jun Sakata ◽  
Kizuki Yuza ◽  
Kazuki Moro ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Cystic Duct ◽  
Bile Ducts ◽  
Early Stage ◽  
English Literature ◽  
Gallstone Disease ◽  
Primary Adenocarcinoma ◽  
Tubular Adenocarcinoma ◽  
Extrahepatic Bile Ducts

Abstract Background The cystic duct has been included in the staging classification scheme for gallbladder cancer since the 2010 publication of the AJCC Cancer Staging Manual (7th edition). To our knowledge, only seven other cases of adenocarcinoma arising in the remnant cystic duct following cholecystectomy have been reported in the English-language literature, and none has been reported as primary early-stage T1b remnant cystic duct cancer (CDC). We report, herein, a case of primary adenocarcinoma arising in the remnant cystic duct in a patient with history of laparoscopic cholecystectomy for gallstone disease. Case presentation An 81-year-old female presented with abdominal pain. Her medical history included a laparoscopic cholecystectomy for cholecystolithiasis two years prior. Jaundice was observed; imaging studies suggested that this was caused by choledocholithiasis. Blood chemistry findings showed severe liver dysfunction. Endoscopic retrograde cholangiography revealed haemobilia from the common bile duct with no evidence of choledocholithiasis. A bile sample showed Papanicolaou class IV cytology. As the extent of tumour spread was undetermined by abdominal ultrasonography and endoscopic ultrasonography, peroral cholangioscopy (POCS) was performed, which revealed tiny papillary lesions within the confluence of cystic duct, and fine granular lesions in the centre of bile ducts, signifying early-stage remnant CDC. Extrahepatic bile duct resection with regional lymphadenectomy was done. Histopathological findings revealed a 42-mm tubular adenocarcinoma originating from the remnant cystic duct with the considerable shallow spread across the extrahepatic bile ducts. It invaded the fibromuscular layer, with no lymphovascular or perineural invasion, no lymph node metastasis (13 nodes examined), and uninvolved surgical resection margin (R0 resection), and was staged as pT1bN0M0, Stage I. Conclusions Primary early-stage T1b remnant CDC is an uncommon condition for which early diagnosis is challenging; if intraoperatively recognized, it can complicate surgery. Our experience of this case and an overview of the English literature suggest that POCS is an efficient tool to diagnosis this tumour and assess its spread along the extrahepatic bile ducts.

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 The Critical View Of Safety : Une Attitude Pour Prévenir L’erreur D’identification Dans Les Cholécystectomies Laparoscopiques.

2021 ◽  
Author(s):  
Anisse Tidjane ◽  
Nabil Boudjenan-Serradj ◽  
Benali Tabeti
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Ducts ◽  
Voies Biliaires ◽  
Critical View ◽  
Critical View Of Safety ◽  
Bile Duct Injuries ◽  
Bonnes Pratiques ◽  
Voie Biliaire Principale ◽  
Haptic Sensation

Résumé: Avec la généralisation de la cholécystectomie laparoscopique, l’incidence des traumatismes opératoires des voies biliaires a augmentée de façon significative. La perte de la sensation haptique, la vision bidimensionnelle, et l’éclairage centré favorisent l’illusion aboutissant à des erreurs d’identifications, où le chirurgien confond voie biliaire principale et canal cystique. Ce phénomène explique l’augmentation des traumatismes biliaires à l’ère de la laparoscopie.Récemment, et grâce aux recommandations des sociétés savantes comme la SAGES sur les bonnes pratiques chirurgicales, l’incidence de ces traumatismes est en régression et tend a rejoindre celle décrite à l’ère de la chirurgie ouverte. Parmi ses recommandations, la SAGES met l’accent sur l’adoption par tous les chirurgiens de la « Critical View of Safety » durant la réalisation de la cholécystectomie par voie laparoscopique. L’objectif de cette mise au point est de décrire cette attitude, mais surtout analyser son efficacité et ses limites dans la prévention des traumatismes opératoires des voies biliaires.Abstract:With the generalization of laparoscopic cholecystectomy, the incidence of operative bile ducts injury has increased significantly, the loss of haptic sensation, the two-dimensional vision, and the centered lighting favor the illusion leading to misidentifications, as consequences the surgeon confuses the main bile duct and the cystic duct. This phenomenon explains this increase in the incidence of bile duct injuries in the era of laparoscopy.Recently, and thanks to the recommendations of some learned societies such as SAGES on good surgical practices, the incidence of these complications is declining and tends to join that described in the era of open surgery. Among its many recommendations, SAGES recommends the adoption by all surgeons of the “Critical View of Safety” during the performance of laparoscopic cholecystectomy, an attitude that we will describe, and analyze its effectiveness and its limits in prevention of operative bile ducts injury.

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