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

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

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

International Journal of Recent Surgical and Medical Sciences ◽

10.1055/s-0041-1730123 ◽

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.

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Bile Duct Injuries Following Laparoscopic Cholecystectomy

Journal of Science Foundation ◽

10.3329/jsf.v15i1.34778 ◽

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

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BILE DUCT INJURIES

The Professional Medical Journal ◽

10.29309/tpmj/2014.21.05.2504 ◽

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

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

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh190206030t ◽

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.

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Iatrogenic Bile Duct Injury. A Significant Surgical Problem. Assessment of Treatment Outcomes in the Department's Own Material

Polish Journal of Surgery ◽

10.1515/pjs-2015-0004 ◽

2015 ◽

Vol 86 (12) ◽

Cited By ~ 2

Author(s):

Adam Bobkiewicz ◽

łukasz Krokowicz ◽

Tomasz Banasiewicz ◽

Tomasz Kościński ◽

Maciej Borejsza-Wysocki ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Retrospective Analysis ◽

Bile Duct Injury ◽

Clinical Symptoms ◽

Open Cholecystectomy ◽

Multidisciplinary Treatment ◽

Laparoscopic Technique ◽

Primary Surgery ◽

Iatrogenic Bile Duct Injury

AbstractIatrogenic bile duct injuries (BDI) are still a challenging diagnostic and therapeutic problem. With the introduction of the laparoscopic technique for the treatment of cholecystolithiasis, the incidence of iatrogenic BDI increased.was a retrospective analysis of 69 patients treated at the department due to iatrogenic BDI in the years 2004-2014.. In this paper, we presented the results of a retrospective analysis of 69 patients treated at the Department due to iatrogenic BDI in the years 2004-2014. The data were analysed in terms of age, sex, type of biliary injury, clinical symptoms, the type of repair surgery, the time between the primary surgery and the BDI management, postoperative complications and duration of hospital stay.. 82.6% of BDI occurred during laparoscopic cholecystectomy, 8.7% occurred during open cholecystectomy, whereas 6 cases of BDI resulted from surgeries conducted for other indications. In order to assess the degree of BDI, Bismuth and Neuhaus classifications were used (for open and laparoscopic cholecystectomy respectively). 84.1% of patients with confirmed BDI, were transferred to the Department from other hospitals. The average time between the primary surgery and reoperation was 6.2 days (SD 4). The most common clinical symptom was biliary fistula observed in 78.3% of patients. In 28 patients, unsuccessful attempts to manage BDI were made prior to the admission to the Department in other centres. The repair procedure was mainly conducted by laparotomy (82.6%) and by the endoscopic approach (15.9%). Hepaticojejunostomy was the most common type of reconstruction following BDI (34.7%).. The increase in the rate of iatrogenic bile duct injury remains a challenging surgical problem. The management of BDI should be multidisciplinary treatment. Referring patients with both suspected and confirmed iatrogenic BDI to tertiary centres allows more effective treatment to be implemented.

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The Prevention of Laparoscopic Bile Duct Injuries: An Analysis of 300 Cases of from a Human Factors and Cognitive Psychology Perspective

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/154193120705101103 ◽

2007 ◽

Vol 51 (11) ◽

pp. 617-620 ◽

Cited By ~ 1

Author(s):

Lygia Stewart ◽

Lawrence W. Way

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Human Factors ◽

Bile Duct Injury ◽

Human Error ◽

Perceptual Illusion ◽

Bile Duct Injuries ◽

Psychology Perspective ◽

Cause Of Error ◽

Key Steps

Application of human factors concepts to high-risk activities has facilitated reduction in human error. With introduction of laparoscopic cholecystectomy, the incidence of bile duct injury increased. Seeking ideas for prevention, we analyzed 300 laparoscopic bile duct injuries within the framework of human error analysis. The primary cause of error (97%) was a visual perceptual illusion. The laparoscopic environment contributed to 75% of injuries, poor visibility 22%. Most injuries involved deliberate major bile duct transection due to misperception of the anatomy. This illusion was so compelling that the surgeon usually did not recognize it. Even when irregular cues were detected, improper rules were employed, eliminating feedback. Since the complication-causing error occurred at few key steps during laparoscopic cholecystectomy; we instituted focused training to heighten vigilance, and have formulated specific rules to decrease the incidence of bile duct injury. In addition, factors in the laparoscopic environment contributing to this illusion are discussed.

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Experience of Laparoscopic Cholecystectomies in a Tertiary Care Hospital: a Retrospective Study

Galician Medical Journal ◽

10.21802/gmj.2020.4.3 ◽

2020 ◽

Vol 27 (4) ◽

pp. E202043

Author(s):

Aamir Hussain Hela ◽

Haseeb Mohammad Khandwaw ◽

Rahul Kumar ◽

Mir Adnan Samad

Keyword(s):

Laparoscopic Cholecystectomy ◽

Retrospective Study ◽

Bile Duct ◽

Surgical Site Infection ◽

Tertiary Care Hospital ◽

Open Cholecystectomy ◽

Tertiary Care ◽

Care Hospital ◽

Site Infection ◽

The Mean

Introduction: Laparoscopic cholecystectomy is the most commonly performed surgical procedure of digestive tract. It has replaced open cholecystectomy as gold standard treatment for cholelithiasis and inflammation of gallbladder. It is estimated that approximately 90% of cholecystectomies in the United States are performed using a laparoscopic approach. The aim of this study was to evaluate the outcome of Laparoscopic cholecystectomy in context to its complications, morbidity and mortality in a tertiary care hospital. Methods: This retrospective study was conducted on 1200 patients, who underwent laparoscopic cholecystectomies, during the period from January 2019 to December 2019, at Government Medical College Jammu J & K, India and necessary data was collected and reviewed. Results: In our study, a total of 1200 patients were studied including 216 males (18%) and 984 females (82%). The mean age of the patients was 43.35±8.61. The mean operative time in our study was 55.5±10.60 minutes with range of 45 – 90 minutes. Conversion rate was 2.6%. 2 patients were re-explored. Bile duct injury was found in 6 patients (0.5%). Conclusions: Gallstone disease is a global health problem. Laparoscopic cholecystectomy has now replaced open cholecystectomy as the first choice of treatment for gallstones. Gall stone diseases is most frequently encountered in female population. The risk factors for conversion to open cholecystectomy include male gender, previous abdominal surgery, acute cholecystitis, dense adhesions and fibrosis in Calot’ s triangle, anatomical variations, advanced age, comorbidity, obesity, suspicion of common bile duct stones, jaundice, and decreased surgeon experience. The incidence of surgical site infection has significantly decreased in laparoscopic cholecystectomy compared to open cholecystectomy. In our study we could not find any case of surgical site infection.

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Prolonged (Longer than 3 Hours) Laparoscopic Cholecystectomy: Reasons and Results

The American Surgeon ◽

10.1177/000313481107700814 ◽

2011 ◽

Vol 77 (8) ◽

pp. 981-984 ◽

Cited By ~ 10

Author(s):

Gokulakkrishna Subhas ◽

Aditya Gupta ◽

Jasneet Bhullar ◽

Linda Dubay ◽

Lorenzo Ferguson ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Bile Duct Injury ◽

Operative Time ◽

Intraoperative Complications ◽

Open Cholecystectomy ◽

Stepwise Logistic Regression ◽

Intraabdominal Adhesions ◽

Average Operative Time ◽

Prolonged Surgery

For the experienced surgeon, the average operative time for a laparoscopic cholecystectomy is less than 1 hour. There has been no study documenting the causes and results of prolonged (longer than 3 hours) surgery. A retrospective study was done of patients who underwent cholecystectomy between January 2003 and December 2007. A total of 3126 cholecystectomies were done. After excluding patients who had a planned open cholecystectomy and patients who had additional laparoscopic surgeries, we identified 70 patients who had a planned laparoscopic cholecystectomy with operative time exceeding 3 hours. Multivariate stepwise logistic regression was performed analyzing the various factors leading to prolonged surgery. Of the 70 patients, ranging in age from 21 to 92 years (mean, 57 years), most (n = 53) were female. Operative time ranged from 3 hours to 6 hours 40 minutes (mean, 3 hours 37 minutes). Emergency:elective admission ratio was 9:5 and acute cholecystitis (n = 40) was the most common indication. Common characteristics were obesity (n = 44, P = 0.031), intraabdominal adhesions (n = 43, P = 0.004), and previous abdominal surgeries (n = 40, P = 0.002). Intraoperative complications included spillage of stones (n = 6), bile duct injury (n = 3), and bleeding (n = 3). The possibility of prolonged laparoscopic cholecystectomy should be anticipated in patients with obesity and previous abdominal operations. Prolonged surgery increases the risk of complications (bile duct injury, bleeding) and prolongs the postoperative hospital stay.

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