Laparoscopic cholecystectomy-related bile duct injuries-surgical strategy and results
Draganova,V., Chernopolsky,Pl., Bozhkov,V.,Madjov.,R.
EAES Academy. Draganova V. 07/05/22; 363030; P074
Draganova,V., Chernopolsky,Pl., Bozhkov,V.,Madjov.,R.
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Abstract
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Aims:
Iatrogenic lesions (IL) of the bile ducts are one of the rare but most unpleasant complications after laparoscopic cholecystectomy. They represent a significant clinical problem that requires serious medical, social and financial resources. Diagnosis, treatment methods, operative risk and outcome of biliary tract injuries vary considerably and are highly dependent on the type of injury and its location.
Methods:
For the period 2001-2021 in our Department 69 patients with evidence of iatrogenic lesions of the extra hepatic bile ducts were hospitalized aged 27 to 77 years old. Five of these patients were admitted after primary reconstructive surgery of the biliary tree after laparoscopic cholecystectomy underwent in another hospital, in 4 cases this was the site of the lesion (found intra operatively in two and in the early postoperative period in two others).
Results:
In the presence of a partial defect of the extra hepatic bile ducts, in our opinion the most appropriate method of choice is primary reconstruction over Kehr drainage, although the method hides possible occurrence of late biliary strictures. In our series all patients with other types of injuries underwent Roux-en-Y biliodigestive reconstruction –mostly hepatico-jejuno anastomosis and choledocho-jejuno anastomosis. Only in two patients, after careful dissection and preparation of the common bile duct, there was no tension and choledocho-duodeno anastomosis was performed.
Conclusion: The best tactic to prevent iatrogenic lesions of the extra hepatic bile ducts is prevention through good surgical technique. In case of a lesion found during the operative intervention, the best approach and consequently the best results are obtained if the reconstructive operation is performed immediately by an experienced biliary surgeon. When the bile duct injury is diagnosed postoperatively various surgical and endoscopic procedures can be used.
Iatrogenic lesions (IL) of the bile ducts are one of the rare but most unpleasant complications after laparoscopic cholecystectomy. They represent a significant clinical problem that requires serious medical, social and financial resources. Diagnosis, treatment methods, operative risk and outcome of biliary tract injuries vary considerably and are highly dependent on the type of injury and its location.
Methods:
For the period 2001-2021 in our Department 69 patients with evidence of iatrogenic lesions of the extra hepatic bile ducts were hospitalized aged 27 to 77 years old. Five of these patients were admitted after primary reconstructive surgery of the biliary tree after laparoscopic cholecystectomy underwent in another hospital, in 4 cases this was the site of the lesion (found intra operatively in two and in the early postoperative period in two others).
Results:
In the presence of a partial defect of the extra hepatic bile ducts, in our opinion the most appropriate method of choice is primary reconstruction over Kehr drainage, although the method hides possible occurrence of late biliary strictures. In our series all patients with other types of injuries underwent Roux-en-Y biliodigestive reconstruction –mostly hepatico-jejuno anastomosis and choledocho-jejuno anastomosis. Only in two patients, after careful dissection and preparation of the common bile duct, there was no tension and choledocho-duodeno anastomosis was performed.
Conclusion: The best tactic to prevent iatrogenic lesions of the extra hepatic bile ducts is prevention through good surgical technique. In case of a lesion found during the operative intervention, the best approach and consequently the best results are obtained if the reconstructive operation is performed immediately by an experienced biliary surgeon. When the bile duct injury is diagnosed postoperatively various surgical and endoscopic procedures can be used.
Aims:
Iatrogenic lesions (IL) of the bile ducts are one of the rare but most unpleasant complications after laparoscopic cholecystectomy. They represent a significant clinical problem that requires serious medical, social and financial resources. Diagnosis, treatment methods, operative risk and outcome of biliary tract injuries vary considerably and are highly dependent on the type of injury and its location.
Methods:
For the period 2001-2021 in our Department 69 patients with evidence of iatrogenic lesions of the extra hepatic bile ducts were hospitalized aged 27 to 77 years old. Five of these patients were admitted after primary reconstructive surgery of the biliary tree after laparoscopic cholecystectomy underwent in another hospital, in 4 cases this was the site of the lesion (found intra operatively in two and in the early postoperative period in two others).
Results:
In the presence of a partial defect of the extra hepatic bile ducts, in our opinion the most appropriate method of choice is primary reconstruction over Kehr drainage, although the method hides possible occurrence of late biliary strictures. In our series all patients with other types of injuries underwent Roux-en-Y biliodigestive reconstruction –mostly hepatico-jejuno anastomosis and choledocho-jejuno anastomosis. Only in two patients, after careful dissection and preparation of the common bile duct, there was no tension and choledocho-duodeno anastomosis was performed.
Conclusion: The best tactic to prevent iatrogenic lesions of the extra hepatic bile ducts is prevention through good surgical technique. In case of a lesion found during the operative intervention, the best approach and consequently the best results are obtained if the reconstructive operation is performed immediately by an experienced biliary surgeon. When the bile duct injury is diagnosed postoperatively various surgical and endoscopic procedures can be used.
Iatrogenic lesions (IL) of the bile ducts are one of the rare but most unpleasant complications after laparoscopic cholecystectomy. They represent a significant clinical problem that requires serious medical, social and financial resources. Diagnosis, treatment methods, operative risk and outcome of biliary tract injuries vary considerably and are highly dependent on the type of injury and its location.
Methods:
For the period 2001-2021 in our Department 69 patients with evidence of iatrogenic lesions of the extra hepatic bile ducts were hospitalized aged 27 to 77 years old. Five of these patients were admitted after primary reconstructive surgery of the biliary tree after laparoscopic cholecystectomy underwent in another hospital, in 4 cases this was the site of the lesion (found intra operatively in two and in the early postoperative period in two others).
Results:
In the presence of a partial defect of the extra hepatic bile ducts, in our opinion the most appropriate method of choice is primary reconstruction over Kehr drainage, although the method hides possible occurrence of late biliary strictures. In our series all patients with other types of injuries underwent Roux-en-Y biliodigestive reconstruction –mostly hepatico-jejuno anastomosis and choledocho-jejuno anastomosis. Only in two patients, after careful dissection and preparation of the common bile duct, there was no tension and choledocho-duodeno anastomosis was performed.
Conclusion: The best tactic to prevent iatrogenic lesions of the extra hepatic bile ducts is prevention through good surgical technique. In case of a lesion found during the operative intervention, the best approach and consequently the best results are obtained if the reconstructive operation is performed immediately by an experienced biliary surgeon. When the bile duct injury is diagnosed postoperatively various surgical and endoscopic procedures can be used.
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