Bile duct injuries: management of late complications

Santibañés, Eduardo de; Palavecino, Martín; Ardiles, Victoria; Pekolj, Juan

doi:10.1007/s00464-006-0491-8

Cited by 74 publications

(56 citation statements)

References 33 publications

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“…In contrast, the success rate was 63% among those in whom surgical repair was the Roux-Y bypass. In our sample, the Hepp-Couinaud surgery was preferred when the left hepatic duct was good and when the hepatic duct confluence was intact, as suggested by other authors 20 . By the end of the study, no patient had returned with restenosis.…”

Section: Discussion Discussion Discussion Discussion Discussionsupporting

confidence: 48%

“…Although these two patients did not require further intervention, one had serious septic complications of biliary origin. However, Santibañes et al 20 reported good results for IBDI patients who required hepatectomy.…”

Section: Discussion Discussion Discussion Discussion Discussionmentioning

confidence: 99%

“…Patients may experience repeated episodes of cholangitis, biliary cirrhosis (HBC), liver failure and death. Some variables have been proposed to explain the different results of treatment between these patients: the level of estenosis 15 , extent and quality of the proximal bile duct 16 , the number of previous attempts to Barros Barros Barros Barros Barros The influence of time referral in the treatment of iatrogenic lesions of biliary tract repair it 17,18 , hepatic function 19 , laparoscopic versus conventional cholecystectomy 20,21,22 , diagnosis of the injury still during surgery 16,23 and especially the experience of the multidisciplinary team to deal with te problem 24,25 . However, the time between injury and surgical repair by a team of liver transplantation (LT) in a tertiary center (reference time -RT), has not been described as a modifying factor in these patients' outcome.…”

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

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A influência do tempo de referencia no tratamento das lesões iatrogênicas da via biliar

Barros

Fernandes²,

Oliveira

et al. 2010

Rev. Col. Bras. Cir.

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Objective: To evaluate the prognosis of patients with iatrogenic bile duct injury (IBDI) regarding time of referral (RT) to the unit of liver transplantation (LT). Methods: We reviewed 51 charts of patients who had suffered some kind of IBDI during cholecystectomy and who were referred to the Bonsucesso General Hospital (HGB) LT unit. Lesions were grouped according to the Bismuth classification. Besides cholecystectomy (time of injury), we also evaluated the RT and outcome. Results: Among the 51 patients studied, there were 17 men and 34 women, with a mean age of 42.7 years. Twenty-two patients (43.1%) had a type II lesion, 13 (25.5%) type III, 10 (19.6%) type I, 5 (9.8%) type IV and only 1 (2%) type V. Forty patients were operated, and three did not return for medical review, therefore, 37 were evaluated in relation to outcome. Among these, 25 patients (67.6%) had excellent or good results with average RT of 11.5 months (range: 2-48 months) and 47.2 months (range: 3-180 months) respectively. The 12 patients (32.4%) with poor results had a mean RT of 65.9 months (range: 3 264 months), which was significantly higher than the group with excellent or good results (p=0.004). Seven patients were listed for LT, but only two were transplanted. The RT of these seven patients was significantly higher (p=0.04) than those patients not listed. Seven patients died, six of which were due to liver complications. Conclusion: RT significantly influenced the prognosis of patients in our sample.

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Section: Discussion Discussion Discussion Discussion Discussionsupporting

confidence: 48%

Section: Discussion Discussion Discussion Discussion Discussionmentioning

confidence: 99%

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

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A influência do tempo de referencia no tratamento das lesões iatrogênicas da via biliar

Barros

Fernandes²,

Oliveira

et al. 2010

Rev. Col. Bras. Cir.

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“…Despite the known benefits of a mini-invasive surgical approach, treatment and prevention of BDI are still challenging because, in most cases, BDI represents a serious problem and can have late complications. 1 The incidence of BDI seems to have decreased compared with earlier periods. 2 However, several studies have shown a persistently higher rate and complexity of BDI when LC is performed compared with the open procedure (0.3% to 0.6% vs 0.2%).…”

Section: Introductionmentioning

confidence: 92%

Untitled

Xie

Luo²,

Yang³

et al. 2018

Exp Clin Transplant

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Objectives: We investigated the effects of autologous vein transplant on bile duct injury repair, through observation of the hepatic and biliary system tissue morphology changes and animal survival after bile duct injury repair. Materials and Methods: Rabbits were equally divided into groups. Group A had cholecystectomy and common bile duct resection (length of 0.5 cm), transplant of an autologous vein (length of 0.5 cm), and stent implant. Group B had cholecystectomy and common bile duct resection (length of 1.0 cm), transplant of an autologous vein (length of 1.0 cm), and stent implant. The third group (group C) had cholecystectomy only. Results: Two rabbits died in group A and group B; all experimental animals from group C survived. Regarding liver biochemical indexes at preoperative week 1, at postoperative month 1, and at postoperative month 3, we found no significant differences (paired t test, P > .05). Liver biochemical indexes between groups were also not significantly different (P > .05). At month 3, postoperative liver pathology of experimental animals showed no significant changes and no cholestasis; biliary epithelial cells were seen in the transplant vascular. Conclusions: We conclude that autologous vein graft can effectively repair bile duct injury for a short coloboma. Key words: Bile duct resection, Biliary repair, Cholecystectomy, Experimental study IntroductionBile duct injury (BDI) is one of the most serious complications in biliary tract surgery, which can be indicated after trauma, for biliary neoplasms, and for cancer that has infiltrated into the bile duct. Severe bile duct injury can lead to repeated biliary infection, biliary stricture, biliary cirrhosis, liver failure, and even death. Laparoscopic cholecystectomy (LC) has become the standard surgical treatment for gallstone disease and is one of the most routinely performed abdominal procedures by general surgeons. Despite the known benefits of a mini-invasive surgical approach, treatment and prevention of BDI are still challenging because, in most cases, BDI represents a serious problem and can have late complications. 1 The incidence of BDI seems to have decreased compared with earlier periods. 2 However, several studies have shown a persistently higher rate and complexity of BDI when LC is performed compared with the open procedure (0.3% to 0.6% vs 0.2%). [3][4][5][6] However, the incidence of BDI in the LC were reported to be different in some retrospective studies. [7][8][9] To date, the best management strategy in terms of timing of repair remains controversial. [10][11][12] Most authors agree that intraoperative recognition of BDI with immediate repair by specialized hepatopancreatobiliary surgeons offers the best results. 13 In recent years, different materials and methods have been reported for BDI repair, with each having different effects. Our study investigated autologous vein graft for repair of BDI using an animal model. Materials and MethodsThis study was carried out in strict accordance with the recommendations...

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“…However, the incidence of complications in the form of bile duct injury (BDI) is high, and it has been reported to be as high as twice the normal rate [1,2] . Once such BDI occurs, it increases postoperative morbidity [3] and mortality [4,5] , and decreases long-term quality of life [6] , which consequently results in a high number of lawsuits [7] ; therefore, it should be prevented if at all possible [1,8] . It is necessary to have a sufficient understanding of the biliary anatomy to prevent BDI [1] , yet the damage is often caused by misidentification of the bile duct and other normal structures [9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

Intraoperative ultrasound as an educational guide for laparoscopic biliary surgery

Hakamada¹,

Narumi²,

Toyoki³

et al. 2008

WJG

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AIM:To analyze the efficacy of routine intraoperative ultrasound (IOUS) as a guide for understanding biliary tract anatomy, to avoid bile duct injury (BDI) after laparoscopic cholecystectomy (LC), as well as any burden during the learning period. METHODS:A retrospective analysis was performed using 644 consecutive patients who underwent LC from 1991 to 2006. An educational program with the use of IOUS as an operative guide has been used in 276 cases since 1998. RESULTS:IOUS was highly feasible even in patients with high-grade cholecystitis. No BDI was observed after the introduction of the educational program, despite 72% of operations being performed by inexperienced surgeons. Incidences of other morbidity, mortality, and late complications were comparable before and after the introduction of routine IOUS. However, the operation time was significantly extended after the educational program began (P < 0.001), and the grade of laparoscopic cholecystitis (P = 0.002), use of IOUS (P = 0.01), and the experience of the surgeons (P = 0.05) were significant factors for extending the length of operation.CONCLUSION: IOUS during LC was found to be a highly feasible modality, which provided accurate, realtime information about the biliary structures. The educational program using IOUS is expected to minimize the incidence of BDI following LC, especially when performed by less-skilled surgeons.

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Bile duct injuries: management of late complications

Cited by 74 publications

References 33 publications

A influência do tempo de referencia no tratamento das lesões iatrogênicas da via biliar

A influência do tempo de referencia no tratamento das lesões iatrogênicas da via biliar

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Intraoperative ultrasound as an educational guide for laparoscopic biliary surgery

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