Cystic Duct Stump Leaks

Eisenstein, Samuel; Greenstein, Alexander J.; Kim, Unsup; Divino, Celia M.

doi:10.1001/archsurg.143.12.1178

Cited by 20 publications

(13 citation statements)

References 23 publications

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“…Another strength of this study was the ability to detect the entire spectrum of injuries, ranging from less severe bile leakages after surgery (such as the cystic duct or lesions to peripheral ducts in the liver bed) to severe injuries (with transections and tissue loss located at or above the hepatic confluence). The vast majority of studies on this topic have focused either on severe bile duct injury, referred to and treated by tertiary hepato-biliary centers,1 2 4 5 10 or on a selection of cases accessible to endoscopic treatment 1112 13 Larger, population based studies originating from administrative national registries with injury identification through ICD diagnosis or procedure codes have substantial difficulties with the identification of less severe bile duct injuries, owing to the inconsequent registration of complication codes.…”

Section: Discussionmentioning

confidence: 99%

Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study

Jaquith

2012

BMJ

295

162

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Objectives To determine whether the routine use of intraoperative cholangiography can improve survival from complications related to bile duct injuries.Design Population based cohort study.Setting Prospectively collected data from the Swedish national registry of gallstone surgery and endoscopic retrograde cholangiopancreatography, GallRiks. Multivariate analysis done by Cox regression. Population All cholecystectomies recorded in GallRiks between 1 May 2005 and 31 December 2010.Main outcome measures Evidence of bile duct injury, rate of intended use of intraoperative cholangiography, and rate of survival after cholecytectomy.Results During the study, 51 041 cholecystectomies were registered in GallRiks and 747 (1.5%) iatrogenic bile duct injuries identified. Patients with bile duct injuries had an impaired survival compared with those without injury (mortality at one year 3.9% v 1.1%). Kaplan-Meier analysis showed that early detection of a bile duct injury, during the primary operation, improved survival. The intention to use intraoperative cholangiography reduced the risk of death after cholecystectomy by 62% (hazard ratio 0.38 (95% confidence interval 0.31 to 0.46)). ConclusionsThe high incidence of bile duct injury recorded is probably from GallRiks' ability to detect the entire range of injury severities, from minor ductal lesions to complete transections of major ducts. Patients with bile duct injury during cholecystectomy had impaired survival, and early detection of the injury improved survival. The intention to perform an intraoperative cholangiography reduced the risk of death after cholecystectomy. IntroductionBile duct injury during cholecystectomy is a serious surgical complication that can have devastating consequences, including a significant risk of early death.1 2 Bile duct injury also has a major effect on healthcare costs, since injured patients frequently need prolonged and repeated hospital stay, multiple reinterventions, and long sick leave. 3 Many efforts have been made to determine which factors affect the risk of death after bile duct injury. Advanced age and severe comorbidity have been clearly established as causally linked to poor survival. 1 2 4 Indeed, the most intensely debated factor is the use of intraoperative cholangiography; previous studies by our group 2 and other researchers 1 have shown an association between the performance of intraoperative cholangiography and improved survival. However, since all previous results have been based on data for intraoperative cholangiography actually performed, skeptics have validly argued that this association might be due to bias through differential misclassification.In anatomically difficult cholecystectomies, which probably carry a high risk of bile duct injury, it is difficult to perform a successful intraoperative cholangiogram, thus reducing the cholangiography rate in cholecystectomies prone to bile duct injury. In the present study, we have the advantage, compared with previous studies, of using data that are validated, pr...

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Section: Discussionmentioning

confidence: 99%

Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study

Jaquith

2012

BMJ

295

162

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“…Bile leak from the cystic duct stump remains a significant complication of this operation [ 1 , 2 ]. Bile peritonitis, subhepatic abscesses, bile duct stricture, and perihepatic inflammation leading to fibrosis have all been associated with bile leaks [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Cystic duct leak is the commonest biliary complication of cholecystectomy [ 1 , 2 ]. Frequency of cystic duct leak ranges from 0.07 to 0.63% in large series [ 3 ]. Endoscopy with sphincterotomy and stenting is the first line of treatment with a success rate greater than 90% [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Successful Treatment of Persistent Postcholecystectomy Bile Leak Using Percutaneous Cystic Duct Coiling

Rai

Beckley

Fabre

et al. 2015

Case Reports in Surgery

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Laparoscopic cholecystectomy is one of the most commonly performed operations worldwide. Cystic duct is the most common site of bile leak after cholecystectomy. The treatment of choice is usually conservative. Using sufficient percutaneous drainage of the biloma cavity and endoscopic retrograde cholangiography (ERCP) with sphincterotomy and/or stenting, the cure rate of bile leaks is greater than 90%. In very rare cases, all of these measures remain unsuccessful. We report a technique for the successful treatment of persistent cystic duct leak. After failed ERCP and stenting, bile leak was treated by coiling the cystic duct through a drain tract. This technique is safe and effective and helps avoid the morbidity of reoperation.

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“…Cystic duct stump leaks occur in 0.12% of cholecystectomies. 1 Initial management is typically endoscopic and includes sphincterotomy or biliary stenting. 2,3 With failure rates as high as 10%, alternative approaches to the treatment of cystic duct stump leaks may be required.…”

Section: Introductionmentioning

confidence: 99%

Management of a Persistent Cystic Duct Stump Leak Following Cholecystectomy With Percutaneous Transabdominal Cystic Duct Stump Embolization

et al. 2019

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Cystic duct stump leak remains a difficult clinical problem despite advancements in endoscopic techniques. When these minimally invasive strategies fail, patients are often subject to high morbidity and mortality associated with open surgical exploration. We report the successful treatment of persistent biliary leak from the cystic duct stump following cholecystectomy using percutaneous transabdominal access of the cystic duct and coil embolization.

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Cystic Duct Stump Leaks

Cited by 20 publications

References 23 publications

Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study

Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study

Successful Treatment of Persistent Postcholecystectomy Bile Leak Using Percutaneous Cystic Duct Coiling

Management of a Persistent Cystic Duct Stump Leak Following Cholecystectomy With Percutaneous Transabdominal Cystic Duct Stump Embolization

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