Early specialist repair of biliary injury

Thomson, Benjamin; Parks, Rowan W.; Madhavan, Krishnakumar; Wigmore, Stephen J.; Garden, O. James

doi:10.1002/bjs.5194

Cited by 109 publications

(82 citation statements)

References 23 publications

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“…However many authors have failed to identify early repair as an individual risk factor. 12,14,15 In this series, early repair within 3 weeks was associated with the lowest incidence of major complications, as reported in some other series also. 16 Patients with late repairs and repeat surgeries were associated with significantly higher incidence of major complications though timing of repair was not an independent predictor of outcome.…”

Section: Discussionsupporting

confidence: 85%

Predictors of outcome after reconstructive hepaticojejunostomy for post cholecystectomy bile duct injuries

Gomes¹

2015

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Section: Discussionsupporting

confidence: 85%

Predictors of outcome after reconstructive hepaticojejunostomy for post cholecystectomy bile duct injuries

Gomes¹

2015

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“…[15] Yet in this study, 57% of injuries were only recognised after a median delay of 5 days, with 19 of 25 patients presenting with sepsis due to cholangitis or biliary peritonitis or septic bilomas, a finding similar to previously reported data. [7] These findings reinforce the maxim that all laparoscopic cholecystectomy patients require careful assessment and thorough investigation to exclude iatrogenic injury to the bile ducts in the event of any unexpected postoperative symptoms.…”

Section: Discussionsupporting

confidence: 90%

A cost analysis of operative repair of major laparoscopic bile duct injuries

2015

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Background. Major bile duct injuries occur infrequently after laparoscopic cholecystectomy, but may result in life-threatening complications. Few data exist on the financial implications of duct repair. This study calculated the costs of operative repair in a cohort of patients who underwent reconstruction of the bile duct after major ductal injury. Objective. To calculate the total in-hospital cost of surgical repair of patients referred with major bile duct injuries. Methods. A prospective database was reviewed to identify all patients referred to the University of Cape Town Private Academic Hospital, South Africa, between 2002 and 2013 for assessment and repair of major laparoscopic bile duct injuries. The detailed clinical records and billing information were evaluated to determine all costs from admission to discharge. Total costs for each patient were adjusted for inflation between the year of repair and 2013. Results. Forty-four patients (33 women, 11 men; median age 48 years, range 30 -78) underwent reconstruction of a major bile duct injury. First-time repairs were performed at a median of 24.5 days (range 1 -3 662) after initial surgery. Median hospital stay was 15 days (range 6 -86). Mean cost of repair was ZAR215 711 (range ZAR68 764 -980 830). Major contributors to cost were theatre expenses (22%), admission to intensive care (21%), radiology (17%) and specialist fees (12%). Admission to a general ward (10%), consumables (7%), pharmacy (5%), endoscopy (3%) and laboratory costs (3%) made up the balance. Conclusions. The cost of repair of a major laparoscopic bile duct injury is substantial owing to prolonged hospitalisation, complex surgical intervention and intensive imaging requirements.

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“…Although the Hepp-Couinaud reconstruction appears to offer some advantages, it has never been tested in a comparative trial; on the other hand, it cannot be used in all injuries. Bismuth type V injuries would require separate duct anastomoses [26, 27] and sometimes hepatic resection [28]. Lillemoe et al [26] have described a technique similar to that used for a left-sided approach, by resecting the base of the gallbladder fossa, exposing the right ducts to allow separate anastomoses to be fashioned.…”

Section: Introductionmentioning

confidence: 99%

Vascular Injuries in Laparoscopic Cholecystectomy: An Underestimated Problem

Tzovaras

Dervenis²

2006

Dig Surg

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Background: Bile duct injury is a severe complication of laparoscopic cholecystectomy and many reports focus on this topic, especially regarding the long-term success of repair of these injuries. There is some concern, however, as to whether concomitant vascular injuries can jeopardize reconstruction of a bile duct injury following laparoscopic cholecystectomy. Methods: A review of the current literature on the clinical significance and management of a concomitant vascular injury to the outcome of reconstruction of bile duct injuries following laparoscopic cholecystectomy. Relevant articles were extracted through PubMed, with secondary references obtained from key articles. Results: Although the relevant literature is generally poor, there is a trend of appearance of relatively large series on the topic over the last five years, as opposed to case reports or small series during the previous decade. Conclusion: The disruption of the hepatic arterial flow during laparoscopic cholecystectomy is usually well tolerated in an otherwise healthy patient. There is strong evidence that concomitant vascular injuries do not have any impact on mortality after biliary reconstruction. There is also evidence that does increase overall morbidity, but when it comes specifically to long-term anastomotic stricture formation, there is no strong evidence to support a negative impact of a concomitant vascular injury; this is especially true for centers/surgeons with HPB interest.

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Early specialist repair of biliary injury

Cited by 109 publications

References 23 publications

Predictors of outcome after reconstructive hepaticojejunostomy for post cholecystectomy bile duct injuries

Predictors of outcome after reconstructive hepaticojejunostomy for post cholecystectomy bile duct injuries

A cost analysis of operative repair of major laparoscopic bile duct injuries

Vascular Injuries in Laparoscopic Cholecystectomy: An Underestimated Problem

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