Iatrogenic bile duct injuries: Etiology, diagnosis and management

Abstract

Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popular and simple classification of IBDI is the Bismuth scale. Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered. Different surgical reconstructions are performed in patients with IBDI. According to the literature, Rouxen-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors. In the opinion of some authors, a more physiological and equally effective type of reconstruction is endto-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI; the Terblanche scale, based on clinical biliary symptoms, is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life.

Long-Term Results in the Surgical Treatment of Iatrogenic Bile Duct Injuries

“…Roux-Y hepaticojejunostomy is the most frequently performed surgical reconstruction of IBDI (1,37,38). In our patients, different methods of reconstruction were performed.…”

“…The anastomosis should be tension-free and properly vascularized. It should be performed in a single layer with absorbable sutures (1,25,36).…”

“…A cholecystectomy is the most frequent cause of IBDI. Incidence of IBDI has increased because of widespread of laparoscopic cholecystectomy (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). Incidence of IBDI following laparoscopic cholecystectomy (LC) is higher two-fold than after open cholecystectomy (OC) (approximally 0.4% vs 0.2%).…”

Lesão iatrogênica de via biliar pós-colecistectomia

“…The late identification of such injury may lead to serious complications, such as biliary cirrhosis, liver failure and death 6 . Only 15-30% of injuries of the biliary tract are diagnosed during the initial procedure 11 .…”

“…The goal of surgery in these cases is the reconstitution of the biliary path to the food tract 6 . In relation to the surgical procedure, the Rouxen-Y hepatico-jejunostomy is the best therapeutic option and the most frequently employed 9,10 , which was also recorded in our study, where 85.2% of patients have undergone this type of treatment.…”