Iatrogenic bile duct stricture: An avoidable surgical hazard?

Johnston, G. W.

doi:10.1002/bjs.1800730402

Cited by 34 publications

(19 citation statements)

References 9 publications

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“…The junction of the cystic and common hepatic duct is reported by many authors as the most frequently injured region [9,10]. Bile duct injuries are seen in 25%-30% of the cases during operation [11,12]. Primary end-to-end anastomosis can be used if the distance between the severed tips is not more than 15 mm [13,14].…”

Section: Discussionmentioning

confidence: 99%

Fascioperitoneal graft with T-tube drainage for patching bile duct defects

et al. 1997

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Reconstruction of choledochal wall defects in an experimental dog model by T-tube plus fascioperitoneal graft and an evaluation of the short-term results were the aims of this study. Twelve randomly selected mongrel dogs of both sexes, having an average weight of 22.15 +/- 1.85 kg, were anaesthetized with ketamine HCI and xylazine and underwent laparatomy. The front wall of choledoch canal were excised with its all layers 0.5 cm in diameter at the distal part of the cystic duct junctions. These defects were repaired by using grafts prepared of the same diameter from the dorsal fascias of rectus muscles and peritoneum. T-tubes were introduced into the common ducts on the proximal part of the grafts. One of the animals died in the postoperative period due to evantration. T-tube cholangiograms on the twelfth day did not indicate any extravasation or stricture. Histopathological examination of the graft regions on the sixtieth day revealed that the epithelialization had commenced on the border between the bile epithelium and grafts. Based on these early findings, it was suggested that if supported by further studies it may be thought of as a clinical method.

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Section: Discussionmentioning

confidence: 99%

Fascioperitoneal graft with T-tube drainage for patching bile duct defects

et al. 1997

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“…Biliary reconstruction failures are usually manifested by episodes of cholangitis which occur with increasing fre quency. Sometimes, however, the onset has an insidious course with subclinical symptoms [8][9][10], In such cases, unless periodic follow-up examinations are performed, biliary stricture becomes clinically evident very late, at a stage of advanced degenerative lesions in the liver. In the case of 4 patients operated in our Department, hepaticoje junostomy occurred to be eventually unsuccessful.…”

Section: Discussionmentioning

confidence: 99%

“…Recurrent stricture is observed in approximately 20% of the operated patients [1][2][3][4][5][6][7], Stricture recurrence is usually manifested by recurrent cholangitis, most often within the first 5 years of postoperative follow-up. Some times (in about 20% of cases) recurrent stricture has an insidious course with occult and minimal clinical symp toms [3,[8][9][10], Under such circumstances, unless system atic postoperative observation is conducted, stricture of The numbers in parentheses represent operations in our Department.…”

Section: Introductionmentioning

confidence: 99%

Hepaticojejunostomy in Benign Biliary Stricture – Influence of Careful Postoperative Observations on Long-Term Results

Kozicki¹,

Bielecki²

1997

Dig Surg

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Operative treatment of benign biliary strictures, particularly those caused by iatrogenic injuries, is burdened by a relatively high risk of recurrent strictures. We have analyzed late results of Roux-en-Y hepaticojejunostomies, the most common surgical procedure for benign biliary strictures. The results of 74 hepaticojejunostomies performed in 62 patients in the years 1965-1995 are presented in this work. Fifty-five patients (67 operations) were subjected to long-term follow-up. The mean observation period was 12.5 years (1-31 years). Since 1976 up to now, the patients have been under careful, periodic assessments, with emphasis on the first 5 postoperative years. The main aim of these systematic examinations was to diagnose early a possible operative failure and to make a quick decision for reoperation. We have found that duration of cholangitis was on average 2 times shorter before reoperation than in the case of primary hepaticojejunostomy. None of 12 reoperations resulted in death. Effectiveness of particular hepaticojejunostomies, as judged by cumulative patency rate, was 75% (83% for I and II Bismuth type, and 60.5% for III and IV Bismuth type). The distant cumulative patency rate increased to 92%, assuming the second successful reconstruction as continuation of effective treatment. All hepaticojejunostomies according to Hepp for hilar stricture were successful, although only in 5 cases among 15 patients, follow-up was longer than 10 years. Our long-term results indicate that careful, periodic postoperative follow-up of patients after hepaticojejunostomy for benign biliary stricture, especially of iatrogenic origin, has a positive influence on final outcome of surgical treatment.

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“…It has been noted that dangerous anatomy, dangerous pathology and dangerous surgery (or surgeon) account for IBDI [3]. Dangerous anatomy: It is important for surgeons to have a thorough understanding of anatomy in every single operation that is performed.…”

Section: Introductionmentioning

confidence: 99%

Iatrogenic bile duct injuries during laparoscopic cholecystectomy

Pathirana

2012

Sri Lanka j Surg

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Iatrogenic bile duct stricture: An avoidable surgical hazard?

Cited by 34 publications

References 9 publications

Fascioperitoneal graft with T-tube drainage for patching bile duct defects

Fascioperitoneal graft with T-tube drainage for patching bile duct defects

Hepaticojejunostomy in Benign Biliary Stricture – Influence of Careful Postoperative Observations on Long-Term Results

Iatrogenic bile duct injuries during laparoscopic cholecystectomy

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