Iatrogenic Injury to the Bile Duct

Moossa, A. R.

doi:10.1001/archsurg.1990.01410200092014

Cited by 131 publications

(67 citation statements)

References 17 publications

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“…The level of stricture as defined by Bismuth has influenced the outcome of repair in a number of series. Moossa et al [21] reported a mortality rate of 65% in their patients having type III/IV BBS with poor-long term results. Csendes et al [22] reported a mortality rate of 25% with a failure rate of 40% following surgical repair in their series of type III/IV BBS.…”

Section: Discussionmentioning

confidence: 99%

Postcholecystectomy Benign Biliary Strictures – Long-Term Results

Sikora¹,

Pottakkat²,

Givvimani³

et al. 2006

Dig Surg

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Background: Cholecystectomy is the most frequently performed general surgical procedure. Bile duct injury is a dreaded complication and is associated with serious long-term morbidity. Patients and Methods: Three hundred patients with postcholecystectomy benign biliary strictures were managed from January 1989 to February 2004 at a tertiary care unit in northern India. Demographic data, clinical presentation, and immediate- and long-term results of surgical repair are analyzed from a prospective database. Results: The time from cholecystectomy (open, n = 262; laparoscopic, n = 38) to stricture repair ranged from 0.2 to 360 (median 7) months. Thirty-six patients (12%) had prior stricture repair. Bismuth classification of the bile duct strictures was 32 type I, 113 type II, 126 type III, 18 type IV, and 11 type V. Two hundred and ninety-two patients (97%) underwent repair by a Roux-en-Y hepaticojejunostomy. One hundred patients (33.3%) had postoperative morbidity following stricture repair. Four patients (1.3%) died during the postoperative period. Of the 149 patients with a minimum available follow-up period of 5 years (mean 9.5, median 9.4 years; range 5–15.4 years), 134 (90%) had an excellent outcome (grade A, n = 122; grade B, n = 12); only 8 patients (5.4%) had a poor outcome. Conclusion: Excellent long-term outcomes with minimal morbidity and mortality can be achieved in the subgroup of benign biliary strictures managed in dedicated units with meticulous attention to the central tenets of biliary surgery.

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Section: Discussionmentioning

confidence: 99%

Postcholecystectomy Benign Biliary Strictures – Long-Term Results

Sikora¹,

Pottakkat²,

Givvimani³

et al. 2006

Dig Surg

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“…Concomitantly, it became obvious that the incidence of bile duct injury rose from 0.06% to 0.3%, as known for open cholecystectomy, to 0.5% to 1.4% when performed laparoscopically [2][3][4][5][6] . Bile duct injury following cholecystectomy is an iatrogenic catastrophe associated with significant perioperative morbidity and mortality [7,8] , reduced long-term survival and quality of life [9,10] , and high rates of subsequent litigation. Apparently, it is a great surgical challenge to handle with biliary restricture after Roux-en-Y hepaticojejunostomy for bile duct injury.…”

Section: Introductionmentioning

confidence: 99%

Surgical management in biliary restricture after Roux-en-Y hepaticojejunostomy for bile duct injury

Ji-Qi¹,

Yan²,

Chenghong³

et al. 2007

WJG

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AIM:To discuss the surgical method and skill of biliary restricture after Roux-en-Y hepaticojejunostomy for bile duct injury. METHODS:From November 2005 to December 2006, eight patients with biliary restricture after Roux-en-Y hepaticojejunostomy for bile duct injury were admitted to our hospital. Their clinical data were analyzed retrospectively. RESULTS:Bile duct injury was caused by cholecystectomy in the eight cases, including seven cases with laparoscopic cholecystectomy and one with miniincision choleystectomy. According to the classification of Strasberg, type E1 injury was found in one patient, type E2 injury in three, type E3 injury in two and type E4 injury in two patients. Both of the type E4 injury patients also had a vascular lesion of the hepatic artery. Six patients received Roux-en-Y hepaticojejunostomy for the second time, and one of them who had type E4 injury with the right hepatic artery disruption received right hepatectomy afterward. One patient who had type E4 injury with the proper hepatic artery lesion underwent liver transplantation, and the remaining one with type E3 injury received external biliary drainage. All the patients recovered fairly well postoperatively. CONCLUSION:Roux-en-Y hepaticojejunostomy is still the main approach for such failed surgical cases with bile duct injury. Special attention should be paid to concomitant vascular injury in these cases. The optimal timing and meticulous and excellent skills are essential to the success in this surgery.

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“…The fundus-first approach has proven to have a low incidence of biliary stricture post-operatively [9] and such a stricture was not observed in any of our 30 cases. The site of opening of the cystic duct is seen much better when the gall bladder is detached from its bed.…”

Section: Discussionmentioning

confidence: 57%

Cholecystectomy : Fundus to Porta Approach

Maudar

1996

Medical Journal Armed Forces India

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Cholecystectomy is a commonly performed operation but there is still controversy whether dissection of the gall bladder should proceed from the fundus to the cystic duct or in the opposite direction. In usual practice the fundus-first method is adopted whenever difficulty is encountered in visualizing the anatomy of the cystic duct and Calot's triangle. Akhough haemorrhage is a little greater than with the duct-first method the risk of damage to the common bile duct or right hepatic artery is minimized. This article describes a brief experience with thirty randomized patients in whom cholecystectomies were performed with planned fundus-first approach. MJAFI 1996; 52 : 79-82

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Iatrogenic Injury to the Bile Duct

Cited by 131 publications

References 17 publications

Postcholecystectomy Benign Biliary Strictures – Long-Term Results

Postcholecystectomy Benign Biliary Strictures – Long-Term Results

Surgical management in biliary restricture after Roux-en-Y hepaticojejunostomy for bile duct injury

Cholecystectomy : Fundus to Porta Approach

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