Laparoscopic Bile Duct Injuries: Spectrum at a Tertiary-Care Center

Sikora, Sadiq S.; Kumar, Ashok; Das, Narayan; Sarkari, Anuj; Saxena, Rajan; Kapoor, Vinay K.

doi:10.1089/109264201750162239

Cited by 18 publications

(12 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our observation, type A injury was more common with laparoscopic cholecystectomy whereas type E3 was more common with open cholecystectomy. This contradicts the earlier observation that laparoscopic surgery is associated with severe and more complex BDI [10,11].…”

Section: Discussioncontrasting

confidence: 88%

“…When recognized, the basic principles of management are: convert to open in case of laparoscopic cholecystectomy, assess the injury, perform on-table cholangiogram, seek help from more experienced surgeon and carry out an optimal repair [1]. Partial injury should be repaired over the T-tube [11]. Complete transection of the bile duct is best repaired by hepaticojejunostomy for a better long-term outcome.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Management of Bile Duct Injury at Various Stages of Presentation: Experience from a Tertiary Care Centre

et al. 2012

View full text Add to dashboard Cite

The clinical presentation, management and outcome of all patients with bile duct injury who presented to our tertiary care centre at various stages after cholecystectomy were analyzed. The patients were categorized into three groups: group A-patients in whom the injury was detected during cholecystectomy, group B-patients who presented within 2 weeks of cholecystectomy and group C-patients who presented after 2 weeks of cholecystectomy. Our team acted as rescue surgeons and performed 'on-table' repair for injuries occurring in another unit or in another hospital. Strasberg classification of bile duct injury was followed. In group A, partial and complete transections were managed by repair over T-tube and high hepaticojejunostomy, respectively. Patients in group B underwent endoscopic retrograde cholangiogram and/ or magnetic resonance cholangiogram to evaluate the biliary tree. Those with intact common bile duct underwent endoscopic papillotomy and stenting in addition to drainage of intraabdominal collection when present. For those with complete transection, early repair was considered if there was no sepsis. In presence of intra-abdominal sepsis an attempt was made to create controlled external biliary fistula. This was followed by hepatico jejunostomy at least after 3 months. Group C patients underwent hepaticojejunostomy at least 6 weeks after the injury. The outcome was graded into three categories: grade A-no clinical symptoms, normal LFT; grade B-no clinical symptoms, mild derangement of LFT or occasional episodes of pain or fever; grade C-pain, cholangitis and abnormal LFT; grade D-surgical revision or dilatation required. Fifty nine patients were included in the study and the distribution was group A-six patients, group B-33 patients and group C-20 patients. In group A, one patient with complete transection of the right hepatic duct (type C) and partial injury to left hepatic duct (LHD) underwent right hepaticojejunostomy and repair of the LHD over stent. Two patients with type D and three patients with type E 2 injury underwent repair over T-tube and hepaticojejunostomy, respectively. In group B, all except one of the 18 patients with type A injury underwent endoscopic papillotomy and stenting. The bile leak subsided at a mean interval of 8 days in all, except one patient who died of fulminant sepsis. Of the 15 patients with type E injury, five underwent hepaticojejunostomy after a minimum gap of 3 months. Early repair was considered in 10 patients. Twenty patients in group C underwent hepaticojejunostomy. In a mean follow-up of 40 months, the outcome was grade A in 54 patients, grade B in three patients (one from each of the three groups) and grade D in one patient (group C). The latter patient with a type E3 injury developed recurrent stricture and cholangitis necessitating percutaneous transhepatic dilatation. The high success rate of bile duct repair in the present study can be attributed to the appropriate timing, meticulous technique and the tertiary care experience.Keywords Cholecystect...

show abstract

Section: Discussioncontrasting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Management of Bile Duct Injury at Various Stages of Presentation: Experience from a Tertiary Care Centre

et al. 2012

View full text Add to dashboard Cite

show abstract

“…The incidence rate of major bile duct injury is 0.2e0.3% after open cholecystectomy and 0.4e0.6% after a laparoscopic cholecystectomy. 2,3,4 Most of the benign biliary strictures following injury during cholecystectomy go unrecognized at the time of surgery (as many as 75% of cases). Presentation after more than 5 years may occur in 30% of cases.…”

Section: Postoperative Injury After Cholecystectomymentioning

confidence: 99%

Benign bile duct strictures

Dadhwal

Kumar

2012

Medical Journal Armed Forces India

View full text Add to dashboard Cite

“…The exact incidence of BDI following LC is not known, but is definitely higher than that following open cholecystectomy and reportedly varies between 0.4-0.6% [4][5][6][7][8][9][10]. It is also felt that biliary injuries following LC are more severe and complex than that encountered during an open cholecystectomy [11,12].…”

Section: Classification Of Bile Duct Injurymentioning

confidence: 99%