Laparoscopic Cholecystectomy: Bile Duct and Vascular Injuries: Management and Outcome

Mathisen, Øystein; Søreide, Odd; Bergan, A.

doi:10.1080/003655202317316123

Cited by 53 publications

(40 citation statements)

References 31 publications

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“…Diese beinhaltet interventionelle Maßnahmen wie Dilatationen und erneute operative Eingriffe bis hin zur Lebertransplantation [11]. Hierbei ist meist das Ausmaß der vaskulären Begleitverletzung prognosebestimmend [40,41]. Im eigenen Krankengut, welches über einen Zeitraum von 20 Jahren 81 Fälle mit iatrogenen Gallenwegsverletzungen nach offener Gallenblasenchirurgie umfasst, verstarben 23 Patienten direkt oder indirekt an den Folgen dieser Verletzung [21].…”

Section: Prognosefaktoren Und Langzeitergebnisseunclassified

Chirurgische Behandlung benigner Läsionen und Strikturen der Gallenwege

Tracey

Moossa

2006

Chirurg

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Benign strictures of the biliary ducts are treated surgically in 90% of cases. Usually they are caused by trauma to the choledochous duct during gallbladder operations. Younger patients are frequently affected and, particularly if the strictures go untreated, can suffer from secondary complications such as cholangitis or secondary biliary cirrhosis with the serious dangers of portal hypertension and even hepatic failure and death. Although immediate treatment by end-to-end anastomosis has sometimes been described, this method is reasonable only for smooth cuts to the choledochous duct. Good long-term results have been achieved in 86% of cases with Roux-en-Y hepaticojejunostomy. In general, the best way to avoid complications is the all-important surgical maxim of correct indication for the primary operation. The best course is to limit the decision for surgery to symptomatic gallstones.

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Section: Prognosefaktoren Und Langzeitergebnisseunclassified

Chirurgische Behandlung benigner Läsionen und Strikturen der Gallenwege

Tracey

Moossa

2006

Chirurg

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“…The reason is the better blood supply in the section of the duct near the hilum provided by the central vascular plexus that is supplied by branches of the posterior duodenal artery and centrally via the right hepatic artery. Concomitant injuries to the hilar vascular structures, above all the left hepatic aretery, increase the complication rate for every kind of reconstructive measure and are responsible for postoperative morbidity and mortality [13,[33][34][35][36].…”

Section: Stenoses and Reconstructive Methodsmentioning

confidence: 99%

Management of bile duct injury after laparoscopic cholecystectomy*

et al. 2011

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Background: Even with standardization and increasing experience, laparoscopic cholecystectomy still entails the risk of injury to the bile ducts. The incidence of iatrogenic bile-duct injury is currently estimated at 0.3-0.9%. In spite of the downward trend compared to the historical course, the incidence of iatrogenic bile duct injuries is still higher and so continues to be a determining factor for morbidity with LCHE.Methods and results: Independent of the frequency, the nature of bile duct lesions has also changed. There are not only direct injuries, similar to the direct transection of the bile duct with open LCHE, but there are also long substance defects due to resection of the hepatic duct up to or beyond the bifurcation. In one-quarter of cases, neighboring vascular structures are also injured. With inadequate treatment, the life quality suffers due to functional long-term damage reflected in cholangitis or secondary biliary cirrhosis with portal hypertension up to loss of liver function.Conclusions: Corrective surgery requires suitable surgical expertise in hepatobiliary surgery as well as institutional resources that allow an individual treatment plan based on interdisciplinary cooperation among surgeon, interventional radiologist and gastroenterologist. The long-term prognosis will depend on early diagnosis and efficient therapeutic management.

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“…Occlusion of the hepatic propria artery usually resulted in expansive necrotic areas involving a moderate reduction of liver function sometimes up to liver failure, when collateral vessels were not able to compensate for the hepatic ischemia. In clinical practice, these complications are also seen as a result of hepatic artery thrombosis [41] or hepatic artery injury after surgery [42,43,44,45,46,47,48]. After an accidental injury of the right hepatic artery, asymptomatic courses have been described [49,50].…”

Section: Discussionmentioning

confidence: 99%

“…These are hypothetically related to collateral arterial perfusion [51,52,53]. In most cases of right hepatic artery injuries, complications are observed with simultaneous injuries of the collateral arterial system [42,43,44,45,46,47,48,49,50]. …”

Section: Discussionmentioning

confidence: 99%

Limits of and Complications after Embolization of the Hepatic Artery and Portal Vein to Induce Segmental Hypertrophy of the Liver: A Large Mini-Pig Study

et al. 2016

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Background: The aim of this study was to compare arterial embolization (AE) with portal vein embolization (PVE) for the induction of segmental hypertrophy regarding procedural efficacy, safety and outcome. Methods: A total of 29 mini pigs were subjected to PVE, AE or assigned to the sham (SO) group. Correspondingly, 75% of the hepatic artery or portal vein branches were embolized. Growth and atrophy of the liver lobes, calculating the liver-to-body weight index (LBWI), laboratory data, arteriography, portography, Doppler ultrasound (US) and histopathology were analyzed. Results: After PVE, 2 animals had to be excluded due to technical problems. After AE, 4 animals had to be excluded because of technical problems and early sacrifice. Postprocedural US demonstrated effective AE and PVE of the respective lobes. Four weeks after PVE, portography showed a slow refilling of the embolized lobe by collateral portal venous vessels. Four weeks after AE, arteriography revealed a slight revascularization of the embolized lobes by arterial neovascularization. Segmental AE led to extensive necrotic and inflammatory alterations in the liver and bile duct parenchyma. Significant hypertrophy of the non-embolized lobe was only noted in the PVE group (LBWI: 0.91 ± 0.28%; p = 0.001). There was no increase in the non-embolized lobe in the AE (LBWI: 0.45 ± 0.087%) and SO group (LBWI: 0.45 ± 0.13%). Conclusion: PVE is safe and effective to induce segmental hypertrophy. Portal reperfusion by collateral vessels may limit hypertrophy. AE did not increase the segmental hepatic volume but carries the risk of extensive necrotic inflammatory damage.

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Laparoscopic Cholecystectomy: Bile Duct and Vascular Injuries: Management and Outcome

Abstract: Bile duct injuries continue to occur, are serious and may result in death. Injury to the right hepatic artery is present in many cases. Patients are referred late to a competent center, resulting in serious infection in 70%.

Cited by 53 publications

References 31 publications

Chirurgische Behandlung benigner Läsionen und Strikturen der Gallenwege

Chirurgische Behandlung benigner Läsionen und Strikturen der Gallenwege

Management of bile duct injury after laparoscopic cholecystectomy*

Limits of and Complications after Embolization of the Hepatic Artery and Portal Vein to Induce Segmental Hypertrophy of the Liver: A Large Mini-Pig Study

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