Major Liver Resection as Definitive Treatment in Post‐cholecystectomy Common Bile Duct Injuries

Pekolj, Juan; Yanzon, Alejandro; Dietrich, Alexander; Valle, Gabriela del; Ardiles, Victoria; Santibañés, Eduardo de

doi:10.1007/s00268-014-2933-0

Cited by 19 publications

(15 citation statements)

References 45 publications

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“…The mechanisms of these injuries involve thermal injuries, scissors, ligatures or clips [ 15 , 16 , [18] , [19] , [20] ]. These injuries are dangerous with significant morbidity, and mortality [ 13 , [21] , [22] , [23] , [24] , [25] ].…”

Section: Introductionmentioning

confidence: 99%

“…Surgical biliary-enteric reconstruction including the Hepp-Couinaud approach at a specialist hepatobiliary center by an experienced surgeon, is the most effective treatment of these injuries with perfect long-term results [ 3 , 20 , [28] , [29] , [30] , [31] ]. However, end-to-end biliary anastomosis can be utilized as a treatment strategy if major BDI (MBDI) is detected during surgery, with no extensive tissue loss, or inflammation [ 32 ].…”

Section: Introductionmentioning

confidence: 99%

“…The surgical techniques: After opening the abdomen, adhesiolysis and mobilization of the liver were done. Intraoperative doppler-ultrasound was used to detect vascular involvement (if suspected), Pringle maneuver was systematically done, hilar structures were exposed and IOC was performed to assess the biliary tree [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

“…In HJ cases, the anastomosis was performed with a Roux-en-Y HJ, with extension to the left hepatic duct (Hepp– Couinaud approach) [ 42 ] to achieve adequate stoma size where absorbable sutures were used with or without trans-anastomotic stenting depending upon the stricture type, and technical difficulty [ 3 , 19 , 20 , 30 , 37 , 43 ]. However, in RT hepatectomy cases, the parenchymal transection was performed using cavitron ultrasonic surgical aspirator (CUSA) in combination with the harmonic scalpel and then a Roux-en-Y HJ between the LT hepatic duct and the jejunum using trans-anastomotic stenting was performed.…”

Section: Introductionmentioning

confidence: 99%

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Surgical management of laparoscopic cholecystectomy (LC) related major bile duct injuries; predictors of short-and long-term outcomes in a tertiary Egyptian center- a retrospective cohort study

Gad

Ayoup

Kamel

et al. 2018

Annals of Medicine and Surgery

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ObjectivesLaparoscopic cholecystectomy - associated bile duct injury is a clinical problem with bad outcome. The study aimed to analyze the outcome of surgical management of these injuries.Patients and methodsWe retrospectively analyzed 69 patients underwent surgical management of laparoscopic cholecystectomy related major bile duct injuries in the period from the beginning of 2013 to the beginning of 2018.ResultsRegarding injury type; the Leaking, Obstructing, leaking + obstructing, leaking + vascular, and obstructing + vascular injuries were 43.5%, 27.5%, 18.8%, 2.9%, and 7.2% respectively. However, the Strasberg classification of injury was as follow E1 = 25, E2 = 32, E3 = 8, and E4 = 4. The definitive procedures were as follow: end to end biliary anastomosis with stenting, hepaticojejunostomy (HJ) with or without stenting, and RT hepatectomy plus biliary reconstruction with stenting in 4.3%, 87%, and 8.7% of patients respectively. According to the time of definitive procedure from injury; the immediate (before 72 h), intermediate (between 72 h and 1.5months), and late (after1.5 months) management were 13%, 14.5%, and 72.5% respectively. The hospital and/or 1month (early) morbidity after definitive treatment was 21.7%, while, the late biliary morbidity was 17.4% and the overall mortality was 2.9%, on the other hand, the late biliary morbidity-free survival was 79.7%. On univariate analysis, the following factors were significant predictors of early morbidity; Sepsis at referral, higher Strasberg grade, associated vascular injury, right hepatectomy with biliary reconstruction as a definitive procedure, intra-operative bleeding with blood transfusion, liver cirrhosis, and longer operative times and hospital stays. However, the following factors were significantly associated with late biliary morbidity: Sepsis at referral, end to end anastomosis with stenting, reconstruction without stenting, liver cirrhosis, operative bleeding, and early morbidity.ConclusionSepsis at referral, liver cirrhosis, and operative bleeding were significantly associated with both early and late morbidities after definitive management of laparoscopic cholecystectomy related major bile duct injuries, so it is crucial to avoid these catastrophes when doing those major procedures.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical management of laparoscopic cholecystectomy (LC) related major bile duct injuries; predictors of short-and long-term outcomes in a tertiary Egyptian center- a retrospective cohort study

Gad

Ayoup

Kamel

et al. 2018

Annals of Medicine and Surgery

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“…3 We present an interesting case of grade IV bile duct injury sustained during open cholecystectomy that was managed with right hepatectomy and hepaticojejunostomy.…”

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confidence: 99%

Hepatic resection for bile duct injury: A case report

Joshi

Bhandari

2017

J Chitwan Med Coll

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Background: Bile duct injury is a serious complication following both open and laparoscopic cholecystectomy. The extent of injury may be severe enough to consider biliary reconstruction procedures like Roux-en-Y hepaticojejunostomy or even hepatectomy in rare instances for the definitive management. Case: A 56 year old female, who underwent open cholecystectomy and detected bile duct injury intraoperatively. Small feeding tube was placed in the bile duct, exteriorized and patient was referred to our center for further management. Liver function tests at presentation revealed cholestatic patterns of liver derangement but the patient did not show any signs suggestive of sepsis. Endoscopic Retrograde Cholangiopancreatography revealed complete stricture of common hepatic duct. Magnetic Resonance Cholangiopancreatography revealed Bismuth type 4 bile duct stricture. The plan was to perform a bilateral hepaticojejunostomy, however, because of the very difficult anatomy and failure to identify the right duct, right hepatectomy with left duct hepaticojejunostomy was performed as a definitive management for her type IV bile duct injury. The patient had an uneventful post-operative course. Conclusion: Infrequently, liver resection remains an important therapeutic option in cases of complicated and major forms of bile duct injuries where the bilateral biliary reconstruction is not feasible.

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Postoperative Biliary Stricture

Cantù

2020

Endotherapy in Biliopancreatic Diseases: ERCP Meets EUS

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Major Liver Resection as Definitive Treatment in Post‐cholecystectomy Common Bile Duct Injuries

Abstract: In our series, major hepatectomy due to CBDI was a successful treatment with high rates of postoperative morbidity and excellent long-term outcomes which require a multidisciplinary approach in referral centres of HPB surgery.

Cited by 19 publications

References 45 publications

Surgical management of laparoscopic cholecystectomy (LC) related major bile duct injuries; predictors of short-and long-term outcomes in a tertiary Egyptian center- a retrospective cohort study

Surgical management of laparoscopic cholecystectomy (LC) related major bile duct injuries; predictors of short-and long-term outcomes in a tertiary Egyptian center- a retrospective cohort study

Hepatic resection for bile duct injury: A case report

Postoperative Biliary Stricture

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