Management of iatrogenic bile duct injury in cholecystectomy: a single centre experience

Sharma, Mohit; Singh, Rajeev Kumar; Singh, Neeti Rajan

doi:10.18203/2349-2902.isj20163974

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…The question of early or delayed surgical repair of BDI is still debatable. Many authors consider the delayed repair to be associated with fewer complications in the short and long term [ 24 , 25 ]. Arguments to support this are the opportunity to stabilize patients’ condition, control sepsis, improve focal inflammation, and microvascular damage to the bile ducts, all of which interfere negatively on the clinical outcomes.…”

Section: Resultsmentioning

confidence: 99%

Hepatico-Duodenal Fistula Following Iatrogenic Strasberg Type E4 Bile Duct Injury: A Case Report

Hristov,

Doykov,

Stanchev

et al. 2023

Medicina

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Introduction: Gallstone disease (GSD) is among the most common disorders worldwide. Gallstones are established in up to 15% of the general population. Laparoscopic cholecystectomy (LC) has become the “gold standard” for treatment of GSD but is associated with a higher rate of certain complications, namely, bile duct injury (BDI). Biliary fistulas (BF) are a common presentation of BDI (44.1% of all patients); however, they are mainly external. Post-cholecystectomy internal BF are exceedingly rare. Case report: a 33-year Caucasian female was admitted with suspected BDI after LC. Strasberg type E4 BDI was established on endoscopic retrograde cholangiopancreatography (ERCP). Urgent laparotomy established biliary peritonitis. Delayed surgical reconstruction was planned and temporary external biliary drains were positioned in the right and left hepatic ducts. During follow-up, displacement of the drains occurred with subsequent evacuation of bile through the external fistula, which resolved spontaneously, without clinical and biochemical evidence of biliary obstruction or cholangitis. ERCP established bilio-duodenal fistula between the left hepatic duct (LHD) and duodenum, with a stricture at the level of the LHD. Endoscopic management was chosen with staged dilation and stenting of the fistulous tract over 18 months until fistula maturation and stricture resolution. One year after stent extraction, the patient remains symptom free. Discussion: Management of post-cholecystectomy BDI is challenging. The optimal approach is determined by the level and extent of ductal lesion defined according to different classifications (Strasberg, Bismuth, Hannover). Type E BDI are managed mainly surgically with a delayed surgical approach generally deemed preferable. Only three cases of choledocho-duodenal fistulas following LC BDI currently exist in the literature. Management is controversial, with expectant approach, surgical treatment (biliary reconstruction), or liver transplantation being described. Endoscopic treatment has not been described; however, in the current paper, it proved to be successful. More reports or larger case series are needed to confirm its applicability and effectiveness, especially in the long term.

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Section: Resultsmentioning

confidence: 99%

Hepatico-Duodenal Fistula Following Iatrogenic Strasberg Type E4 Bile Duct Injury: A Case Report

Hristov,

Doykov,

Stanchev

et al. 2023

Medicina

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“…In a prior research, 84% of patients with bile duct injuries who were monitored and treated at a facility with an experienced hepatobiliary surgeon, an endoscopist and a radiologist with complete vision of the biliary tree survived the surgical procedure. [28] Another study found a greater success rate (92.3%) than what was previously reported in the literature while treating 26 injuries using clinic-based surgeries.…”

Section: Type Of Treatmentmentioning

confidence: 85%

Experience of Treatment of Iatrogenic Bile Duct Injuries Following Laparoscopic Cholecystectomy in Tertiary Care Hospitals of Khyber Pukhtunkhwa

Khan¹,

Durrani²,

Rahman³

et al. 2022

PJMHS

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Objective: This research aims to learn how often iatrogenic bile duct injuries caused during laparoscopic cholecystectomy are treated and how well they heal after surgery. Study Design: A retrospective study Place and Duration: General Surgery Department of different hospitals of Khyber Pukhtunkhwa i.e Bacha Khan Medical Complex, Swabi, Peshawar Institute of Medical Sciences, Peshawar and Naseer Teaching Hospital, Peshawar for duration of two years from February 2020 to January 2022. Methods: In this research, 105 patients of both genders aged 18-68 years were enrolled. Included patients had iatrogenic bile duct injuries during laparoscopic cholecystectomy. Age, sex, place of residence, and body mass index were among the specific demographics of the enrolled cases that were calculated after receiving informed written consent. Strasberg classification was used to classify bile duct injuries. The outcome of treatment in all cases was measured in terms of effectiveness, complications, mortality and need for repeated treatment. SPSS 23.0 was used to analyze all data. Results: Among 105 presented cases, there were 68 (64.8%) females and 37 (35.2%) males. The mean age of the patients was 55.2±6.30 years and mean BMI 23.8±4.19 kg/m2. 55 (52.4%) patients were from urban areas. Most common symptom was epigastric pain, followed by fever, chills and jaundice. We found that Strasberg A was the most common injury found in 56 (53.3%) cases, followed by Strasberg D in 17 (16.2%) cases and Strasberg C in 12 (11.4%) cases. In all 105 cases, the majority of the patients received endoscopy in 67 (63.8%) cases and surgical treatment in 38 (36.2%) cases. Complications were bile leakage from the incision site, abdominal pain and bile leakage from the drain. Frequency of mortality was 4 (3.8%). Conclusion: We concluded in this study that the iatrogenic bile duct injuries were effectively treated with endoscopy and surgical treatment by using Strasberg classification. There was higher effectiveness and the mortality rate was low. Keywords: Iatrogenic Bile Duct Injury, Endoscopy, LC, Surgical, Mortality, Complications

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“…Laparoscopic cholecystectomy has altered the treatment method for patients with cholelithiasis. Due to the lesser discomfort associated with the surgery, it soon became the treatment of choice for the majority of patients with symptomatic stones 2 . When a common bile duct was injured during a laparoscopic cholecystectomy, serious complications occurred.…”

Section: Introductionmentioning

confidence: 99%

Bile duct injury during laparoscopic cholecystectomy

Khan¹,

Billah²,

Zeb³

et al. 2023

ijhs

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Background and Aim: Bile duct injuries (BDIs) are complex complications developed during laparoscopic cholecystectomy leading to the postoperative morbidity and mortality. Auxiliary bile duct injury, vascular structures injuries, portal vein, cyst duct leakage and damage to right hepatic artery are caused by bile duct injuries. The purpose of the present study was to investigate the incidence, clinical presentation, and treatment modality of bile duct injuries during laparoscopic cholecystectomy. Patients and Methods: This descriptive case series was conducted on 96 extra hepatic biliary injuries in the Department of General Surgery, Rehman Medical Institute, Peshawar from April 2022 to March 2023. Patients with extra hepatic biliary injuries of either gender were enrolled. Abdominal ultrasonography, ERCP, and MRCP were the different investigating modalities performed on each individual. Complete blood picture, activated Partial thromboplastin time (APTT), liver function tests, blood sugar, prothrombin time (PT), Creatinine, serum electrolytes, and Urea were thoroughly performed on each patient. HIV, HBs, and HCV were various screening tests performed. SPSS version 27 was used for data analysis. Results: Of the total 96 patients, there were 26 (27.1%) male and 70 (72.9%) females.

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Management of iatrogenic bile duct injury in cholecystectomy: a single centre experience

Cited by 3 publications

References 16 publications

Hepatico-Duodenal Fistula Following Iatrogenic Strasberg Type E4 Bile Duct Injury: A Case Report

Hepatico-Duodenal Fistula Following Iatrogenic Strasberg Type E4 Bile Duct Injury: A Case Report

Experience of Treatment of Iatrogenic Bile Duct Injuries Following Laparoscopic Cholecystectomy in Tertiary Care Hospitals of Khyber Pukhtunkhwa

Bile duct injury during laparoscopic cholecystectomy

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