scholarly journals Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
M. Crespi ◽  
G. Montecamozzo ◽  
D. Foschi
Keyword(s):  
Gastrointestinal Tract ◽  
Bile Duct ◽  
Therapeutic Option ◽  
Late Results ◽  
Endoscopic Stenting ◽  
Hepatobiliary Surgery ◽  
Experienced Surgeon ◽  
Bile Duct Injuries ◽  
Accurate Preoperative Diagnosis ◽  
Bile Duct Damage

Biliary fistulas are rare complications of gallstone. They can affect either the biliary or the gastrointestinal tract and are usually classified as primary or secondary. The primary fistulas are related to the biliary lithiasis, while the secondary ones are related to surgical complications. Laparoscopic surgery is a therapeutic option for the treatment of primary biliary fistulas. However, it could be the first responsible for the development of secondary biliary fistulas. An accurate preoperative diagnosis together with an experienced surgeon on the hepatobiliary surgery is necessary to deal with biliary fistulas. Cholecystectomy with a choledocoplasty is the most frequent treatment of primary fistulas, whereas the bile duct drainage or the endoscopic stenting is the best choice in case of minor iatrogenic bile duct injuries. Roux-en-Y hepaticojejunostomy is the extreme therapeutic option for both conditions. The sepsis, the level of the bile duct damage, and the involvement of the gastrointestinal tract increase the complexity of the operation and affect early and late results.

scholarly journals Referral Pattern, Management, and Long-Term Results of Laparoscopic Bile Duct Injuries: A Case Series of 44 Patients

Medicina ◽  
2012 ◽  
Vol 48 (3) ◽  
pp. 19 ◽  
Author(s):  
Giedrius Barauskas ◽  
Saulius Paškauskas ◽  
Žilvinas Dambrauskas ◽  
Antanas Gulbinas ◽  
Juozas Pundzius
Keyword(s):  
Bile Duct ◽  
Initial Treatment ◽  
Immediate Early ◽  
Long Term Results ◽  
Rank Test ◽  
Endoscopic Stenting ◽  
Bile Duct Injuries ◽  
Log Rank Test ◽  
The Mean

Background and Objective. The incidence of bile duct injuries (BDIs) after laparoscopic cholecystectomy (LC) is higher than after open cholecystectomy, and the management of these lesions is still controversial. This study analyzed diagnostic and management strategies as well as long-term outcomes after BDI. Material and Methods. A prospective database of patients with BDIs at the Clinic of Surgery was maintained during the 8-year period (2000–2007). The long-term results were evaluated during 2008–2010, after 36- to 120-month follow-up (median, 84 months). Results. In our series, 21 patients (48%) presented with minor and 23 (52%) with major BDIs. The overall incidence of BDIs was 0.24%. In 92% of cases in the minor BDI group, endoscopic stenting resulted in a good outcome. Major BDIs were treated by immediate, early, or delayed surgery depending on the timeliness of diagnosis and presence of biliary sepsis and/or cholangitis. The mean estimated time to failure after the initial treatment in the minor BDI group was significantly longer when compared with the major BDI group (114.3 vs. 81.8 months, log-rank test P=0.048). The hazard ratio of initial treatment failure after major versus minor BDIs was 6.06 (95% CI, 1.01–17.59). The mean estimated time to develop a biliary stricture after immediate, early, and delayed reconstructions was not different (P>0.05 in pairwise comparisons by log-rank test). Conclusions. Minor BDIs are best served by endoscopy, while surgical repair may be an efficient option when injury is diagnosed intraoperatively. The timing of reconstruction after major BDIs does not portend a different outcome; consequently, every attempt to achieve infection control should be warranted. Referral to a tertiary care center should be encouraged to facilitate a proper classification of preoperative injuries and multidisciplinary approach

scholarly journals Management of Bile Duct Injury Following Cholecystectomy

2020 ◽  
Vol 18 (2) ◽  
pp. 214-218
Author(s):  
Bala Ram Malla ◽  
Nripesh Rajbhandari ◽  
Robin Man Karmacharya
Keyword(s):  
Bile Duct ◽  
Bile Duct Injury ◽  
Open Cholecystectomy ◽  
Biliary Tree ◽  
Endoscopic Stenting ◽  
Bile Duct Injuries ◽  
Biliary Anastomosis ◽  
Classification Management

Background: Laparoscopic cholecystectomy is responsible for 80-85% of the bileduct injury, and twice as frequentcompared to open cholecystectomy.Injury affects the quality of life and overall survival of the patient. The management of these injuries is complex and challenging. There are few locally published reports regarding management of bile duct injury. The objective of this study is to evaluate the management of bile duct injury and its outcome Methods: This retrospective study includes patients bile duct injury following cholecystectomy who were managed at Dhulikhel Hospital, Nepal, during January 2014 to December 2016. The clinical features, type of injuries(Strasberg classification) management, outcome (as per McDonald and colleague grading system) and follow up were analyzed descriptively. Results: Out of 35 bile duct injuries,only 3 (8.57%)occurred following open cholecystectomy. Three (8.7%) cases of bile duct injury were diagnosed intraoperatively and had primary biliary anastomosis over T-tube. Five (14.28%) were diagnosed postoperatively and underwent Roux-en-y hepatojejunostomy 6 weeks after index surgery. And, 27(77.14%) with type A injuries were treated by endoscopic retrograde cholangio-pancreatography and stenting. After surgical repair, 1 (2.85%) had transient biliary leak. One patient had grade B outcome. During 18 months follow up, no stricture or cholangitis were observed. Conclusions: Bile duct injury with intact continuity of the duct can be successfully managed with endoscopic stenting of the biliary tree. Intraoperative diagnosis of bile duct injury and immediate surgical management has good outcome. Keywords: Bile duct injury; cholecystectomy; repair; strasberg classification

Treatment of bile duct injuries at our department

2009 ◽  
Vol 47 (05) ◽  
Author(s):  
L Lauf ◽  
P Mészáros ◽  
A Fekete ◽  
L Topa ◽  
M Bély ◽  
...  
Keyword(s):  
Bile Duct ◽  
Bile Duct Injuries

scholarly journals Iatrogenic Bile Duct Injuries: An Overview and A Review of Literature

2021 ◽  
Vol 07 (01) ◽  
pp. 037-043
Author(s):  
Vinoth M. ◽  
Abhijit Joshi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Surgical Procedures ◽  
Surgical Repair ◽  
Review Of Literature ◽  
Bile Duct Injuries ◽  
Iatrogenic Bile Duct Injury

Abstract​ Laparoscopic cholecystectomy (LC) is one of the most frequently performed surgical procedures worldwide. Iatrogenic bile duct injury (IBDI) is a serious complication of LC and has an incidence of 0.3 to 0.7%. Since it is associated with a significant and potentially lifelong morbidity as well as mortality, diagnosing IBDI as early as possible is of paramount importance. Management of bile duct injuries and prognosis of their surgical repair depend on the timing of its recognition, type and the extent of the injury. In this paper, we present a case of IBDI and attempt to discuss all its dimensions.

Intrahepatic Repair of Bile Duct Injuries. A Comparative Study

2007 ◽  
Vol 12 (2) ◽  
pp. 364-368 ◽  
Author(s):  
Miguel Ángel Mercado ◽  
Carlos Chan ◽  
Noel Salgado-Nesme ◽  
Federico López-Rosales
Keyword(s):  
Bile Duct ◽  
Comparative Study ◽  
Bile Duct Injuries

scholarly journals Erratum to: Age and Obesity are Independent Predictors of Bile Duct Injuries in Patients Undergoing Laparoscopic Cholecystectomy

2015 ◽  
Vol 39 (7) ◽  
pp. 1809-1809 ◽  
Author(s):  
Hassan Aziz ◽  
Viraj Pandit ◽  
Bellal Joseph ◽  
Tun Jie ◽  
Evan Ong
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injuries

Quality-of-life assessment in the treatment of iatrogenic bile duct injuries: hepaticojejunostomy versus end-to-end biliary reconstructions

2012 ◽  
Vol 82 (12) ◽  
pp. 923-927 ◽  
Author(s):  
Beata Jabłońska ◽  
Marek Olakowski ◽  
Paweł Lampe ◽  
Zygmunt Górka ◽  
Łukasz Bułdak
Keyword(s):  
Quality Of Life ◽  
Bile Duct ◽  
Life Assessment ◽  
Quality Of Life Assessment ◽  
Bile Duct Injuries ◽  
End To End

The Prevention of Laparoscopic Bile Duct Injuries: An Analysis of 300 Cases of from a Human Factors and Cognitive Psychology Perspective

2007 ◽  
Vol 51 (11) ◽  
pp. 617-620 ◽  
Author(s):  
Lygia Stewart ◽  
Lawrence W. Way
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Human Factors ◽  
Bile Duct Injury ◽  
Human Error ◽  
Perceptual Illusion ◽  
Bile Duct Injuries ◽  
Psychology Perspective ◽  
Cause Of Error ◽  
Key Steps

Application of human factors concepts to high-risk activities has facilitated reduction in human error. With introduction of laparoscopic cholecystectomy, the incidence of bile duct injury increased. Seeking ideas for prevention, we analyzed 300 laparoscopic bile duct injuries within the framework of human error analysis. The primary cause of error (97%) was a visual perceptual illusion. The laparoscopic environment contributed to 75% of injuries, poor visibility 22%. Most injuries involved deliberate major bile duct transection due to misperception of the anatomy. This illusion was so compelling that the surgeon usually did not recognize it. Even when irregular cues were detected, improper rules were employed, eliminating feedback. Since the complication-causing error occurred at few key steps during laparoscopic cholecystectomy; we instituted focused training to heighten vigilance, and have formulated specific rules to decrease the incidence of bile duct injury. In addition, factors in the laparoscopic environment contributing to this illusion are discussed.

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