scholarly journals Two Cases of Subvesical Bile Duct Injury Detected and Repaired Simultaneously during Laparoscopic Cholecystectomy

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Atsushi Kohga ◽  
Kenji Suzuki ◽  
Takuya Okumura ◽  
Kiyoshige Yajima ◽  
Kimihiro Yamashita ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Case Report ◽  
Bile Duct ◽  
Acute Cholecystitis ◽  
Bile Duct Injury ◽  
Cystic Duct ◽  
Previous History ◽  
Laparoscopic Suturing ◽  
History Of ◽  
Gallbladder Fossa

Introduction. Subvesical bile duct (SVBD) injury is a secondary major cause of minor bile duct injury after laparoscopic cholecystectomy (LC). However, this injury is usually not recognized intraoperatively, but postoperatively. Case Report. Case 1: the patient was an 84-year-old female, preoperatively diagnosed with acute cholecystitis. During LC, a tiny hole in the gallbladder fossa from which bile juice oozing was confirmed. Suturing was performed laparoscopically. Case 2: the patient was an 81-year-old male, preoperatively diagnosed with cholelithiasis. Because of a previous history of gastrectomy, laparoscopic adhesiolysis around the gallbladder was performed. During dissection, a small amount of bile was oozing from the surface of the liver adjacent to the gallbladder fossa. Suturing was performed laparoscopically. Conclusion. If a small amount of bile juice was detected, meticulous observation not only around the cystic duct stump but also the gallbladder fossa should be performed. Simultaneous laparoscopic suturing was feasible, and an ideal procedure against SVBD injury developed during LC.

scholarly journals Cystic vein: a guide for safer laparoscopic cholecystectomy

2017 ◽  
Vol 4 (10) ◽  
pp. 3238
Author(s):  
Debasish Samal ◽  
Rashmiranjan Sahoo ◽  
Sujata Priyadarsini Mishra ◽  
Krishnendu B. Maiti ◽  
Kalpita Patra ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Duct Injury ◽  
Cystic Duct ◽  
Cystic Artery ◽  
Anatomic Landmark ◽  
Complications Of Laparoscopic Cholecystectomy ◽  
Constant Feature ◽  
The Relationship

Background: Major complications of laparoscopic cholecystectomy are bleeding and bile duct injury, and it is necessary to clearly identify structures endoscopically to keep bleeding and injury from occurring. The aim of this study was to depict the anatomic landmark in the Calots triangle, a vein (cystic vein), a constant feature which can help Laparoscopic surgeons to conduct a safe LC along with other precautions to be adopted. Methods: A total of 100 patients (58 male, 42 female) who underwent cholecystectomy were examined preoperatively by clinically. The origin and number of cystic veins and their relationship with the Calot triangle was evaluated. Results: The cystic veins were delineated intraoperatively in 80 of the 93 patients. The relationship between the cystic vein and the Calot triangle was identified in 80 (86.02%) of the 93 patients. One cystic vein was found in 53 (66.25%) patients, while multiple cystic veins were found in 27 (33.75%) patients. All these veins are above the cystic common bile duct junction. Conclusion: The configuration of the cystic veins and their relationship in the Calot triangle with cystic artery and cystic duct can be identified intraoperatively and used as a guideline for safe laparoscopic cholecystectomy. 

scholarly journals P-BN59 Danger is there, do we want to know about it? Routine intra operative cholangiography highlights dangerous biliary anatomy for safer cholecystectomy

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Noor Ul ain ◽  
Saira Bibi ◽  
Ian Tait ◽  
Samer Zino
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Cystic Duct ◽  
Filling Defect ◽  
Single Session ◽  
Biliary Anatomy ◽  
Operative Cholangiography ◽  
Transcystic Approach ◽  
Contrast Flow

Abstract Background Normal biliary anatomy is uncommon. Different classification for biliary anatomy has been described, with Huang Types A4 & A5 of great interest for laparoscopic cholecystectomy (LC) due to the proximity of aberrant bile duct to Cystic duct (CD). These types of dangerous anatomy might contribute to bile duct injury. This study aims to analyse the prevalence of dangerous biliary anatomy. Methods Prospectively collected data for all patients who underwent laparoscopic cholecystectomy was analysed. All LC were performed by single surgeon or under  his direct supervision, between 01/07/2020 and 20/08/2021. Index admission and single session management of cholelithiasis disease with routine Laparoscopic cholecystectomy + intra operative cholangiography (IOC) +/- LCBD exploration were standard practice. Results Laparoscopic cholecystectomy was performed in 137 patients. Mean age was 56y (17-84).  62% were females.   66% of Laparoscopic cholecystectomies were emergency. IOC was performed in 92% of cases. Abnormal biliary anatomy was found in 54% : Huang A1 - 48%, A2 - 29%, A3 - 12%, A4 - 9.7% and A5 - 0.7%. Dangerous anatomy (A4 and A5) was found in 10.5%, 78 % were females.  Female with dangerous anatomy were younger than males 49 y, 60y respectively. Nassar difficulty grading for dangerous anatomy was as follows: G2 28%, G3 42% and G3 28% Abnormal cholangiogram was found in 48%, due to filling defect in 58%, no contrast flow into duodenum in 4%, Cystic duct stone in 4%, and short CD in 8%. CBD stones were treated using transcystic approach in 92% of cases. No intra-operative or post operative complications were recorded for patients with dangerous anatomy.  Conclusions This study demonstrates that dangerous biliary anatomy, that could lead to bile duct injury is relatively common, occurring in 10.7% of LCs. Routine intra-operative cholangiography highlights these high-risk variations in biliary anatomy and may prevent inadvertent bile duct injury in such cases.

Case report. Bile duct injury following laparoscopic cholecystectomy

1992 ◽  
Vol 79 (3) ◽  
pp. 231-232 ◽  
Author(s):  
S. Cheslyn-Curtis ◽  
M. Emberton ◽  
H. Ahmed ◽  
R. C. N. Williamson ◽  
N. A. Habib
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Case Report ◽  
Bile Duct ◽  
Bile Duct Injury

scholarly journals Strategies for Management of Bile Duct Injury During Laparoscopic Cholecystectomy

2001 ◽  
Vol 7 (2) ◽  
pp. 55-61 ◽  
Author(s):  
Tatsuya Aoki ◽  
Akihiko Tsuchida ◽  
Hitoshi Saito ◽  
Yuichi Nagakawa ◽  
Keiichi Kitamura ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Bile Duct Injury ◽  
Cystic Duct ◽  
Hepatic Duct ◽  
Common Hepatic Duct ◽  
Tube Drainage ◽  
T Tube ◽  
Aberrant Bile Duct

We encountered 10 patients with bile duct injuries during laparoscopic cholecystectomy. Their causes were electrocautery in 2 patients, misjudgment in 2, mechanical injury in 3, aberrant bile duct in 2, and weakness of the bile duct wall in one. The sites of injury were cystic duct in 4 patients, common bile duct in 2, aberrant bile duct in 2, common hepatic duct in one, and common bile duct plus right hepatic duct in one. Treatments for the injuries discovered intraoperatively consisted of T-tube drainage above in 2 patients, re-ligation of the cystic duct in one, ligation of an aberrant bile duct in one, simple suture and T-tube in one, and choledochojejunostomy in one. In the remaining 4 patients discovered postoperatively, 2 were conservatively treated by endoscopic retrograde biliary drainage. The duration of hospitalization was 9–12 days in the 4 patients with simple suture or ligation, 10–21 days in 2 cases of bile drainage, and 34–43 days in 3 with T-tube drainage. The patient with choledochojejunostomy suffered repeated cholangitis, resulting in hepatic abscess with hospitalization for 6 months. Since laparoscopic surgery should be minimally invasive, meticulous attention is necessary before and during surgery to avoid bile duct injury.

scholarly journals Laparoscopic cholecystectomy: an experience of university hospital in eastern Nepal

2012 ◽  
Vol 10 (2) ◽  
pp. 134-136
Author(s):  
A Bajracharya ◽  
S Adhikary ◽  
C S Agrawal
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
University Hospital ◽  
Biliary Colic ◽  
Female Ratio ◽  
Open Operation ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
History Of

Introduction: Laparoscopic cholecystectomy has become the standard treatment for symptomatic gall stones disease. Objective of this study to assess the safety of this procedure, to audit the conversion and bile duct injury rates and the factors which influence these. Methods: A total of 346 laparoscopic cholecystectomy over a six months period (15 April 2010 to 14 October 2010) with their demographics and ethnic group, conversion to open operation and bile duct injury were recorded. Pre operative, operative and the relevant data were collected prospectively. A chi squire test was done to determine significance of any differences between subgroups. Results: Male to female ratio was 1:4. The most common indication for surgery was biliary colic/dyspepsia (51%),cholecystitis (chronic- 49.4%, acute- 12%), pancreatitis, gallbladder polyp, history of recurrent attacks 16.5%,obesity 19.1%. 128 were operated by consultant, 170 by junior consultants, 48 were by senior residents. There was no statistically significant difference found in the duration of surgery between consultants and junior consultants (P=0.264), however significance between consultants and senior residents (P=<0.001)was observed. Conclusion: Despite limited resources, laparoscopic cholecystectomy is feasible and safe for gallstones disease even in developing country like Nepal.DOI: http://dx.doi.org/10.3126/hren.v10i2.6582 Health Renaissance 2012; Vol 10 (No.2); 134-136 

scholarly journals Iatrogenic injury of an aberrant right posterior sectoral bile duct

2011 ◽  
Vol 15 (3) ◽  
pp. 89-90
Author(s):  
John Cantrell
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Ducts ◽  
Anterior Abdominal Wall ◽  
Sinus Tract ◽  
The Other ◽  
Endoscopic Retrograde ◽  
History Of ◽  
The Right ◽  
Gallbladder Fossa

A 34-year-old woman presented with a history of a previous laparoscopic cholecystectomy, followed within a few days by a formal laparotomy for a suspected bile duct injury. Approximately one week after the laparotomy, she developed a sinus on the anterior abdominal wall that was draining bile. She was then referred to our institution for further management. The earlier surgery was done at another hospital, and these details were not clear. A CT scan, including a CT sinogram, was performed. The sinogram was done by inserting a catheter into the sinus and running in diluted contrast under gravity. CT images showed the sinus tract communicating with a collection in the gallbladder fossa, as well as contrast opacification of the segment 6 and 7 bile ducts. A week later, an endoscopic retrograde cholangiopancreatography (ERCP) examination was performed. This showed no filling of the right posterior sectoral ducts but normal opacification of the other ducts. These findings led to the diagnosis of an aberrant right posterior sectoral bile duct that was not identified prior to surgery and that was damaged at the time of laparoscopic cholecystectomy. This duct now drained into the gallbladder fossa, causing the collection and draining sinus.

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