Document Detail


Bile duct injuries during laparoscopic cholecystectomy. Factors that influence the results of treatment.
MedLine Citation:
PMID:  7575127     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To analyze the treatment of bile duct injuries during laparoscopic cholecystectomy to discern the factors affecting outcome. DESIGN: An analysis of the treatment of 88 patients with laparoscopic bile duct injuries. SETTING: A university hospital. PATIENTS: Eighty-eight patients with major bile duct injuries following laparoscopic cholecystectomy. MAIN OUTCOME MEASURES: Success of treatment, morbidity rate, mortality rate, and length of illness. RESULTS: Operations to repair bile duct injuries were unsuccessful in 27 (96%) of 28 procedures when cholangiograms were not obtained preoperatively, and they were unsuccessful in 69% when cholangiographic data were incomplete. In some cases, lack of complete cholangiographic information led to an inappropriate and harmful operation. When cholangiographic data were complete, the first repair was successful in 16 (84%) of 19 patients. A primary end-to-end repair over a T tube (13 patients) was unsuccessful in every case in which the duct had been divided. Direct closure of a partial defect in the duct was successful in four of seven patients. Fifty-four (63%) of 84 Roux-en-Y hepaticojejunostomies were successful. Factors responsible for the unsuccessful outcomes were the following: incomplete excision of the scarred duct, use of nonabsorbable suture material, use of two-layer anastomosis, and failure to eradicate subhepatic infection before the attempted repair. Dilatation and stenting was uniformly unsuccessful as primary treatment (three patients) and was unsuccessful in only seven of 26 patients following a previous operative repair. Patients first treated by the primary surgeon had an average length of illness of 222 days (P < .01). Only 17% of primary repair attempts and no secondary repair attempts performed by the laparoscopic surgeon were successful. Patients whose first repair was performed by tertiary care biliary surgeons had a length of illness of 78 days (P < .01), and 45 (94%) of 48 repairs by tertiary care biliary surgeons were successful. CONCLUSIONS: Surgeons who specialize in the repair of bile duct injuries achieve much better results than those with less experience. The worse results of other surgeons could be attributed in many instances to specific correctable errors. Nonsurgical treatment was usually unsuccessful and substantially increased the duration of disability.
Authors:
L Stewart; L W Way
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of surgery (Chicago, Ill. : 1960)     Volume:  130     ISSN:  0004-0010     ISO Abbreviation:  Arch Surg     Publication Date:  1995 Oct 
Date Detail:
Created Date:  1995-11-13     Completed Date:  1995-11-13     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9716528     Medline TA:  Arch Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1123-8; discussion 1129     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University of California, San Francisco, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anastomosis, Roux-en-Y / adverse effects
Anastomosis, Surgical / adverse effects,  methods
Balloon Dilatation / adverse effects
Bile Ducts / injuries*,  surgery
Cholangiopancreatography, Endoscopic Retrograde
Cholangitis / etiology
Cholecystectomy, Laparoscopic*
Female
Humans
Intraoperative Complications* / etiology
Length of Stay
Male
Middle Aged
Stents / adverse effects
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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