Document Detail


Laparoscopic bile duct injuries: spectrum at a tertiary-care center.
MedLine Citation:
PMID:  11327128     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Laparoscopic cholecystectomy (LC) is associated with a higher incidence of bile duct injury than is open cholecystectomy. We reviewed our experiences with the management of laparoscopic bile duct injuries.
PATIENTS AND METHODS: From October 1992 through August 1998, 34 patients with bile duct injuries (BDI) following LC were seen. The presentation, type of injury (Strasberg classification), management, and outcome were analyzed in these patients.
RESULTS: Of the 16 patients who sustained injury at our center (type A [N = 9], D [N = 5], and E1 [N = 2]), in 14, the injury was detected during LC, and two patients manifested with postoperative bile leak. All patients had an excellent outcome at a median follow-up of 5.5 (range 1.9-8.0) years. Of the 18 patients who sustained injury elsewhere (type C [N = 1], D [N = 2], E [N = 14; 6 with external biliary fistula (EBF) and 8 with benign biliary stricture (BBS)], and not known [1]), 9 had EBF, 1 had biliary peritonitis, and 8 had BBS at the time of presentation. Of these 18 patients, 4 underwent early repair of the BDI before referral (repair over a T-tube [N = 2] and Roux-Y hepaticojejunostomy [N = 2]). Three of them developed restricture. One patient was referred to us within 12 hours of injury and had a successful repair over a T-tube. Two patients with early repair for lateral injury had an excellent outcome. Eleven patients with BBS underwent repair with an excellent (N = 10) or fair (N = 1) outcome at a median follow-up of 5.0 (2.0-6.2) years. Three patients were lost to follow-up.
CONCLUSION: The spectrum of injuries sustained at LC at a tertiary-care center is different from that in the community hospitals. Missed injuries and attempts at repair in inexperienced hands result in serious sequelae of stricture formation and long-term morbidity.
Authors:
S S Sikora; A Kumar; N R Das; A Sarkari; R Saxena; V K Kapoor
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of laparoendoscopic & advanced surgical techniques. Part A     Volume:  11     ISSN:  1092-6429     ISO Abbreviation:  J Laparoendosc Adv Surg Tech A     Publication Date:  2001 Apr 
Date Detail:
Created Date:  2001-04-30     Completed Date:  2001-10-11     Revised Date:  2014-07-28    
Medline Journal Info:
Nlm Unique ID:  9706293     Medline TA:  J Laparoendosc Adv Surg Tech A     Country:  United States    
Other Details:
Languages:  eng     Pagination:  63-8     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Bile Ducts, Extrahepatic / injuries*
Cholecystectomy, Laparoscopic / adverse effects*
Cholelithiasis / surgery*
Female
Humans
Intraoperative Complications* / classification,  surgery
Male
Middle Aged
Referral and Consultation
Treatment Outcome

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


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