The real incidence of bile duct injury bdi during laparoscopic cholecystectomy lc is not known. A retrospective analysis was performed on all patients referred for management of an iatrogenic bile duct injury from 1981 to 2000. Iatrogenic intestinal injury concomitant to iatrogenic bile duct injury. Whereas, intact ttube retained in common bile duct cbd for years after bdi was very rare. Iatrogenic bile duct injuries ibdi remain an important problem in gastrointestinal surgery. Ct diagnosis of an iatrogenic bile duct injury bmj case reports. Iatrogenic combined bile duct and right hepatic artery injury.
Iatrogenic injury to the bile duct is one of the most serious and feared complication of cholecystectomy, with a. Type of injury bile duct incontinuity cystic duct leak leak from partial injury of bile duct narrowing of bile duct clip or endoloop leak from duct of luschka in gb fossa leak from cut liver edge bile duct transected level of injury wrt to confluence of bile ducts separation of hepatic ducts. Bile duct injury bdi is the most serious iatrogenic complication during laparoscopic cholecystectomy lc and occurs easily in inexperienced surgeons since the position of common bile duct cbd. An update on iatrogenic biliary injuries surgical clinics. Massaad2 through out the last decade we used to receive at ibn sina hospital a steady rate of referrals of iatrogenic major bile duct injuries imbdis which had been inflicted mainly during open cholecystectomy1. Bile duct injury bdi is a devastating complication following cholecystectomy. Iatrogenic bile duct injuries in the laparoscopic era.
Recontructive biliary surgery in the treatment of iatrogenic. An estimated 25%32% of bile duct injuries are recognized at laparoscopic cholecystectomy and. Bile duct injury, biliary leak, laparoscopic cholecystectomy, surgical repair background iatrogenic bile duct injuries bdis are potentially lifethreatening with high morbidity and mortality. Iatrogenic biliary injury common bile duct injury cholecystectomy. Major bile duct injury is a serious and potentially lifethreatening complication of cholecystectomy.
Iatrogenic bile duct injury during cholecystectomy presenting after. As a result of the injury, the bile duct no longer. In recent years, endoscopy has acquired a fundamental role in the management of this. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly. Iatrogenic combined bile duct and right hepatic artery injury during single incision laparoscopic cholecystectomy amareshwar chiruvella, md, juan m. Chartrandlefebvre c, dufresne mp, lafortune m, lapointe r, dagenaism r. Accidental traumas are responsible only for 15% of the total number of biliary injuries. Widespread use of surgical procedures on bile ducts was associated with occurrence of ibdi.
Pdf iatrogenic intestinal injury concomitant to iatrogenic. Iatrogenic bile duct injuries following laparoscopic. Management of concomitant hepatic artery injury in patients with iatrogenic major bile duct injury after laparoscopic cholecystectomy j. The early and accurate diagnosis of ibdi is very important for surgeons and gastroenterologists, because unrecognized ibdi lead to serious complications such.
The role of endoscopic retrograde cholangiopancreatography in the management of iatrogenic bile duct injury after cholecystectomy. Difficult iatrogenic bile duct injuries following different. Methods patients who underwent cholecystectomy in the period from 1965 to 2005 were identified from the swedish inpatient register. Li department of general, visceral and transplantation surgery, university hospital essen, hufelandstrasse 55, 45122 essen, germany. The clinical manifestations of bile duct injuries depend on the timing of injury recognition, type of injury, and presence of complications. Iatrogenic major bile duct injuries injury mam ibnouf1, a.
An estimated 25%32% of bile duct injuries are recognized at laparoscopic cholecystectomy and may be repaired immediately if a surgeon with experience in bile duct repair is available 6. Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. A postoperative bile leak occurs in less than 1% of cholecystectomies. Complete occlusion resulting in major injuries, biliary leakage, and bile duct stricture is a severe longterm complication after lc besides minor bile leakage. Mortensen1 1department of surgery, odense university hospital, odense c, 2department of surgical gastroenterology c. Iatrogenic bile duct injury account for about 95% of all benign biliary strictures bbs. Jan 31, 2009 bile duct injury is a severe and potentially lifethreatening complication of laparoscopic cholecystectomy. Bile duct injury in the era of laparoscopic cholecystectomy dkmic. Iatrogenic bile duct injury during cholecystectomy presenting. Sep 07, 2009 iatrogenic bile duct injuries ibdi remain an important problem in gastrointestinal surgery. The aim of this study was to analyze the presentation, characteristics, related investigation, and treatment results of major bile duct injuries after laparoscopic.
A radiologists guide to characterization, outcome, and management issues. Pdf classification and management of bile duct injuries. A bile duct injury is damage to the bile duct during gallbladder surgery. There were few cases about retained fragments of ttube. Bile duct injury in the era of laparoscopic cholecystectomy. The vast majority of bile duct injuries is iatrogenic and occurs during abdominal surgeries or other interventions such as endoscopic or percutaneous cannulation of the biliary tree. Iatrogenic bile duct injuries are not the inevitable result of haptic misperception. Iatrogenic bile duct injuries bdis after laparoscopic cholecystectomy, being one of the most common performed surgical procedures, remain a substantial problem in gastrointestinal surgery with a significant impact on patients quality of life. Pedicled omental patch as a bridging procedure for iatrogenic bile duct injury. The conditions in which these patients arrived at our center are highly variable. Iatrogenic bile duct injury with a retained ttube in common. Biliary trauma is rare and includes injury to the bile ducts or gallbladder. Bile duct injury is a severe and potentially lifethreatening complication of laparoscopic cholecystectomy. For this, a classificationbearing therapeutic prognostic implications is needed.
Iatrogenic bile duct injuries journal of the american college of. A bile injury may also be unrecognized at the time of surgery but evident in the postoperative period. Numerous recent reports describe the performance of laparoscopic procedures through a single. He also reported the first choledochoduodenostomy chd for calculi 1891 7, 10. Classification and management of bile duct injuries. Sweeney, md, edward lin, do, steven scott davis jr, md abstract background. Benign biliary strictures is a broad concept encompassing not only strictures caused by injuries, but also as a re sult of other causal factors 1, 11 12. Bile duct injury during laparoscopic cholecystectomy classification of iatrogenic bile duct injury repair of common bile duct injury over a t tube kocher maneuver transhepatic biliary drain placement biliary reconstruction with rouxeny hepaticojejunostomy. If a bile duct injury occurs, an immediate repair should be performed with no hesitation in asking for the help of a surgeon experienced in biliary repair. Using questionnaires, we analyzed 91,232 lc performed by 170 surgical units in brazil between 1990 and 1997.
They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. This is a pdf file of an unedited manuscript that has been accepted for publication. Common hepatic duct division, 2 cm from bifurcation e2. Classification of bile duct injury classification of iatrogenic bile duct injury. Cuendisvelazquez a, moraleschavez c, aguirreolmedo i, et al. Longterm effects of iatrogenic bile duct injury during. High injuries were inflicted during the performance of cholecystectomy while low injuries were related to common bile duct exploration. A scientific sounding excuse for mistakes happen is not an effective. Iatrogenic bile duct injury during cholecystectomy presenting after 11 years as a biliary. The aim of this study was to study survival, factors influencing survival, and causes of death after iatrogenic reconstructed bile duct injury in a large populationbased swedish cohort. The first iatrogenic bile duct injury was described by. The article describes the manifestations, diagnosis, classification, and management of iatrogenic bile duct injuries, with emphasis on the role of the interventional radiologist. The rouxeny hepaticojejunostomy hj is generally accepted as the standard of care for complex bile duct injury. Most commonly occurring during laparoscopic cholecystectomy, and to the common bile duct on the biliary tree, bile ducts can get cut, burned, or pinched leading to painful and sometimes fatal symptoms if not treated.
Iatrogenic duodenal injury 1 during cholecystectomy muharrem. Longterm effects of iatrogenic bile duct injury during cholecystectomy clinical gastroenterology and hepatology, 2009, 7, 101018 ii. Iatrogenic bile duct injury a cost analysis europe pmc. Bile duct injury bdi, a major complication of cholecystectomy, usually needs hepaticojejunostomy or primary repair over ttube in severe cases. The first iatrogenic bile duct injury was described by sprengel in 1891. Iatrogenic bile duct injury ibdi is a complication with a high morbidity after cholecystectomy. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly dependent on the type of injury and its location. In 1892, doyenn reported the first choledochocholedochostomy for the same condition 7. During an 18year period we studied 603 patient candidates for surgical treatment of iatrogenic bile duct injury. The diagnosis of noniatrogenic traumatic bile duct injuries is challenging as current crosssectional imaging tests are. Using mr cholangiopancreatography to evaluate iatrogenic bile. Laparoscopic hepaticojejunostomy after bile duct injury.
Depending on the type of injury, appropriate management methods may include endoscopic, percutaneous, and surgical interventions. Management of concomitant hepatic artery injury in patients. Iatrogenic bile duct injury with loss of confluence. In recent years, endoscopy has acquired a fundamental role. Clinical manifestations the clinical manifestations of bile duct injuries depend on the timing of injury recognition, type of injury, and presence of complications. Mar 06, 2019 iatrogenic bile duct injuries bdis after laparoscopic cholecystectomy, being one of the most common performed surgical procedures, remain a substantial problem in gastrointestinal surgery with a significant impact on patients quality of life.
Iatrogenic bile duct injuries are an important complication of cholecystectomy, since despite being a rare occurrence, at 0. They are most frequently caused by laparoscopic cholecystectomy, which is one of the commonest surgical procedures in the world. For injuries sustained at lc, details of time between lc and recognition of the. Iatrogenic bile duct lesions are feared complications reported to occur in approximately 0. Iatrogenic bile duct injuries i 2019 ihu strasbourg. Management of major bile duct injury after laparoscopic.
Bile duct injury bdi during cholecystectomy may have a severe effect on the health of patients, including mortality and considerable disability, and can be costly for the individual patient and for the health care system. Iatrogenic bile duct injury during cholecystectomy is a feared complication with a frequently troublesome course, requiring substantial resources and hazarding the patients health and quality of life. Common bile duct injuries represent a serious and challenging. Common hepatic duct division, a national danish multicentre study nicolaj m. Pdf iatrogenic bile duct injury with loss of confluence. Jan 22, 2020 bile duct injury bdi is the most dramatic complication after cholecystectomy, showing an increased incidence after introduction of the laparoscopic procedure 0. Evolution of bile duct repair in a low and middleincome country lmic. Involvement of aberrant right hepatic duct alone or with concomitant stricture of the chd learning objectives 1 outline advantages and disadvantages of different imaging modalities with regard to detection and characterization of bile duct injuries 2 identify and characterize bile duct injuries on imaging 3 describe key findings with. Among identified hazards following repair of bile duct injury is high age, comorbidity, and outcome is related to. Longterm impact of iatrogenic bile duct injury fulltext digestive.
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