In recent years, endoscopy has acquired a fundamental role in the management of this. 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. The conditions in which these patients arrived at our center are highly variable. Depending on the type of injury, appropriate management methods may include endoscopic, percutaneous, and surgical interventions. Methods patients who underwent cholecystectomy in the period from 1965 to 2005 were identified from the swedish inpatient register. Iatrogenic bile duct injury ibdi is a complication with a high morbidity after cholecystectomy. Chartrandlefebvre c, dufresne mp, lafortune m, lapointe r, dagenaism r. Iatrogenic bile duct injuries are not the inevitable result of haptic misperception. A radiologists guide to characterization, outcome, and management issues. They are most frequently caused by laparoscopic cholecystectomy, which is one of the commonest surgical procedures in the world.
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. Bile duct injury in the era of laparoscopic cholecystectomy dkmic. 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. Pdf iatrogenic bile duct injury with loss of confluence. Management of concomitant hepatic artery injury in patients with iatrogenic major bile duct injury after laparoscopic cholecystectomy j. During an 18year period we studied 603 patient candidates for surgical treatment of iatrogenic bile duct injury. Ct diagnosis of an iatrogenic bile duct injury bmj case reports. Accidental traumas are responsible only for 15% of the total number of biliary injuries. The role of endoscopic retrograde cholangiopancreatography in the management of iatrogenic bile duct injury after cholecystectomy. Common hepatic duct division, a national danish multicentre study nicolaj m. 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. Using mr cholangiopancreatography to evaluate iatrogenic bile.
Bile duct injury, biliary leak, laparoscopic cholecystectomy, surgical repair background iatrogenic bile duct injuries bdis are potentially lifethreatening with high morbidity and mortality. Widespread use of surgical procedures on bile ducts was associated with occurrence of ibdi. Using questionnaires, we analyzed 91,232 lc performed by 170 surgical units in brazil between 1990 and 1997. Iatrogenic bile duct injury a cost analysis europe pmc. A postoperative bile leak occurs in less than 1% of cholecystectomies. Cuendisvelazquez a, moraleschavez c, aguirreolmedo i, et al. Iatrogenic major bile duct injuries injury mam ibnouf1, a. Jan 31, 2009 bile duct injury is a severe and potentially lifethreatening complication of laparoscopic cholecystectomy. Iatrogenic bile duct injury during cholecystectomy presenting. Additional papers, among the most important an d cited in literature, reporting incidence of bdi following lcs, were individually searched for, excluding case report articles. Management of major bile duct injury after laparoscopic.
Iatrogenic intestinal injury concomitant to iatrogenic bile duct injury. A retrospective analysis was performed on all patients referred for management of an iatrogenic bile duct injury from 1981 to 2000. Bile duct injury is a severe and potentially lifethreatening complication of laparoscopic cholecystectomy. Iatrogenic bile duct injuries i 2019 ihu strasbourg. Evolution of bile duct repair in a low and middleincome country lmic. Classification and management of bile duct injuries.
The first iatrogenic bile duct injury was described by sprengel in 1891. A bile injury may also be unrecognized at the time of surgery but evident in the postoperative period. Sep 07, 2009 iatrogenic bile duct injuries ibdi remain an important problem in gastrointestinal surgery. Clinical manifestations the clinical manifestations of bile duct injuries depend on the timing of injury recognition, type of injury, and presence of complications. A bile duct injury is damage to the bile duct during gallbladder surgery. Longterm effects of iatrogenic bile duct injury during. Bile duct injury bdi is a devastating complication following cholecystectomy. 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. Recontructive biliary surgery in the treatment of iatrogenic.
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. 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. The diagnosis of noniatrogenic traumatic bile duct injuries is challenging as current crosssectional imaging tests are. Iatrogenic bile duct lesions are feared complications reported to occur in approximately 0. Numerous recent reports describe the performance of laparoscopic procedures through a single. Bile duct injury in the era of laparoscopic cholecystectomy. Pedicled omental patch as a bridging procedure for iatrogenic bile duct injury. Iatrogenic bile duct injuries in the laparoscopic era. The real incidence of bile duct injury bdi during laparoscopic cholecystectomy lc is not known. There were few cases about retained fragments of ttube. Iatrogenic bile duct injuries bdis after laparoscopic cholecystectomy, being one of the most common performed surgical procedures, remain a.
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. 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. Classification of bile duct injury classification of iatrogenic bile duct injury. Iatrogenic combined bile duct and right hepatic artery injury.
Iatrogenic bile duct injury with loss of confluence. Iatrogenic bile duct injuries ibdi remain an important problem in gastrointestinal surgery. Complete occlusion resulting in major injuries, biliary leakage, and bile duct stricture is a severe longterm complication after lc besides minor bile leakage. High injuries were inflicted during the performance of cholecystectomy while low injuries were related to common bile duct exploration. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. Iatrogenic bile duct injuries are an important complication of cholecystectomy, since despite being a rare occurrence, at 0. Longterm effects of iatrogenic bile duct injury during cholecystectomy clinical gastroenterology and hepatology, 2009, 7, 101018 ii. Iatrogenic bile duct injury with a retained ttube in common. Iatrogenic bile duct injury account for about 95% of all benign biliary strictures bbs. Whereas, intact ttube retained in common bile duct cbd for years after bdi was very rare. Mortensen1 1department of surgery, odense university hospital, odense c, 2department of surgical gastroenterology c. Management of concomitant hepatic artery injury in patients.
The first iatrogenic bile duct injury was described by. 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, a major complication of cholecystectomy, usually needs hepaticojejunostomy or primary repair over ttube in severe cases. The early and accurate diagnosis of ibdi is very important for surgeons and gastroenterologists, because unrecognized ibdi lead to serious. 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. Common hepatic duct division, 2 cm from bifurcation e2. The aim of this study was to analyze the presentation, characteristics, related investigation, and treatment results of major bile duct injuries after laparoscopic. As a result of the injury, the bile duct no longer. 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. An update on iatrogenic biliary injuries surgical clinics.
A scientific sounding excuse for mistakes happen is not an effective. Iatrogenic combined bile duct and right hepatic artery injury during single incision laparoscopic cholecystectomy amareshwar chiruvella, md, juan m. Li department of general, visceral and transplantation surgery, university hospital essen, hufelandstrasse 55, 45122 essen, germany. 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. Major bile duct injury is a serious and potentially lifethreatening complication of cholecystectomy. Longterm impact of iatrogenic bile duct injury fulltext digestive. Iatrogenic bile duct injuries following laparoscopic.
An estimated 25%32% of bile duct injuries are recognized at laparoscopic cholecystectomy and. The clinical manifestations of bile duct injuries depend on the timing of injury recognition, type of injury, and presence of complications. The early and accurate diagnosis of ibdi is very important for surgeons and gastroenterologists, because unrecognized ibdi lead to serious complications such. 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. Iatrogenic duodenal injury 1 during cholecystectomy muharrem.
Difficult iatrogenic bile duct injuries following different. Sweeney, md, edward lin, do, steven scott davis jr, md abstract background. To describe our experience concerning the surgical treatment of strasberg e4 bismuth iv bile duct injuries. Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. Iatrogenic bile duct injuries journal of the american college of. Biliary trauma is rare and includes injury to the bile ducts or gallbladder. Pdf classification and management of bile duct injuries. In 1892, doyenn reported the first choledochocholedochostomy for the same condition 7. Iatrogenic bile duct injury during cholecystectomy presenting after 11 years as a biliary. He also reported the first choledochoduodenostomy chd for calculi 1891 7, 10. 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.
This is a pdf file of an unedited manuscript that has been accepted for publication. Among identified hazards following repair of bile duct injury is high age, comorbidity, and outcome is related to. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly. Pdf iatrogenic intestinal injury concomitant to iatrogenic. Iatrogenic injury to the bile duct is one of the most serious and feared complication of cholecystectomy, with a. 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. For this, a classificationbearing therapeutic prognostic implications is needed. 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. For injuries sustained at lc, details of time between lc and recognition of the. Iatrogenic bile duct injury during cholecystectomy presenting after. Laparoscopic hepaticojejunostomy after bile duct injury. They mainly occur as a complication of laparoscopic cholecystectomy with a constant frequency of 3 to 6 per cases 1, 2. Common bile duct injuries represent a serious and challenging. 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 biliary injury common bile duct injury cholecystectomy. In recent years, endoscopy has acquired a fundamental role.
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