The early and accurate diagnosis of ibdi is very important for surgeons and gastroenterologists, because unrecognized ibdi lead to serious complications such. Original article iatrogenic bile duct injury a populationbased study of 152776 cholecystectomies in the swedish inpatient registry anne waage, md, phd. Li department of general, visceral and transplantation surgery, university hospital essen, hufelandstrasse 55, 45122 essen, germany. Iatrogenic bile duct injury with loss of confluence. Bile duct injury in the era of laparoscopic cholecystectomy. Iatrogenic major bile duct injuries injury mam ibnouf1, a. Classification and management of bile duct injuries. Bile duct injury bdi is a devastating complication following cholecystectomy.
Longterm effects of iatrogenic bile duct injury during. Iatrogenic bile duct injuries in the laparoscopic era. Common hepatic duct division, 2 cm from bifurcation e2. Iatrogenic bile duct lesions are feared complications reported to occur in approximately 0.
Iatrogenic bile duct injury during cholecystectomy presenting after 11 years as a biliary. Iatrogenic bile duct injuries are not the inevitable result of haptic misperception. Pdf iatrogenic bile duct injury with loss of confluence. 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. 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.
Sweeney, md, edward lin, do, steven scott davis jr, md abstract background. Jan 31, 2009 bile duct injury is a severe and potentially lifethreatening complication of laparoscopic cholecystectomy. Depending on the type of injury, appropriate management methods may include endoscopic, percutaneous, and surgical interventions. Biliary trauma is rare and includes injury to the bile ducts or gallbladder. 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. Chartrandlefebvre c, dufresne mp, lafortune m, lapointe r, dagenaism r. A radiologists guide to characterization, outcome, and management issues. The role of endoscopic retrograde cholangiopancreatography in the management of iatrogenic bile duct injury after cholecystectomy. Whereas, intact ttube retained in common bile duct cbd for years after bdi was very rare. 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. 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.
Among identified hazards following repair of bile duct injury is high age, comorbidity, and outcome is related to. The early and accurate diagnosis of ibdi is very important for surgeons and gastroenterologists, because unrecognized ibdi lead to serious. Numerous recent reports describe the performance of laparoscopic procedures through a single. The article describes the manifestations, diagnosis, classification, and management of iatrogenic bile duct injuries, with emphasis on the role of the interventional radiologist. 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. Recontructive biliary surgery in the treatment of iatrogenic. The real incidence of bile duct injury bdi during laparoscopic cholecystectomy lc is not known. An update on iatrogenic biliary injuries surgical clinics. Iatrogenic bile duct injuries journal of the american college of.
During an 18year period we studied 603 patient candidates for surgical treatment of iatrogenic bile duct injury. 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. Management of concomitant hepatic artery injury in patients. Accidental traumas are responsible only for 15% of the total number of biliary injuries. 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 injury to the bile duct is one of the most serious and feared complication of cholecystectomy, with a. Iatrogenic bile duct injury during cholecystectomy presenting after. Iatrogenic biliary injury common bile duct injury cholecystectomy.
Cuendisvelazquez a, moraleschavez c, aguirreolmedo i, et al. The aim of this study was to analyze the presentation, characteristics, related investigation, and treatment results of major bile duct injuries after laparoscopic. Iatrogenic bile duct injuries are an important complication of cholecystectomy, since despite being a rare occurrence, at 0. Laparoscopic hepaticojejunostomy after bile duct injury. Using mr cholangiopancreatography to evaluate iatrogenic bile. Pedicled omental patch as a bridging procedure for iatrogenic bile duct injury. Pdf iatrogenic intestinal injury concomitant to iatrogenic.
Iatrogenic bile duct injury ibdi is a complication with a high morbidity after cholecystectomy. 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. A bile duct injury is damage to the bile duct during gallbladder surgery. In recent years, endoscopy has acquired a fundamental role. A scientific sounding excuse for mistakes happen is not an effective. 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. Management of major bile duct injury after laparoscopic. Iatrogenic bile duct injuries bdis after laparoscopic cholecystectomy, being one of the most common performed surgical procedures, remain a. He also reported the first choledochoduodenostomy chd for calculi 1891 7, 10. Iatrogenic bile duct injury during cholecystectomy presenting. As a result of the injury, the bile duct no longer. For injuries sustained at lc, details of time between lc and recognition of the. The conditions in which these patients arrived at our center are highly variable.
The first iatrogenic bile duct injury was described by sprengel in 1891. Bile duct injury in the era of laparoscopic cholecystectomy dkmic. Longterm impact of iatrogenic bile duct injury fulltext digestive. They are most frequently caused by laparoscopic cholecystectomy, which is one of the commonest surgical procedures in the world. 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.
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. A retrospective analysis was performed on all patients referred for management of an iatrogenic bile duct injury from 1981 to 2000. Iatrogenic bile duct injuries i 2019 ihu strasbourg. 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. A bile injury may also be unrecognized at the time of surgery but evident in the postoperative period. Iatrogenic bile duct injuries ibdi remain an important problem in gastrointestinal surgery. Iatrogenic combined bile duct and right hepatic artery injury. Iatrogenic bile duct injury account for about 95% of all benign biliary strictures bbs. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly. 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. Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. Using questionnaires, we analyzed 91,232 lc performed by 170 surgical units in brazil between 1990 and 1997. Bile duct injury is a severe and potentially lifethreatening complication of laparoscopic cholecystectomy.
In recent years, endoscopy has acquired a fundamental role in the management of this. 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. For this, a classificationbearing therapeutic prognostic implications is needed. Common hepatic duct division, a national danish multicentre study nicolaj m. Iatrogenic bile duct injury with a retained ttube in common. Iatrogenic duodenal injury 1 during cholecystectomy muharrem. Major bile duct injury is a serious and potentially lifethreatening complication of cholecystectomy. Ct diagnosis of an iatrogenic bile duct injury bmj case reports. Complete occlusion resulting in major injuries, biliary leakage, and bile duct stricture is a severe longterm complication after lc besides minor bile leakage.
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. Difficult iatrogenic bile duct injuries following different. Evolution of bile duct repair in a low and middleincome country lmic. 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. Iatrogenic bile duct injuries following laparoscopic. Iatrogenic combined bile duct and right hepatic artery injury during single incision laparoscopic cholecystectomy amareshwar chiruvella, md, juan m. 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. Widespread use of surgical procedures on bile ducts was associated with occurrence of ibdi. There were few cases about retained fragments of ttube. An estimated 25%32% of bile duct injuries are recognized at laparoscopic cholecystectomy and. Sep 07, 2009 iatrogenic bile duct injuries ibdi remain an important problem in gastrointestinal surgery.
Methods patients who underwent cholecystectomy in the period from 1965 to 2005 were identified from the swedish inpatient register. In 1892, doyenn reported the first choledochocholedochostomy for the same condition 7. A postoperative bile leak occurs in less than 1% of cholecystectomies. To describe our experience concerning the surgical treatment of strasberg e4 bismuth iv bile duct injuries. This is a pdf file of an unedited manuscript that has been accepted for publication. Mortensen1 1department of surgery, odense university hospital, odense c, 2department of surgical gastroenterology c. The clinical manifestations of bile duct injuries depend on the timing of injury recognition, type of injury, and presence of complications. Pdf classification and management of bile duct injuries.
Management of concomitant hepatic artery injury in patients with iatrogenic major bile duct injury after laparoscopic cholecystectomy j. The diagnosis of noniatrogenic traumatic bile duct injuries is challenging as current crosssectional imaging tests are. Clinical manifestations the clinical manifestations of bile duct injuries depend on the timing of injury recognition, type of injury, and presence of complications. Bile duct injury bdi, a major complication of cholecystectomy, usually needs hepaticojejunostomy or primary repair over ttube in severe cases. The rouxeny hepaticojejunostomy hj is generally accepted as the standard of care for complex bile duct injury.
Bile duct injury, biliary leak, laparoscopic cholecystectomy, surgical repair background iatrogenic bile duct injuries bdis are potentially lifethreatening with high morbidity and mortality. Common bile duct injuries represent a serious and challenging. 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. Classification of bile duct injury classification of iatrogenic bile duct injury.
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