Iatrogenic bile duct injuries – clinical problems
Languages of publication
Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures in surgical wards. Iatrogenic bile duct injuries (IBDI) incurred during the procedures are among postoperative complications that are most difficult to treat. The risk of bile duct injury is 0.2-0.4%, and their consequences are unpleasant both for the surgeon and for the patient. The aim of the study was analysis of iatrogenic bile duct injuries and methods of their repair,taking into consideration the circumstances, under which the injuries occur. Material and methods. The study group consisted of 16 patients who had suffered IBDI during surgery. The analysed parameters included sex, age, indications for surgery, the setting of the surgical procedure and the type of bile duct injury. Additionally, the time of injury diagnosis, type of repair and treatment outcome were assessed. The IBDI analysis used the EAES classification of injuries. The time of IBDI repair was defined as immediate, early or late,depending on the time that had passed from the injury. The analysis included complications seen after bile duct repair. Results. The study group consisted of 10 women and 6 men, aged 29-84. Patients underwent 6 classic cholecystectomies, 8 laparoscopic cholecystectomies, one gastrotomy to remove oesophageal prosthesis and one laparotomy due to peptic ulcer. IBDI was diagnosed intraoperatively in 4 patients. In 12 patients IBDI was diagnosed within 1-7 days. The diagnosis was based on endoscopic retrograde cholangiopancreatography and the results of biochemistry tests. According to the EAES classification, the injuries were of type 1 (4 patients), type 2 (8 patients), type 5 (3 patients) and type 6 (1 patients). Reconstruction procedures were performed during the same anaesthesia session in 3 patients, and in the early period in 13 patients. The main procedure was Roux-en-Y anastomosis (12 patients), with the remaining including bile-duct suturing over a T-tube (3 patients) and underpinning of an accessory bile duct in the pocket left after gallbladder removal (1 patient). The most common reconstruction complications included bile leak (3 patients), recurrent cholangitis (3 patients) and bile duct stricture (2 patients). Mortality in the study group was 12.5%. Conclusions. The procedures of laparoscopic and classic cholecystectomy are associated with a risk of IBDI, especially in the presence of inflammatory state of the gall-bladder. IBDI is a complex complication: its treatment poses a challenge for the operating surgeon, and even the most careful treatment adversely affects the patient’s lifedue to complications.
1 - 01 - 2014
27 - 02 - 2014
- 1. Jakimowicz T, Świercz, Szmidt J: Działalność oddziałów chirurgii ogólnej w Polsce. Pol Przegl Chir 2009; 81: 532-43.
- 2. Głuszek S, Stanowski E, Herjan L: Cholecystektomia laparoskopowa w Polsce - wyniki i powikłania. Pol Przegl Chir 1995; 67: 386-94.
- 3. Kozicki I, Durowicz S, Tarnowski W: Czynniki sprzyjające jatrogennym urazom dróg żółciowych podczas cholecystektomii laparoskopowej i sposoby w ich zapobieganiu. Postępy Nauk Medycznych 2011; 1: 42-48.
- 4. Iannelli A, Paineau J, Hamy A et al.: Primary versus delayed repair for bile duct injuries sustained during cholecystectomy: results of a survey of the Association Francaise de Chirurgie. HPB 2013; 15: 611-16.[PubMed]
- 5. Strasberg SM, Hertl M, Soper NJ: An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995; 180: 101-25.
- 6. Eikermann M, Siegel R, Broeders et al.: Neugebauer Prevention and treatment of bile duct injuries during laparoscopic cholecystectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc online (06 oct 2012).[Crossref]
- 7. Lee AY , Gregorius J. Kerlan RK et al.: Percutaneous Transhepatic Balloon Dilation of Biliary- Enteric Anastomotic Strictures after Surgical Repair of Iatrogenic Bile Duct Injuries. Plosone 2012; 7(10): 1-5.
- 8. Törnqvist B, Strömberg C, Persson G et al.: Effect of intended intraoperative cholangiography and early detection of bile duct injury on survival after cholecystectomy: population based cohort study. BMJ 2012; 345 - http://dx.doi.org/10.1136/bmj. e6457 (11 oct 2012).[Crossref]
- 9. Dageforde LA, Landman MP, Feurer ID et al.: A Cost-Effectiveness Analysis of Early vs Late Reconstruction of Iatrogenic Bile Duct Injuries. J Am Coll Surg 2012; 214: 919-27.
- 10. Siert J, Reinders K, Gouma DJ et al.: Laparoscopic cholecystectomy is more difficult after a previous endoscopic retrograde cholangiography. HPB 2013; 15: 230-34.
- 11. Głuszek S, Bonek Z: Stan wideochirurgii kamicy żółciowej w województwie świętokrzyskim. Wideochirurgia 2008; 3(3): 11-18.
- 12. Sarno G, Al-Sarira AA , Ghaneh P et al.: Poston Cholecystectomy-related bile duct and vasculobiliary injuries. Br J Surg 2012; 99: 1129-36.
- 13. Virinder K, Bansal AK , Mahesh C et al.: Factors Affecting Short-Term and Long-Term Outcomes After Bilioenteric Reconstruction for Post- cholecystectomy Bile Duct Injury: Experience at a Tertiary Care Centre. Indian J Surg 2013 - DOI: 10.1007/ s12262-013-0880-x.[Crossref]
- 14. Hiroshi S, Itaru E, Kazuhiro S et al. Kensuke Kubota The current diagnosis and treatment of benign biliary stricture. Surg Today 2012; 42: 1143-53.[WoS]
- 15. Zhu-lin L, Long C, Jian-Dong R et al.: Progressive balloon dilatation following hepaticojejunostomy improves outcome of bile duct stricture after iatrogenic biliary injury. BMC Gastroenterology 2013; 13: 70.[WoS]
- 16. Addeo P, Oussoultzoglou E, Fuchshuher P et al.: Reparative surgery after repair of postcholecystectomy bikle duct injuries: is it worthwhile. World J Surg 2013; 37: 573-81.[WoS][Crossref]
Publication order reference