Iatrogenic bile duct injuries – clinical problems

• Authors: Stanisław Głuszek , Marta Kot , Norbert Bałchanowski , Jarosław Matykiewicz , Jakub Kuchinka , Dorota Kozieł , Iwona Wawrzycka
• Languages of publication: EN

Abstracts

EN

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.

Keywords

EN

laparoscopic surgery; cholecystectomy; iatrogenic bile duct injury

• Publisher: De Gruyter Open
• Journal: Polish Journal of Surgery
• Year: 2015
• Volume: 86
• Issue: 1
• Pages: 17-25

Dates

published

1 - 01 - 2014

online

27 - 02 - 2014

Contributors

author

Stanisław Głuszek

• Department of General, Oncological and Endocrinological Surgery, Provincial Hospital in Kielce
• Department of Surgery and Surgical Nursing with the Scientific Research Laboratory Faculty of Health Sciences Jan Kochanowski University in Kielce

author

Marta Kot

• Department of General, Oncological and Endocrinological Surgery, Provincial Hospital in Kielce

author

Norbert Bałchanowski

• Department of General, Oncological and Endocrinological Surgery, Provincial Hospital in Kielce

author

Jarosław Matykiewicz

author

Jakub Kuchinka

• Department of General, Oncological and Endocrinological Surgery, Provincial Hospital in Kielce

author

Dorota Kozieł

• Department of Surgery and Surgical Nursing with the Scientific Research Laboratory Faculty of Health Sciences Jan Kochanowski University in Kielce

author

Iwona Wawrzycka

• Department of General, Oncological and Endocrinological Surgery, Provincial Hospital in Kielce
• Department of Surgery and Surgical Nursing with the Scientific Research Laboratory Faculty of Health Sciences Jan Kochanowski University in Kielce

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Identifiers

DOI

10.2478/pjs-2014-0004