Iatrogenic Bile Ducts Injuries
Authors:
M. Loveček 1; R. Havlík 1; J. Klein 1; T. Malý 1; M. Köcher 2; M. Černá 2; V. Král 1; Č. Neoral 1
Authors‘ workplace:
I. chirurgická klinika FN a LF UP Olomouc, přednosta: doc. MUDr. Čestmír Neoral, CSc.
1; Radiologická klinika FN a LF UP Olomouc, přednosta: prof. MUDr. Miroslav Heřman, Ph. D.
2
Published in:
Rozhl. Chir., 2010, roč. 89, č. 3, s. 183-187.
Category:
Monothematic special - Original
Overview
Aim:
To evaluate therapeutic options and outcomes of repair of iatrogenic bile duct injuries during cholecystectomy, which were solved in our institution over the past five years. The incidence of this injury is stated in the range of 0–0.4% for open cholecystectomy and 0–0.7% for laparoscopic cholecystectomy.
Methods:
Authors present a group of ten patients who were operated on for iatrogenic bile duct injury incurred during cholecystectomy in 2005–2009. All patiens were refered from other hospitals. Three men and seven women aged 20–71 years. The bile duct injury occured twice during open procedure and during laparoscopic procedure in eight. Incomplete lesion was idenified in one case, complete lesions with tissue loss were found in nine patients. Right hepatic artery injuries were found in four patients with tissue loss injury. Nine patients required reconstruction of the biliary tract using hepaticojejunoanastomosis with Roux-Y loop.
Results:
The bile leak occurred in two patients after reconstruction. In one patient was required early percutaneous transhepatic drainage. The early death occurred in a patient with a complicated course, where our reconstruction of the biliary tract was already in the field of advanced biliary peritonitis as a third operation during 7 days. All other patients are monitored postoperatively at regular intervals in our clinic. They carried out clinical examinations and monitoring of liver enzymes. In the long interval from reconstruction (6–12 months) anastomotic stenosis occurred in three patients. Postoperative radiological intervention in the form of dilation of anastomosis and prolonged transient transanastomotic drainage was necessary (the duration of drainage was 6–7 months).
Conclusion:
Iatrogenic bile duct injury is a serious condition threatening the patient’s life from the progressive failure of liver function on the basis of secondary biliary cirrhosis. Due to the nature of lesions arising from laparoscopic cholecystectomy (loss tissue injuries, thermal damage to surrounding structures, the hepatic artery injuries) reconstructions are extremely difficult. For most patients reconstructive operations are the last possible surgical procedures in this area, except for liver transplantation. Hilar reconstructions have a higher probability of stenosis of the anastomosis. If they occur, there are repeated cholangitis, which pass into the secondary sclerosing cholangitis and cause secondary biliary cirrhosis, with all the consequences of disease (portal hypertension, bleeding esophageal varices). For these reasons, it is necessary for careful long-term postoperative monitoring of liver function and good interdisciplinary cooperation, especially with the intervention radiologist in management postoperatively evolving stenosis of anastomoses. It is necessary for the early identification and indication of radiological interventions in order to prevent damage to the liver parenchyma.
Key words:
cholecystectomy – bile duct – iatrogenic injury – stenosis
Sources
1. Törnqvist, B., Zheng, Z., Ye, W., et al. Long-term effects of iatrogenic bile duct injury during cholecystectomy. Clin. Gastroenterol. Hepatol., 2009; 7: 1013–1018. Epub 2009 May 22.
2. Moore, D. E., Feurer, I. D., Holzman, M. D., et al. Long-term detrimental effect of bile duct injury on health related quality of life. Arch. Surg., 2004; 139: 476–481.
3. deReuver, P. R., Sprangers, M. A., Rauws, E. A., et al. Impact of bile duct injury after laparoscopic cholecystectomy on quality of life: a longitudinal study after multidisciplinary treatment. Endoscopy, 2008; 40: 637–643.
4. Andersson, R., Eriksson, K., Blind, P. J., Tingstedt, B. Iatrogenic bile duct injury-a cost analysis. HPB (Oxford), 2008; 10: 416–419.
5. McCormack, L., QuiĖonez, E. G., Capitanich, P., et al. Acute liver failure due to concomitant arterial, portal and biliary injury during laparoscopic cholecystectomy: is transplantation a valid life-saving strategy? A case report. Patient. Saf. Surg., 2009; 3: 22. (PubMed).
6. Zaydfudim, V., Wright, J. K., Pinson, C. W. Liver transplantation for iatrogenic porta hepatis transection. Am. Surg., 2009; 75: p. 313–316.
7. Ryska, M. Iatrogenní léze žlučových cest – aktuální problém? Bull. HPB chirurgie, 2003; 11: www.hpb.cz
8. Lau, W.-Y., Lai, E. C. H. Classification of iatrogenic bile duct injury. Hepatobiliary Pancreat. Dis. Int., 2007; 6: 459–463.
9. Rubin, H. Bile duct injuries & Laparoscopic cholecystectomy. www.lectlaw.com
10. Spelsberg, F. W., Nusser, F., Hüttl, T. K., et al. Management of cholecysto- and choledocholithiasis – surwey and analysis of 16615 cholecystectomies and common bile duct explorations in bavaria. Zentralbl. Chir., 2009; 134: 120–126.
11. Rudiš, J., Ryska, M., Bělina, F., Mergental, H. Méně obvyklé kombinované iatrogenní poranění žlučových cest a tepenného zásobení jater při cholecystektomii. Bull. HPB chirurgie, 2003; 11: www.hpb.cz
12. Laurent, A., Sauvanet, A., Farges, O., et al. Major hepatectomy for the treatment of complex bile duct injury. Ann. Surg., 2008; 248: 77–83.
13. Bektas, H., Schrem, H., Winny, M., Klempnauer, J. Surgical treatment and outcome of iatrogenic bile duct lesions after cholecystectomy and the impact of different clinical classification systems. Br. J. Surg., 2007; 94: 1119–1127.
14. Král, V., Havlík, R., Neoral, Č. Hepatikojejunoanastomóza: „zlatý standard“ při rekonstrukci žlučových cest po jejich poranění. Bull. HPB chirurgie, 2003; 11: www.hpb.cz
15. Král, V., Havlík, R., Vojáček, P., Vysloužil, K. Má při poranění žlučových cest urgentní či odložený výkon vliv na konečný výsledek léčby? Bull. HPB chirurgie, 1996; 4: www.hpb.cz
16. Ozturk, E., Can, M. F., Yagci, G., et al. Management and mid- to long-term results of early referred bile duct injuries during laparoscopic cholecystectomy. Hepatogastroenterology, 2009; 56: 17–25.
17. Conzo, G., Amato, G., Angrisani, L., et al. Hepaticojejunostomy in the treatment of iatrogenic biliary lesions following laparoscopic cholecystectomy. A retrospective study on 51 cases. Hepatogastroenterology, 2007; 54: 2328–2332.
18. Král, V., Procházka, V., Köcher, M., Havlík, R. Present possibilities of correction of biliary tract injuries. Rozhl. Chir., 1996; 75: 180–184.
19. Köcher, M., Černá, M., Havlík, R., et al. Percutaneous treatment of benign bile duct stricture. Eur. J. Radiol., 2007; 62: 170–174.
20. Thomas, R. P., Köcher, M., Černá, M., Kozák, J., Havlík, R. Biliary manometric perfusion test in the evaluation of benign biliary stricture treatment – a case report. Biomed. Pap., 2008; 152: 293–297.
21. Hogan, A. M., Hoti, E., Winter, D. C., et al. Quality of life after iatrogenic bile duct injury: a case control study. Ann. Surg., 2009; 249: 292–295.
22. Stewart, L., Way, L. V. Laparoscopic bile duct injuries: timing of surgical repair does not influence success rate. A multivariate analysis of factors influencing surgical outcomes. HPB (Oxford), 2009; 11: 516–522.
23. Flum, D. R., Cheadle, A., Prela, C., et al. Bile duct injury during cholecystectomy and survival in medicare beneficiaries. JAMA, 2003; 290: 2168–2173.
24. Bělina, F., Ryska, M. Indikace k transplantaci jater u sekundární biliární cirhózy. Bull. HPB chirurgie, 2003; 11: www.hpb.cz
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Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2010 Issue 3
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