Poranění žlučových cest při cholecystektomii
Authors:
V. K. Kapoor
Authors‘ workplace:
Sanjay Gandhi Post-graduate Institute of Medical Sciences (SGPGIMS), Lucknow India
Published in:
Rozhl. Chir., 2015, roč. 94, č. 8, s. 312-315.
Category:
Review
Overview
Laparoscopic cholecystectomy (LC) is the treatment of choice for gall stones but is associated with an increased risk of bile duct injury (BDI). A BDI detected during LC may be repaired if a biliary surgeon is available but the easiest and safest option for a general surgeon is to place drains in the subhepatic fossa to covert the acute BDI into a controlled external biliary fistula (EBF). Most BDIs are diagnosed in the postoperative period and result in bile leak. Treatment is with percutaneous catheter drainage and endoscopic stenting of the bile duct; early repair is not recommended. Repair, in the form of hepatico-jejunostomy (HJ), should be performed by a biliary surgeon after a delay of 4−6 weeks when the EBF has closed. BDI is a common cause of medico-legal suit and a large burden on healthcare costs. Most BDIs can be prevented by adhering to the principles of safe cholecystectomy.
Key words:
bile duct injury − bile leak − biliary fistula − biliary stricture – cholecystectomy − hepatico-jejunostomy
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Suggested Readings
1. Kapoor VK. Bile duct injury repair – When? What? Who? Journal of HBP Surgery 2007;14:476−9.
2. Kapoor VK. Management of bile duct injuries: a practical approach. American Surgeon 2009;75:1157−60.
3. Kapoor VK. Safe Cholecystectomy – A to Z (Foreword by John G Hunter). Lucknow: Shubham 2010: 1-128. ISBN 978-81-910315-0-8. Available for free download at http://vkkapoor-india.weebly.com/uploads/1/4/6/7/1467272/safe_chole_a_to_z.pdf.pdf
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2015 Issue 8
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