Bile Duct Injuries during Laparoscopic Cholecystectomy: Management and Outcome

The aim of this study is to analyze our experience with the management of bile duct injuries (BDIs) following laparoscopic cholecystectomy (LC). From 1996 to 2004, 21 patients with BDI after LC were treated in our department. The BDIs were graded according to the classification of Strasberg. Ten patients had minor BDI. Minor injuries were classified as A in six and D in four patients. In three patients, endoscopic retrograde cholangiopancreatography sphincterotomy and stent placement was adequate treatment. Six patients required laparotomy and bile duct ligation or suturing, and one patient underwent laparoscopy with additional ligation of a duct of Luschka. Eleven patients had major BDIs. These injuries were classified as E1 in two, E2 in three, E3 in four, and E4 in two patients. Among the patients with a major BDI, Roux- en-Y hepaticojejunostomy was performed. After a median follow-up of 69.45 months, no evidence of biliary disease has been detected among our patients. BDIs should be managed in a specialist unit where surgeons skilled to perform such repairs should undertake definitive treatment. Roux- en-Y hepaticojejunostomy is the procedure of choice in the management of major BDIs as it is accompanied by satisfactory results.

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The subvesical duct of Luschka: A source of bile leakage following gallbladder removal

South African Journal of Radiology ◽

10.4102/sajr.v7i2.1402 ◽

2003 ◽

Vol 7 (2) ◽

pp. 44-46

Author(s):

Ian C. Duncan ◽

Basil J. Sher

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Hepatic Duct ◽

Bile Leakage ◽

Duct Obstruction ◽

Duct Ligation ◽

Duct Of Luschka ◽

Gallbladder Fossa ◽

Bile Leaks ◽

Gallbladder Removal

We describe a case of bile leakage following laparoscopic cholecystectomy further complicated by iatrogenic central bile duct obstruction. The site of leakage was identified not from the site of the inadvertent proper hepatic duct ligation but from a damaged aberrant subvesical duct communicating with the gallbladder fossa. The anatomy of these subvesical ducts is explained as is their surgical importance with relation to the aetiology of bile leaks after cholecystectomy.

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Surgical management of bile duct injuries following laparoscopic cholecystectomy: analysis and follow-up of 28 cases

Langenbeck s Archives of Surgery ◽

10.1007/s00423-002-0330-x ◽

2002 ◽

Vol 387 (7-8) ◽

pp. 286-293 ◽

Cited By ~ 15

Author(s):

Hendrik Seeliger ◽

Alois Fürst ◽

Carl Zülke ◽

Karl-Walter Jauch

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Surgical Management ◽

Bile Duct Injuries

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Laparoscopic Cholecystectomy at Shree Birendra Hospital

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v10i1.6444 ◽

2012 ◽

Vol 10 (1) ◽

pp. 15-19

Author(s):

S Malla ◽

SB Rawal ◽

NK Giri

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Hepatic Duct ◽

Tube Placement ◽

Left Hepatic Duct ◽

Type D ◽

Calot’S Triangle ◽

Bile Duct Injuries ◽

A Prospective Study

Introduction: Since its introduction in Shree Birendra Hospital, laparoscopic cholecystectomy has gradually replaced its open counterpart. Along with its superior results, surgeons had to deal with the difficult challenges of managing bile duct injuries. Methods: A prospective study of all laparoscopic cholecystectomies performed in the General surgical unit of Shree Birendra Hospital from January 2003 to December 2010 was carried out from case records in a separate register kept for laparoscopic surgeries. Results: Out of the total number of 786 patients who underwent laparoscopic cholecystectomy during the study period, 21 (2.67%) required conversion to open procedure with the most common indication being unclear anatomy at Calot’s triangle. There were 14 major post operative complications (1.78%) with bile duct injuries occurring in 7 patients (0.89%). Among these injuries, 3 injuries were recognized during the primary operation. Laparotomy with t tube placement for 6 weeks was the mode of treatment in 2 patients with Strasberg type D injuries detected post operatively. Delayed repair after 3 months were carried out in 2 injuries- one hepaticojejunostomy (Type E2) and the other required anastamosis to the left hepatic duct (Type E3). In follow up, these patients have remained aniciteric and comfortable so far. Conclusion: Bile duct injuries continue to remain a major morbidity factor in laparoscopic cholecystectomy and its management a challenge to the surgeon. Though repair in a specialized hepatobiliary center is recommended, in the absence of such center in our country, it is being done in SBH with good results. DOI: http://dx.doi.org/10.3126/mjsbh.v10i1.6444 Medical Journal of Shree Birendra Hospital Jan-June 2011 10(1) 15-19

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Postcholecystectomy bile duct injuries: evolution of surgical treatment

Polish Journal of Surgery ◽

10.5604/01.3001.0012.7810 ◽

2019 ◽

Vol 91 (1) ◽

pp. 14-21

Author(s):

Audrius Šileikis ◽

Rūta Žulpaitė ◽

Auksė Šileikytė ◽

Martynas Lukšta

Keyword(s):

Laparoscopic Cholecystectomy ◽

Surgical Treatment ◽

Bile Duct ◽

Bile Ducts ◽

Late Complications ◽

Bile Duct Injuries ◽

Appropriate Treatment ◽

The Mean ◽

End To End

Introduction Bile duct injuries (BDIs) still occur during laparoscopic cholecystectomy. Although management of such complications is challenging, collaboration of a multidisciplinary team and development of treatment methods and materials often lead to the successful treatment. Materials and methods Medical records of 67 patients who have experienced bile duct injures after laparoscopic cholecystectomy were retrospectively reviewed. All injures were classified according to the European Association for Endoscopic Surgery ATOM classification and investigated by manifestation of the injury, surgical repair technique, early and late complications. Results In 28 (41.8 %) patients with partial divisions, the surgical treatment of BDI was completed with endoscopic retrograde cholangiopancreatography (ERCP) and stenting while in 14 (20.1%) cases, the defect of bile duct was closed by suture. End-to-end ductal anastomosis was performed for 6 (13.4%) patients with complete division while 19 (28.3%) patients underwent hepaticojejunostomy. We followed up 58 (92.1%) of 63 patients. The mean follow-up duration was 25.7 (3 - 123) months. Twenty-three (39.7%) patients were found with strictures. Discussion Intraoperative detection and management of BDIs is crucial to achieve good results. The routine intraoperative cholangiography and possibilities of repair by initial surgeons in peripheral hospitals remain controversial. Stenting with a covered self-expanding metal stent is promising for the patients with partial divisions of bile ducts. Initial hepaticojejunostomy is often a preferred treatment for transected bile ducts because of lower rate of anastomosis strictures. However, as end-to-end anastomosis is more physiological, and endoscopy allows successful management of the strictures, we suggest choosing this treatment when possible Recommendation for paperwork content: Classifying bile duct injuries according to the new ATOM classification may be useful in the decision of the most appropriate treatment in each case.

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Iatrogenic Bile Duct Injuries: An Overview and A Review of Literature

International Journal of Recent Surgical and Medical Sciences ◽

10.1055/s-0041-1730123 ◽

2021 ◽

Vol 07 (01) ◽

pp. 037-043

Author(s):

Vinoth M. ◽

Abhijit Joshi

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Bile Duct Injury ◽

Surgical Procedures ◽

Surgical Repair ◽

Review Of Literature ◽

Bile Duct Injuries ◽

Iatrogenic Bile Duct Injury

Abstract Laparoscopic cholecystectomy (LC) is one of the most frequently performed surgical procedures worldwide. Iatrogenic bile duct injury (IBDI) is a serious complication of LC and has an incidence of 0.3 to 0.7%. Since it is associated with a significant and potentially lifelong morbidity as well as mortality, diagnosing IBDI as early as possible is of paramount importance. Management of bile duct injuries and prognosis of their surgical repair depend on the timing of its recognition, type and the extent of the injury. In this paper, we present a case of IBDI and attempt to discuss all its dimensions.

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Erratum to: Age and Obesity are Independent Predictors of Bile Duct Injuries in Patients Undergoing Laparoscopic Cholecystectomy

World Journal of Surgery ◽

10.1007/s00268-015-3022-8 ◽

2015 ◽

Vol 39 (7) ◽

pp. 1809-1809 ◽

Cited By ~ 1

Author(s):

Hassan Aziz ◽

Viraj Pandit ◽

Bellal Joseph ◽

Tun Jie ◽

Evan Ong

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Bile Duct Injuries

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The Prevention of Laparoscopic Bile Duct Injuries: An Analysis of 300 Cases of from a Human Factors and Cognitive Psychology Perspective

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/154193120705101103 ◽

2007 ◽

Vol 51 (11) ◽

pp. 617-620 ◽

Cited By ~ 1

Author(s):

Lygia Stewart ◽

Lawrence W. Way

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Human Factors ◽

Bile Duct Injury ◽

Human Error ◽

Perceptual Illusion ◽

Bile Duct Injuries ◽

Psychology Perspective ◽

Cause Of Error ◽

Key Steps

Application of human factors concepts to high-risk activities has facilitated reduction in human error. With introduction of laparoscopic cholecystectomy, the incidence of bile duct injury increased. Seeking ideas for prevention, we analyzed 300 laparoscopic bile duct injuries within the framework of human error analysis. The primary cause of error (97%) was a visual perceptual illusion. The laparoscopic environment contributed to 75% of injuries, poor visibility 22%. Most injuries involved deliberate major bile duct transection due to misperception of the anatomy. This illusion was so compelling that the surgeon usually did not recognize it. Even when irregular cues were detected, improper rules were employed, eliminating feedback. Since the complication-causing error occurred at few key steps during laparoscopic cholecystectomy; we instituted focused training to heighten vigilance, and have formulated specific rules to decrease the incidence of bile duct injury. In addition, factors in the laparoscopic environment contributing to this illusion are discussed.

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