Management of major bile duct injury after laparoscopic. We retrospectively analyzed 92 patients between 1991 and 2011. Common bile duct injuries during laparoscopic cholecystectomy. Objectives laparoscopic cholecystectomy associated bile duct injury is a clinical problem with bad outcome. Management of bile duct problems treatment overview bile duct obstruction bile duct or biliary obstruction occurs for numerous reasons.
Bile duct injuries represent a complex clinical scenario seen with increased frequency owing to aberrant anatomy and more lap cholecystectomies being performed incidence. Creating a culture of safety in cholecystectomy during the sages 2016 annual meeting. Most injuries to the bile duct occur higher in the biliary tree,close to the hilum, thus not allowing for tensionfree anastomosisto the duodenum. The most frequent cause of ibdi is misidentification of the bile duct as the cystic duct in cases of anomalies of cystic duct insertion into the common hepatic duct. The rouxeny hepaticojejunostomy hj is generally accepted as the standard of care for complex bile duct injury. Society of american gastrointestinal and endoscopic surgeons sages 17,398 views. Management of bile duct injury after laparoscopic cholecystectomy. In some cases, lack of complete cholangiographic information led to an inappropriate and harmful operation. Yu tian, shuodong wu, yang su, jing kong, hong yu, and ying fan. Any information contained in this pdf file is automatically generated from. The scar tissue can then constrict the duct wall or thicken the wall leading to a narrowing. The goal of this study is to increase awareness of the problem and educate surgeons about the consequences of these injuries. Pdf recent classifications of the common bile duct injury. Amsterdam classification of bile duct injuries types a, b, c and d.
Causes can include cancerous and noncancerous processes as well as injuries from medical procedures or operations. The diagnosis of noniatrogenic traumatic bile duct injuries is challenging as current crosssectional imaging tests are. About 70%80% of all ibdi are a consequence of misidentification of biliary anatomy before clipping, ligating and dividing structures 12, , 25, 26. Bile duct injuries during laparoscopic cholecystectomy. Survival was significantly lower in the injured cohort compared with the noninjured cohort, with a hazard ratio of 3. Abstract bile duct injuries are the most common serious complication of cholecystectomy. On the other hand, bile duct lesions due to blunt traumas are predominantly caused by traffic accidents compression by safety belt or airbag, falls, kicks, or work accidents. Proper management requires a skilled and experienced hepatobiliary surgical team. As a result of an injury, the bile duct will not be able to work right, leaking bile into the abdomen or blocking.
The main symptoms would be abdominal pain and enlargement. To describe the epidemiological, clinical and surgical features of patients with iatrogenic bile duct injury ibdi attending the general hospital of fortaleza hgf during the period from 2005 to 2009. Injury to the ducts is less common than to the gallbladder. Avoidance of bile duct injury is a key aim of biliary. The clinical manifestations of bile duct injuries depend on the timing of injury recognition, type of injury, and presence of complications.
Before the advent of lc, the most frequent lesion to biliary tract was represented by bile duct stricture, and biliary injuries were classified using the. This topic will focus on the surgical repair of common bile duct injuries. Operations to repair bile duct injuries were unsuccessful in 27 96% of 28 procedures when cholangiograms were not obtained preoperatively, and they were unsuccessful in 69% when cholangiographic data were incomplete. They are most frequently caused by laparoscopic cholecystectomy, which is one of the commonest surgical procedures in the world. Based on the mcmahon classification, lacerations under 25% of the common bile duct cbd diameter or cysticcbd junction was classified as minor injury, whereas transection or laceration over 25% of cbd diameter and postoperative bile duct stricture were classified as major injury. Bile duct injury can also occur during other operative procedures. The median duration of endoscopic therapy was 31 5399 days for patients with peripheral bile duct leakages, 90 4145 days for those with central bile duct leakages, and 446 1821162. A bile duct injury is damage to the bile duct during gallbladder surgery. Wed like to understand how you use our websites in order to improve them. Most commonly occurring during laparoscopic cholecystectomy, and to the common bile duct on the biliary tree, bile ducts can get cut, burned, or pinched leading to painful and sometimes fatal symptoms if not treated.
The most common cause of a torn bile duct is an injury biliary trauma. Pdf classification and management of bile duct injuries. Hugh lund university school of aviation, ljungbyhed, sweden. The patients had been referred to the authors for evaluation or treatment, and the accompanying records were complete with respect to operative notes from the initial operation and any subsequent operations done to repair the injury. Sometimes physical obstructions in the bile duct, like gallstones or biliary duct stones, can block the flow of bile even without inflammation. Aug 31, 2014 they classified the injury by the width of bile duct injury. As a result of a missed injury, bile may leak into the abdominal cavity, resulting in chemical peritonitis.
Aug 20, 2010 complications were not linked with sex, age, bile leak, hospital of origin, jaundice, sepsis, complex bile duct injury, type of repair, or timing of repair. Lewis 1938, recounting a further case, could only find 6 additional ones since rudbergs paper. Clinical manifestations the clinical manifestations of bile duct injuries depend on the timing of injury recognition, type of injury, and presence of complications. The data consistently show a higher incidence of common bile duct injury bdi during lc when compared with open cholecystectomy, at least 0. Accidental traumas are responsible only for 15% of the total number of biliary injuries. The real incidence of bile duct injury bdi during laparoscopic cholecystectomy lc is not known. The incidence of bile duct injuries bdi has approximately doubled 0. Bile duct injuries bdi have a wide array of presentation. Management of bile duct problems treatment overview. Mcmahon et al7 proposed another classification by distinguishing major and minor biliary injuries. These complex injuries are most often a consequence of laparoscopic cholecystectomy lc. The operations of 252 patients who had major bile duct injuries during laparoscopic cholecystectomy were analyzed. Involvement of aberrant right hepatic duct alone or with concomitant stricture of the chd learning objectives 1 outline advantages and disadvantages of different imaging modalities with regard to detection and characterization of bile duct injuries 2 identify and characterize bile duct injuries on imaging 3 describe key findings with. The vast majority of bile duct injuries is iatrogenic and occurs during abdominal surgeries or other interventions such as endoscopic or percutaneous cannulation of the biliary tree.
Malignancies of the bile duct or around the duct which then compresses it can also be the cause of a stricture. Obstruction can occur at different levels of the bile duct tree figure 1a. Feb 09, 2016 bile duct injuries are damage to the bile ducts that happen during gallbladder surgery. Bile duct injury classification and management of diffuse abdominal pain, nausea, fever and impaired intestinal motility. This delay is particularly common among patients who sustain blunt thoracoabdominal trauma and are managed nonoperatively. The pain and swelling are caused by leakage of bile into the belly, which is very irritating. Using questionnaires, we analyzed 91,232 lc performed by 170 surgical units in brazil between 1990 and 1997. Among all patients who experience traumatic bile duct injuries, 8090% are victims of penetrating traumas from stab or gunshot wounds. Iatrogenic common bile duct injury is the worst complication of laparoscopic cholecystectomy. Bile duct injury bdi remains the most serious complication of laparoscopic cholecystectomy lc. The best strategy in terms of timing of repair is still controversial.
Classification and management of bile duct injuries europe. However, repair during the intermediate period between 3 days and 6 weeks put patients at higher risk for biliary stricture p 0. Seldom occurring in isolation, this family of injuries is easily overshadowed by more overt surgical emergencies and can go undetected, potentially leading to adverse outcomes. Imaging is vital for the initial diagnosis of bile duct injury, assessment of its extent, and guidance of its treatment. To evaluate the effect of timing of management and intervention on outcomes of bile duct injury. As a result of the injury, the bile duct no longer. Repair bile duct injuries immediately the doctors channel.
Complete transection or excision of common bile duct. Rudberg 1921 described a case of injury to the common duct and collected 40 other examples of bile duct injury. The aim of this study was to analyze the presentation, characteristics, related investigation, and treatment results of major bile duct injuries after laparoscopic. Longterm effects of iatrogenic bile duct injury during. Management depends on the timing of recognition of injury, the extent of bile duct injury, the patients condition and the availability of experienced hepatobiliary surgeons. The early and accurate diagnosis of ibdi is very important for surgeons and gastroenterologists, because unrecognized ibdi lead to serious complications such.
Early or delayed intervention for bile duct injuries. Classification and management of bile duct injuries. Iatrogenic bile duct injury during cholecystectomy presenting after. Yellow coloration of the urine and skin jaundice can occur after several days. Intraoperative management and repair of bile duct injuries.
Iatrogenic bile duct injuries ibdi remain an important problem in gastrointestinal surgery. Left partial injuries strasberg d of the hepatic duct are the result of excessive traction. Oct 26, 2015 open common bile duct exploration tips, tricks, results duration. Laparoscopic subtotal cholecystectomy as an alternative procedure designed to prevent bile duct injury. However, the incidence rate of bile duct injury has not been changed for many years.
Laparoscopic management of bile duct injury strasberg type d. Jan 31, 2009 bile duct injury is a severe and potentially lifethreatening complication of laparoscopic cholecystectomy. Recent classifications of the common bile duct injury kwangsik chun department of surgery, chungnam national university hospital, daejeon, korea laparoscopic cholecystectomy is now a gold standard treatment modality for gallstone diseases. Jan 01, 20 bile duct injuries may lead to bile leakage, intraabdominal abscesses, cholangitis, and secondary biliary cirrhosis due to chronic strictures. Causes and prevention of laparoscopic bile duct injuries. Longterm detrimental effect of bile duct injury on health. Recent classifications of the common bile duct injury. An estimated 25%32% of bile duct injuries are recognized at laparoscopic cholecystectomy and may be repaired immediately if a surgeon with experience in bile duct repair is available 6. An estimated 25%32% of bile duct injuries are recognized at laparoscopic cholecystectomy and. Current controversies in management of bile duct injuries. Low injuries to the bile duct can be reimplanted into theduodenum.