If a bile duct injury occurs, an immediate repair should be performed with no hesitation in asking for the help of a surgeon experienced in biliary repair. In 1892, doyenn reported the first choledochocholedochostomy for the same condition 7. Iatrogenic combined bile duct and right hepatic artery injury. A bile duct injury is damage to the bile duct during gallbladder surgery. Iatrogenic bile duct injuries ibdi remain an important problem in gastrointestinal surgery. There were few cases about retained fragments of ttube.
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. For injuries sustained at lc, details of time between lc and recognition of the. Benign biliary strictures is a broad concept encompassing not only strictures caused by injuries, but also as a re sult of other causal factors 1, 11 12. Iatrogenic bile duct injuries are an important complication of cholecystectomy, since despite being a rare occurrence, at 0.
Type of injury bile duct incontinuity cystic duct leak leak from partial injury of bile duct narrowing of bile duct clip or endoloop leak from duct of luschka in gb fossa leak from cut liver edge bile duct transected level of injury wrt to confluence of bile ducts separation of hepatic ducts. Recontructive biliary surgery in the treatment of iatrogenic. As a result of the injury, the bile duct no longer. High injuries were inflicted during the performance of cholecystectomy while low injuries were related to common bile duct exploration. Accidental traumas are responsible only for 15% of the total number of biliary injuries. The early and accurate diagnosis of ibdi is very important for surgeons and gastroenterologists, because unrecognized ibdi lead to serious complications such. Massaad2 through out the last decade we used to receive at ibn sina hospital a steady rate of referrals of iatrogenic major bile duct injuries imbdis which had been inflicted mainly during open cholecystectomy1.
A retrospective analysis was performed on all patients referred for management of an iatrogenic bile duct injury from 1981 to 2000. A radiologists guide to characterization, outcome, and management issues. Iatrogenic bile duct injuries following laparoscopic. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly dependent on the type of injury and its location. Iatrogenic bile duct injuries are not the inevitable result of haptic misperception. Li department of general, visceral and transplantation surgery, university hospital essen, hufelandstrasse 55, 45122 essen, germany. Iatrogenic duodenal injury 1 during cholecystectomy muharrem.
Widespread use of surgical procedures on bile ducts was associated with occurrence of ibdi. Iatrogenic bile duct injuries journal of the american college of. Difficult iatrogenic bile duct injuries following different. 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.
Iatrogenic bile duct injuries bdis after laparoscopic cholecystectomy, being one of the most common performed surgical procedures, remain a substantial problem in gastrointestinal surgery with a significant impact on patients quality of life. Bile duct injury bdi is a devastating complication following cholecystectomy. Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. Pdf iatrogenic intestinal injury concomitant to iatrogenic. Iatrogenic bile duct injuries bdis after laparoscopic cholecystectomy, being one of the most common performed surgical procedures, remain a. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly. Iatrogenic bile duct injury during cholecystectomy presenting after 11 years as a biliary.
A bile injury may also be unrecognized at the time of surgery but evident in the postoperative period. Chartrandlefebvre c, dufresne mp, lafortune m, lapointe r, dagenaism r. Pdf classification and management of bile duct injuries. Iatrogenic injury to the bile duct is one of the most serious and feared complication of cholecystectomy, with a. Management of major bile duct injury after laparoscopic. Complete occlusion resulting in major injuries, biliary leakage, and bile duct stricture is a severe longterm complication after lc besides minor bile leakage. Among identified hazards following repair of bile duct injury is high age, comorbidity, and outcome is related to. Jan 22, 2020 bile duct injury bdi is the most dramatic complication after cholecystectomy, showing an increased incidence after introduction of the laparoscopic procedure 0. An estimated 25%32% of bile duct injuries are recognized at laparoscopic cholecystectomy and.
The aim of this study was to analyze the presentation, characteristics, related investigation, and treatment results of major bile duct injuries after laparoscopic. Major bile duct injury is a serious and potentially lifethreatening complication of cholecystectomy. This is a pdf file of an unedited manuscript that has been accepted for publication. Iatrogenic bile duct injury during cholecystectomy presenting.
Iatrogenic bile duct injury with a retained ttube in common. The clinical manifestations of bile duct injuries depend on the timing of injury recognition, type of injury, and presence of complications. Bile duct injury in the era of laparoscopic cholecystectomy dkmic. Iatrogenic bile duct injury account for about 95% of all benign biliary strictures bbs. The role of endoscopic retrograde cholangiopancreatography in the management of iatrogenic bile duct injury after cholecystectomy. Iatrogenic biliary injury common bile duct injury cholecystectomy. 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. Iatrogenic bile duct injuries in the laparoscopic era. Sep 07, 2009 iatrogenic bile duct injuries ibdi remain an important problem in gastrointestinal surgery. The article describes the manifestations, diagnosis, classification, and management of iatrogenic bile duct injuries, with emphasis on the role of the interventional radiologist. Ct diagnosis of an iatrogenic bile duct injury bmj case reports.
A scientific sounding excuse for mistakes happen is not an effective. Longterm effects of iatrogenic bile duct injury during. Using questionnaires, we analyzed 91,232 lc performed by 170 surgical units in brazil between 1990 and 1997. Pedicled omental patch as a bridging procedure for iatrogenic bile duct injury. Iatrogenic major bile duct injuries injury mam ibnouf1, a. Classification of bile duct injury classification of iatrogenic bile duct injury. In recent years, endoscopy has acquired a fundamental role in the management of this. Iatrogenic bile duct injury during cholecystectomy presenting after. The conditions in which these patients arrived at our center are highly variable. Management of concomitant hepatic artery injury in patients. Iatrogenic combined bile duct and right hepatic artery injury during single incision laparoscopic cholecystectomy amareshwar chiruvella, md, juan m.
Longterm effects of iatrogenic bile duct injury during cholecystectomy clinical gastroenterology and hepatology, 2009, 7, 101018 ii. Cuendisvelazquez a, moraleschavez c, aguirreolmedo i, et al. Bile duct injury during laparoscopic cholecystectomy classification of iatrogenic bile duct injury repair of common bile duct injury over a t tube kocher maneuver transhepatic biliary drain placement biliary reconstruction with rouxeny hepaticojejunostomy. Sweeney, md, edward lin, do, steven scott davis jr, md abstract background. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. An update on iatrogenic biliary injuries surgical clinics. Management of concomitant hepatic artery injury in patients with iatrogenic major bile duct injury after laparoscopic cholecystectomy j. The real incidence of bile duct injury bdi during laparoscopic cholecystectomy lc is not known. The aim of this study was to study survival, factors influencing survival, and causes of death after iatrogenic reconstructed bile duct injury in a large populationbased swedish cohort. Laparoscopic hepaticojejunostomy after bile duct injury. Classification and management of bile duct injuries.
The first iatrogenic bile duct injury was described by. Bile duct injury bdi is the most serious iatrogenic complication during laparoscopic cholecystectomy lc and occurs easily in inexperienced surgeons since the position of common bile duct cbd. Bile duct injury is a severe and potentially lifethreatening complication of laparoscopic cholecystectomy. Iatrogenic bile duct injury ibdi is a complication with a high morbidity after cholecystectomy. Bile duct injury in the era of laparoscopic cholecystectomy. Whereas, intact ttube retained in common bile duct cbd for years after bdi was very rare. Numerous recent reports describe the performance of laparoscopic procedures through a single. Mar 06, 2019 iatrogenic bile duct injuries bdis after laparoscopic cholecystectomy, being one of the most common performed surgical procedures, remain a substantial problem in gastrointestinal surgery with a significant impact on patients quality of life. The diagnosis of noniatrogenic traumatic bile duct injuries is challenging as current crosssectional imaging tests are. In recent years, endoscopy has acquired a fundamental role. The first iatrogenic bile duct injury was described by sprengel in 1891. To describe our experience concerning the surgical treatment of strasberg e4 bismuth iv bile duct injuries.
Using mr cholangiopancreatography to evaluate iatrogenic bile. Bile duct injury bdi during cholecystectomy may have a severe effect on the health of patients, including mortality and considerable disability, and can be costly for the individual patient and for the health care system. Iatrogenic bile duct injury with loss of confluence. Bile duct injury, biliary leak, laparoscopic cholecystectomy, surgical repair background iatrogenic bile duct injuries bdis are potentially lifethreatening with high morbidity and mortality. Iatrogenic intestinal injury concomitant to iatrogenic bile duct injury. Bile duct injury bdi, a major complication of cholecystectomy, usually needs hepaticojejunostomy or primary repair over ttube in severe cases. Common hepatic duct division, 2 cm from bifurcation e2. Mortensen1 1department of surgery, odense university hospital, odense c, 2department of surgical gastroenterology c. The rouxeny hepaticojejunostomy hj is generally accepted as the standard of care for complex bile duct injury. They are most frequently caused by laparoscopic cholecystectomy, which is one of the commonest surgical procedures in the world. A postoperative bile leak occurs in less than 1% of cholecystectomies. Additional papers, among the most important an d cited in literature, reporting incidence of bdi following lcs, were individually searched for, excluding case report articles. Common hepatic duct division, a national danish multicentre study nicolaj m.
The early and accurate diagnosis of ibdi is very important for surgeons and gastroenterologists, because unrecognized ibdi lead to serious. Depending on the type of injury, appropriate management methods may include endoscopic, percutaneous, and surgical interventions. Common bile duct injuries represent a serious and challenging. Evolution of bile duct repair in a low and middleincome country lmic. Methods patients who underwent cholecystectomy in the period from 1965 to 2005 were identified from the swedish inpatient register. He also reported the first choledochoduodenostomy chd for calculi 1891 7, 10. Longterm impact of iatrogenic bile duct injury fulltext digestive. During an 18year period we studied 603 patient candidates for surgical treatment of iatrogenic bile duct injury. They mainly occur as a complication of laparoscopic cholecystectomy with a constant frequency of 3 to 6 per cases 1, 2. Iatrogenic bile duct lesions are feared complications reported to occur in approximately 0. Iatrogenic bile duct injury a cost analysis europe pmc. Iatrogenic bile duct injury during cholecystectomy is a feared complication with a frequently troublesome course, requiring substantial resources and hazarding the patients health and quality of life.