Santos-Jasso KA, Asz-Sigall J, Medina-Vega FA, Sáinz-Castro R

Language: Spanish
References: 13
Page: 24-33
PDF size: 742.62 Kb.

ABSTRACT

Objective: To study the frequency and characteristics of the complications of the bile duct in a tertiary care pediatric hospital, and describe the surgical treatment of these lesions.
Material and methods: Descriptive and retrospective study with review of medical records of patients with surgical complication of the bile duct between march 2005- march 2009. The frequency of iatrogenic and now-iatrogenic bile duct injuries was observed. We describe each case and its surgical management.
Results: During a 48 month period 60 patients with bile duct problems underwent surgery: laparoscopic cholecystectomy (31.6%), open cholecystectomy (9%), choledocal cyst excision (18.3%), biliary atresia (23.3%), bile duct trauma (1.7%), bile duct injury (16.6%). Ten patients were identified with a complication of the bile duct: three bile duct injuries during laparoscopic cholecystectomy (one with injury to the common bile duct, another one with injury to the common bile duct and hepatic duct and a third one with cystic duct avulsion). Five patients had stenosis of the hepato-jejunostomy after choledocal cyst excision (two with bile duct stones). One patient had trauma of the bile duct after a motor vehicle accident with injury of the left hepatic duct and subsequent stenosis, and one case of injury to the common bile duct during surgery for persistent hiperinsulinemic hypoglycemia of the newborn. The surgical treatments were diverse and individualized, including hepato-jejunonostomies, porto-enterostomies, cholecysto-jejunostomy and external drainage. The postoperative course has been adequate in all cases without subsequent complications.
Conclusions: Extrahepatic bile duct injury can occur during any upper abdominal surgery, mainly during gallbladder and bile duct surgery. These lesions are infrequent and are generally the result of inadequate identification and exposure of the bile duct anatomy, as well as a non-careful dissection of the structures and overconfidence of the surgeon. The most difficult thing is the early recognition and repair of these lesions to avoid major sequelae. The surgical treatment of these lesions can be complicated by dehiscence and leaks, as well as bile duct stenosis with subsequent metabolic disorders and secondary biliary cirrhosis. There are many surgical options for these patients that should be individualized, most of them with good results. Kasai type portoenterostomy and cholecystoenterostomy are good options for the repair of high bile duct injuries in small children when an adequate hepaticoenterostomy cannot be done.

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