>Year 2010, Issue 3
Mercado MÁ, Arriola JC, Domínguez I, Olaíz AE, Urencio M, Ramírez VF, Aramburo R
Iatrogenic injury of the bile duct with lost of confluence: surgical options
Cir Gen 2010; 32 (3)
PDF: 4. Kb.
Objective: To describe the experience in repairing iatrogenic injuries to the bile duct with loss of confluence at a national reference center in Mexico.
Setting: Third level health care center, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City.
Design: Retrospective, transversal, descriptive study.
Statistical analysis: Percentages as summary measures for qualitative variables.
Patients and methods: The study comprised 43 cases with loss of confluence, in an 18-year period. Group I (GI), neoconfluence plus Roux en Y hepatojejuno- anastomosis; Group II (GII), Roux en Y portoenterostomy; Group III (GIII), double anastomosis; Group IV (GIV), major hepatectomy and hepatojejuno-anastomosis. We reviewed the clinical files of these patients, recording general information, including type of surgery and postoperative results.
Results: GI: 20 cases. One presented stenosis of the anastomosis (5%), one case of repeated cholangitis, and the other required re-intervention (5%). GII: 15 cases, three (20%) coursed with cholangitis, and three (20%) required re-operation. GIII: six cases, three with cholangitis (50%). Three had to be re-operated (two with right hepatectomy, one hepatic transplant). GIV; two cases, none required re-operation.
Conclusion: Bile duct injuries with loss of confluence represent a complex scenario. Several options have to be considered in their repair (neoconfluence, double anastomosis, hepatectomy or portoenterostomy), which have to be selected and performed after a careful analysis based on the characteristics of each patient. Construction of a neoconfluence should always be attempted whenever possible.
||Bile duct injury, neoconfluence, hepatojejunostomy, hepatectomy, portoenterostomy.
Lillemoe KD. Current management of bile duct injury. Br J Surg 2008;95:403-405.
Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995;180:101-125.
Stewart L, Way LW. Bile duct injuries during laparoscopic cholecystectomy. Factors that influence the result of treatment. Arch Surg 1995;130:1123-1129.
Bektas H, Schrem H, Winny M, Klempnauer J. Surgical treatment and outcome of iatrogenic bile duct lesions after cholecystectomy and the impact of different clinical classification systems. Br J Surg 2007;94:1119-1127.
Flum DR, Cheadle A, Prela C, Dellinger EP, Chan L. Bile duct injury during cholecystectomy and survival in nedicare beneficiaries. JAMA 2003;290:2168-2173.
Way LW, Stewart L, Gantert W, Liu K, Lee CM, Whang K, et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg 2003;237:460-469.
Mercado MA, Orozco H, De la Garza L, López MLM, Contreras A, Guillén-Navarro E. Biliary duct injury: partial segment IV resection for intrahepatic reconstruction of biliary lesions. Arch Surg 1999;134:1008-1010.
Mercado MA, Chan C, Salgado-Nesme N, López-Rosales F. Intrahepatic repair of bile duct injuries. A comparative study. J Gastrointest Surg 2008;12:364-368.
McDonald ML, Farnell MB, Nagorney DM, Ilstrup DM, Kutch JM. Benign biliary strictures: repair and outcome with a contemporary approach. Surgery 1995;118:582-591.
Chapman WC, Abecassis M, Jarnagin W, Mulvihill S, Strasberg SM. Bile duct injuries 12 years after the introduction of laparoscopic cholecystectomy. J Gastrointest Surg 2003;7:412-416.
Sicklick JK, Camp MS, Lillemoe KD, Melton GB, Yeo CJ, Campbell KA, et al. Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients. Ann Surg 2005;241:786-792.
Mercado MA, Orozco H, Chan C, Quezada C, Barajas-Olivas A, Borja-Cacho D, et al. Bile duct growing factor: an alternate technique for reconstruction of thin bile ducts after iatrogenic injury. J Gastrointest Surg 2006;10:1164-1169.
Strasberg SM, Picus DD, Drebin JA. Results of a new strategy for reconstruction of biliary injuries having an isolated right-sided component. J Gastrointest Surg 2001;5:266-274.
Mercado MA, Chan C, Orozco H, Villalta JM, Barajas-Olivas A, Eraña J, et al. Long term evaluation of biliary reconstruction after partial resection of segments IV and V in iatrogenic injuries. J Gastrointest Surg 2006;10:77-82.
Mercado MA, Chan C, Orozco H, Hinojosa CA, Podgaetz E, Ramos-Gallardo G, et al. Prognostic implications of preserved bile duct confluence after iatrogenic injury. Hepatogastroenterology 2005;52:40-44.
Mercado MA. Early versus late repair of bile duct injuries. Surg Endosc 2006; 20:1644-1647.
Bismuth H, Majno PE. Biliary strictures: classification based on the principles of surgical treatment. World J Surg 2001;25:1241-1244.
Stewart L, Robinson TN, Lee CM, Liu K, Whang K, Way LW. Right hepatic artery injury associated with laparoscopic bile duct injury: incidence, mechanism and consequences. J Gastrointest Surg 2004;8:523-531.
Li J, Frilling A, Nadalin S, Paul A, Malagὸ M, Broelsch CE. Management of concomitant hepatic artery injury in patients with iatrogenic major bile duct injury after laparoscopic cholecystectomy. Br J Surg 2008;95:460-465.
Pickleman J, Marsan R, Borge M. Portoenterostomy: an old treatment for a new disease. Arch Surg 2000;135:811-817.
Laurent A, Sauvanet A, Farges O, Watrin T, Rivkine E, Belghiti J. Major hepatectomy for the treatment of complex bile duct injury. Ann Surg 2008; 248:77-83.
Mercado MA, Chan C, Orozco H, Cano GG, Chaparro JM, Galindo E. et al. To stent or not to stent bilioenteric anastomosis after iatrogenic injury: a dilemma not answerd? Arch Surg 1999;134:1008-1010.
Mercado MA, Sanchez N, Urencio M. Major hepatectomy for the treatment of complex bile duct injury. Letter to the editor. Ann Surg 2009;249:542-543.
>Year 2010, Issue 3