Surgical management of bile duct injuries following laparoscopic cholecystectomy: analysis and follow-up of 28 cases
| Autor: | Alois Fürst, Hendrik Seeliger, Carl Zülke, Karl-Walter Jauch |
|---|---|
| Rok vydání: | 2002 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Adolescent medicine.medical_treatment Iatrogenic Disease Bile Duct Diseases Gallbladder Diseases Postoperative Complications Intensive care Laparotomy Outcome Assessment Health Care Humans Medicine Endoscopic stenting Aged Retrospective Studies Trauma Severity Indices business.industry Bile duct General surgery Middle Aged Surgery medicine.anatomical_structure Cholecystectomy Laparoscopic Biliary tract Cystic duct Female Cholecystectomy Bile Ducts business Follow-Up Studies Abdominal surgery |
| Zdroj: | Langenbeck's Archives of Surgery. 387:286-293 |
| ISSN: | 1435-2443 |
| DOI: | 10.1007/s00423-002-0330-x |
| Popis: | Background. Biliary tract lesions pose a dreaded complication of laparoscopic cholecystectomy. In a retrospective study we analyzed the clinical presentation, diagnostic and therapeutic management and outcome of 28 patients presenting with iatrogenic bile duct injuries. Patients and methods. Between 1994 and 2001 we treated 28 patients with bile duct lesions following laparoscopic cholecystectomy at our center. Operation notes and charts of all patients were reviewed systematically. A follow-up examination of each patient was performed after a median of 12 months (range 1–90). Results. Twenty-two patients presented with major circumferential bile duct defect lesions. Less severe injuries (n=6) were two minor bile leaks, one bile duct stricture and three tangential lesions. Twenty-six patients were referred to our institution within 16 days (range 0–226 days). Six patients were treated by nonsurgical procedures: endoscopic stenting in four and percutaneous intervention in two. In one of the remaining patients a cystic duct leak was closed via laparotomy, and in 21 a hepaticojejunostomy was performed. Reconstruction of a hepaticojenunostomy was performed in two of these patients. Patients were dismissed from the hospital after a median of 13 days (range 4–156). Four patients presenting with generalized biliary peritonitis required prolonged intensive care. One or more episodes of cholangitis were seen in five patients during follow-up examinations. Conclusions. Major iatrogenic bile duct injuries are associated with high morbidity and prolonged hospitalization. Interdisciplinary cooperation and early referral to an experienced center is crucial in the management of patients suffering from this affliction. Cholangitis is a marked problem in the follow-up. |
| Databáze: | OpenAIRE |
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