| Autor: |
D J, Gouma, E A, Rauws, Y C, Keulemans, J J, Bergman, K, Huibregtse, H, Obertop |
| Jazyk: |
Dutch; Flemish |
| Rok vydání: |
1999 |
| Předmět: |
|
| Zdroj: |
Nederlands tijdschrift voor geneeskunde. 143(12) |
| ISSN: |
0028-2162 |
| Popis: |
Eight years after the introduction of laparoscopic cholecystectomy a decrease of the incidence of bile duct injuries is reported in the literature. The incidence of a bile duct injury after laparoscopic cholecystectomy is now slightly higher than after open cholecystectomy. A minority of these injuries are detected during surgery. Most patients have a delayed identification of the bile duct injury, even after discharge from the hospital. An early diagnostic work-up with ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) is mandatory in every patient with persisting symptoms (more than 48 hours) after laparoscopic cholecystectomy. Still, one-third of the patients are subjected to a 'diagnostic' exploratory laparotomy without preoperative visualization of the biliary tract by ERCP or percutaneous transhepatic cholangiography. Minor lesions are mostly treated successfully by endoscopy with a stent. After transection of the bile duct surgical reconstruction by a hepaticojejunostomy has to be performed. A delayed elective reconstruction was associated with fewer complications than acute repair under suboptimal circumstances such as local inflammatory changes and bile leakage. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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