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Surgical management of laparoscopic cholecystectomy (LC) related major bile duct injuries; predictors of short-and long-term outcomes in a tertiary Egyptian center- a retrospective cohort study. ANNALS OF MEDICINE AND SURGERY (2012) 2018. [PMID: 30505442 DOI: 10.1016/j.amsu.2018.11.006.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objectives Laparoscopic cholecystectomy - associated bile duct injury is a clinical problem with bad outcome. The study aimed to analyze the outcome of surgical management of these injuries. Patients and methods We retrospectively analyzed 69 patients underwent surgical management of laparoscopic cholecystectomy related major bile duct injuries in the period from the beginning of 2013 to the beginning of 2018. Results Regarding injury type; the Leaking, Obstructing, leaking + obstructing, leaking + vascular, and obstructing + vascular injuries were 43.5%, 27.5%, 18.8%, 2.9%, and 7.2% respectively. However, the Strasberg classification of injury was as follow E1 = 25, E2 = 32, E3 = 8, and E4 = 4. The definitive procedures were as follow: end to end biliary anastomosis with stenting, hepaticojejunostomy (HJ) with or without stenting, and RT hepatectomy plus biliary reconstruction with stenting in 4.3%, 87%, and 8.7% of patients respectively. According to the time of definitive procedure from injury; the immediate (before 72 h), intermediate (between 72 h and 1.5months), and late (after1.5 months) management were 13%, 14.5%, and 72.5% respectively. The hospital and/or 1month (early) morbidity after definitive treatment was 21.7%, while, the late biliary morbidity was 17.4% and the overall mortality was 2.9%, on the other hand, the late biliary morbidity-free survival was 79.7%. On univariate analysis, the following factors were significant predictors of early morbidity; Sepsis at referral, higher Strasberg grade, associated vascular injury, right hepatectomy with biliary reconstruction as a definitive procedure, intra-operative bleeding with blood transfusion, liver cirrhosis, and longer operative times and hospital stays. However, the following factors were significantly associated with late biliary morbidity: Sepsis at referral, end to end anastomosis with stenting, reconstruction without stenting, liver cirrhosis, operative bleeding, and early morbidity. Conclusion Sepsis at referral, liver cirrhosis, and operative bleeding were significantly associated with both early and late morbidities after definitive management of laparoscopic cholecystectomy related major bile duct injuries, so it is crucial to avoid these catastrophes when doing those major procedures.
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Gad EH, Ayoup E, Kamel Y, Zakareya T, Abbasy M, Nada A, Housseni M, Abd-Elsamee MAS. Surgical management of laparoscopic cholecystectomy (LC) related major bile duct injuries; predictors of short-and long-term outcomes in a tertiary Egyptian center- a retrospective cohort study. Ann Med Surg (Lond) 2018; 36:219-230. [PMID: 30505442 PMCID: PMC6251332 DOI: 10.1016/j.amsu.2018.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/30/2018] [Accepted: 11/06/2018] [Indexed: 02/08/2023] Open
Abstract
Objectives Laparoscopic cholecystectomy - associated bile duct injury is a clinical problem with bad outcome. The study aimed to analyze the outcome of surgical management of these injuries. Patients and methods We retrospectively analyzed 69 patients underwent surgical management of laparoscopic cholecystectomy related major bile duct injuries in the period from the beginning of 2013 to the beginning of 2018. Results Regarding injury type; the Leaking, Obstructing, leaking + obstructing, leaking + vascular, and obstructing + vascular injuries were 43.5%, 27.5%, 18.8%, 2.9%, and 7.2% respectively. However, the Strasberg classification of injury was as follow E1 = 25, E2 = 32, E3 = 8, and E4 = 4. The definitive procedures were as follow: end to end biliary anastomosis with stenting, hepaticojejunostomy (HJ) with or without stenting, and RT hepatectomy plus biliary reconstruction with stenting in 4.3%, 87%, and 8.7% of patients respectively. According to the time of definitive procedure from injury; the immediate (before 72 h), intermediate (between 72 h and 1.5months), and late (after1.5 months) management were 13%, 14.5%, and 72.5% respectively. The hospital and/or 1month (early) morbidity after definitive treatment was 21.7%, while, the late biliary morbidity was 17.4% and the overall mortality was 2.9%, on the other hand, the late biliary morbidity-free survival was 79.7%. On univariate analysis, the following factors were significant predictors of early morbidity; Sepsis at referral, higher Strasberg grade, associated vascular injury, right hepatectomy with biliary reconstruction as a definitive procedure, intra-operative bleeding with blood transfusion, liver cirrhosis, and longer operative times and hospital stays. However, the following factors were significantly associated with late biliary morbidity: Sepsis at referral, end to end anastomosis with stenting, reconstruction without stenting, liver cirrhosis, operative bleeding, and early morbidity. Conclusion Sepsis at referral, liver cirrhosis, and operative bleeding were significantly associated with both early and late morbidities after definitive management of laparoscopic cholecystectomy related major bile duct injuries, so it is crucial to avoid these catastrophes when doing those major procedures. Sepsis at referral was associated with poor outcome after management of LC related MBDIs. Liver cirrhosis and operative bleeding were associated with poor outcome after management of these injuries. It is crucial to avoid these catastrophes when doing those major procedures.
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Affiliation(s)
- Emad Hamdy Gad
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | - Eslam Ayoup
- Hepatobiliary Surgery, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | - Yasmin Kamel
- Anaesthesia, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | - Talat Zakareya
- Hepatology and Endoscopy, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | - Mohamed Abbasy
- Hepatology and Endoscopy, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | - Ali Nada
- Hepatology and Endoscopy, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
| | - Mohamed Housseni
- Radioligy, National Liver Institute, Menoufia University, Shebein Elkoum, Egypt
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Major bile duct injuries during cholecystectomy in children: conservative laparoscopic approach is possible. Surg Laparosc Endosc Percutan Tech 2012; 22:e91-3. [PMID: 22487648 DOI: 10.1097/sle.0b013e318244edc3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Major bile duct injury is an inherent complication in cases of both open and laparoscopic cholecystectomies. In case of choledochal lesion, conservative treatment or internal derivation by a Roux-en-Y can be proposed. We report the case of a 5-year-old boy referred to our center for an iatrogenic choledochal ligation after open cholecystectomy (performed 20 d before) for asymptomatic gallbladder stone. We performed a laparoscopic conservative treatment with a consistent good result 5 years after the procedure.
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Nau P, Liu J, Ellison EC, Hazey JW, Henn M, Muscarella P, Narula VK, Melvin WS. Novel reconstruction of the extrahepatic biliary tree with a biosynthetic absorbable graft. HPB (Oxford) 2011; 13:573-8. [PMID: 21762301 PMCID: PMC3163280 DOI: 10.1111/j.1477-2574.2011.00337.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The reference standard technique for the reconstruction of the extrahepatic biliary tree is Roux-en-Y hepaticojejunostomy. This procedure is not without complications and may not be feasible in some patients. This project sought to evaluate a novel approach for repairing common bile duct injuries with a biosynthetic graft. This allows for the reconstruction of the anatomy without necessitating an intestinal bypass. METHODS Study subjects were 11 mongrel hounds. Utilizing an open approach, the common bile duct was transected in each animal. A 1-cm graft of a synthetic bioabsorbable prosthesis was interposed over a 5-Fr pancreatic stent and sewn in place as an interposition tube graft with absorbable sutures. Intraoperative cholangiograms and monthly liver function tests were completed. Animals were killed at 6, 7, 8, 10 and 12 months. RESULTS The first five animals were killed early in the process of protocol development. One animal developed obstructive symptoms and was killed on postoperative day 14. The next five animals were longterm survivors without evidence of clinically significant graft stenosis. Mean alkaline phosphatase and total bilirubin were normal, at 140 U/l and 0.2 mg/dl, respectively. Histology showed the complete replacement of the graft with native tissue at 6 months. CONCLUSIONS Biliary reconstruction using a synthetic bioabsorbable prosthetic as an interposition tube graft is feasible based on initial results.
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Affiliation(s)
- Peter Nau
- Department of Surgery, Ohio State University School of Medicine and Public HealthColumbus, OH, USA
| | - James Liu
- Department of Pathology, Ohio State University School of Medicine and Public HealthColumbus, OH, USA
| | - E Christopher Ellison
- Department of Surgery, Ohio State University School of Medicine and Public HealthColumbus, OH, USA
| | - Jeffrey W Hazey
- Department of Surgery, Ohio State University School of Medicine and Public HealthColumbus, OH, USA
| | - Matthew Henn
- Department of Surgery, Ohio State University School of Medicine and Public HealthColumbus, OH, USA
| | - Peter Muscarella
- Department of Surgery, Ohio State University School of Medicine and Public HealthColumbus, OH, USA
| | - Vimal K Narula
- Department of Surgery, Ohio State University School of Medicine and Public HealthColumbus, OH, USA
| | - W Scott Melvin
- Department of Surgery, Ohio State University School of Medicine and Public HealthColumbus, OH, USA
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Non-operative management of right posterior sectoral duct injury following laparoscopic cholecystectomy. J Gastrointest Surg 2011; 15:1237-42. [PMID: 21347873 DOI: 10.1007/s11605-011-1455-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 01/30/2011] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The purpose of this study is to describe the outcomes of conservative management for patients with right posterior sectoral bile duct injury acquired during laparoscopic cholecystectomy. METHODS This retrospective, consecutive case series reviews seven patients with an isolated injury to the right posterior or right hepatic duct occurring during laparoscopic cholecystectomy. RESULTS Seven patients with an isolated right sectoral duct injury were studied, six women and one man aged 22 to 71 years (mean age, 43.6 years). Diagnosis of bile duct injury occurred between 1 day and 13 weeks after the initial cholecystectomy. Three patients had plastic biliary stents placed and six patients had JP drains placed. All patients in this series were managed conservatively, with no reoperation for formal repair of the bile duct. Length of follow-up ranged from 2 to 14 months (mean, 8.2 months). At last follow-up, all patients were asymptomatic with no biliary drainage. CONCLUSIONS Conservative management is an important option for patients with an isolated right posterior bile duct injury.
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Schmidt SC, Fikatas P, Denecke T, Schumacher G, Aurich F, Neumann U, Seehofer D. Hepatic resection for patients with cholecystectomy related complex bile duct injury. Eur Surg 2010. [DOI: 10.1007/s10353-010-0524-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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"Sideways": results of repair of biliary injuries using a policy of side-to-side hepatico-jejunostomy. Ann Surg 2009; 249:426-34. [PMID: 19247030 DOI: 10.1097/sla.0b013e31819a6b2e] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Hepp-Couinaud technique describes side-to-side HJ to the main left hepatic duct but a side-to-side approach is not consistently used when repairing other ducts. Compared with end-to-side repairs, side-to-side anastomoses require less dissection, theoretically preserving blood supply to the bile ducts, and usually permit wider anastomoses. METHODS We report the treatment results of 113 consecutive biliary injuries, with intention to perform side-to side anastomosis in all. RESULTS 113 biliary injuries, 109 associated with cholecystectomy, were treated from 1992-2006. Injury types were B (7 patients, 6%); C (11 patients, 10%); E1 (8 patients, 7%); E2 (37 patients, 33%); E3 (20 patients, 18%); E4 (24 patients, 21%); E5 (6 patients, 5%). 19% of repairs were early (within 1 week after cholecystectomy), 58% were delayed (at least 6 weeks after cholecystectomy), and 22% were reoperations for recurrent strictures. In 92% of cases, side-to-side repair was accomplished. 23/113 (20%) developed postoperative complications, with one postoperative death. Mean follow-up was 4.9 years. Excellent anastomotic function was achieved in 107/112 (95%). "Poor" anastomotic results occurred in 5 patients: 2 patients with E4 injuries had postoperative anastomotic stenting >3 months, and 3 developed strictures requiring percutaneous dilation. There have been no reoperations for biliary strictures. CONCLUSIONS HJ using side-to-side anastomosis has theoretical advantages and is usually possible. In some high right-sided injuries it could not be achieved. 95% excellent anastomotic function without intervention attests to the benefit of the method, especially as postoperative stenting >3 months was considered to be a "poor" result.
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Kim JY, Kim KJ, Moon HG, Jeong SH, Jeong CY, Ju YT, Jung EJ, Lee YJ, Choi SK, Ha WS, Park ST, Hong SC. Clinical Experiences of Management of Bile Duct Injuries during Laparoscopic Cholecystectomy. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.77.5.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ju-Yeun Kim
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ka-Jeong Kim
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hyung-Gon Moon
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chi-Young Jeong
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young-Tae Ju
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Eun-Jung Jung
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young-Joon Lee
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Sang-Kyung Choi
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Woo-Song Ha
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Soon-Tae Park
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Soon-Chan Hong
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
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Abstract
BACKGROUND Postcholecystectomy complex bile duct injuries involving the hilar confluence, which are often associated with vascular injuries and liver atrophy, remain a considerable surgical challenge. The aim of this study is to report our experience of major hepatectomy with long-term outcome in these patients. METHODS From January 1987 to January 2002, 18 patients underwent a major hepatectomy for complex bile duct injuries. The hilar confluence was involved in all cases and was associated with vascular injuries in 13 (72%), including arterial injuries in 11, and partial liver atrophy in 15 (83%). The average time interval between the initial cholecystectomy and hepatectomy was 43 +/- 63 months and 16 (88%) patients had previously undergone an average of 2 (range 1-3) surgical repairs. RESULTS Major liver resection included a right hepatectomy in 14 (78%) patients, a left hepatectomy in 3, and a left trisectionectomy in one. There was no postoperative mortality, but severe postoperative morbidity was experienced in 11 (61%) patients, including biliary fistula in 7 (39%), prolonged ascites in 8 (44%) and hemorrhage requiring reoperation in one. With a median follow-up time of 8 years (range 3 to 12), 17 (94%) patients have excellent or good results, including 13 patients without symptoms. CONCLUSION This study shows that salvage major hepatectomy is an efficient treatment for patients with complex hilar bile duct injuries and should be considered before liver transplantation or recourse to metallic stents.
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Crema E, Trentini EA, Llanos JC. Proposal of a new technique for bile duct reconstruction after iatrogenic injury: study in dogs and review of the literature. Acta Cir Bras 2007; 22:162-7. [PMID: 17546287 DOI: 10.1590/s0102-86502007000300002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 03/16/2007] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: Interposition of a jejunal tube between the common bile duct and duodenum. METHODS: Five adult mongrel dogs of both sexes, weighing on average 22.3 kg (18 to 26.5 kg), were used. Obstructive jaundice was induced by ligation of the distal common bile duct. After one week, a 2.5-cm long jejunal tube was fabricated from a segment of the loop removed 15 cm from the Treitz angle and interposed between the common bile duct and duodenum. RESULTS: The animals presented good clinical evolution and no complications were observed. After 6 weeks, complete integration was noted between the bile duct mucosa, tube and duodenum and a significant reduction in total bilirubin and alkaline phosphatase was observed when compared to the values obtained one week after ligation of the common bile duct. CONCLUSION: The jejunal tube interposed between the dilated bile duct and duodenum showed good anatomic integration and reduced total bilirubin and alkaline phosphatase levels in the animals studied.
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Affiliation(s)
- Eduardo Crema
- Experimental Laboratory of Surgery Techniques, Department of Surgery, Federal University of Triângulo Mineiro (UFTM), Minas Gerais, Brazil.
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Watanabe M, Yamazaki K, Tsuchiya M, Otsuka Y, Tamura A, Shimokawa K, Kaneko H, Teramoto T. Use of an opened umbilical vein patch for the reconstruction of the injured biliary tract. ACTA ACUST UNITED AC 2007; 14:270-5. [PMID: 17520202 DOI: 10.1007/s00534-006-1183-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Accepted: 08/11/2006] [Indexed: 12/24/2022]
Abstract
BACKGROUND/PURPOSE When iatrogenic biliary tract injury occurs, there is the risk of complications such as bile leak and biliary stricture, and hepaticojejunostomy is the conventional procedure used for injury repair. However, this procedure can be complicated by retrograde biliary tract infection and the procedure can destroy the normal anatomical structure. METHODS We report here a method of end-to-end biliary tract reconstruction that uses an opened umbilical vein (OUV) patch and two stents to reduce bile leakage and biliary stricture formation following injury to the common bile duct or right main bile duct. The postoperative courses of four patients are reviewed. RESULTS In two of the patients, there was a small amount of postoperative bile drainage (for 3 days in the first patient and 2 days in the second patient). Of the two stents, the first stent was removed 1 month postoperatively, and the second stent at 2 to 3 months postoperatively. Three patients have returned to normal activity without symptoms after 44, 62, and 93 months, respectively. One patient died of a liver tumor recurrence in the fifth postoperative month, without a biliary problem. CONCLUSIONS An OUV patch for end-to-end biliary reconstruction reduced the volume and duration of bile leakage. Further research is needed to accurately evaluate the stenting period so as to reduce its duration.
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Affiliation(s)
- Masashi Watanabe
- Department of Surgery, Omori Hospital, Toho University School of Medicine, 6-11-1 Omorinishi, Tokyo 143-8541, Japan
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Heistermann HP, Palmes D, Stratmann U, Hohlbach G, Hierlemann H, Langer M, Spiegel HU. A new technique for reconstruction of the common bile duct by an autologous vein graft and a biodegradable endoluminal stent. J INVEST SURG 2006; 19:57-60. [PMID: 16546930 DOI: 10.1080/08941930500444560] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The incidence of severe bile duct injuries has significantly increased since the introduction of laparoscopic cholecystectomy. The ideal reconstruction procedure for traumatic defects of the bile duct should be technically simple and should preserve both the physiological passage of bile and the sphincter of Oddi. In this article we describe a new technique for bile duct reconstruction in a pig model by means of an autologous vein graft that is splinted by a endoluminal biodegradable polylactate acid stent. In 12 pigs the external jugular vein was removed and used as an autologous vein graft. After performing a median laparotomy a 2-cm segment was resected from the bile duct. The common bile duct was reconstructed by a venous interponate that had been endoluminally stented by a biodegradable polylactate acid stent. For the examination of stent degradation, 2 pigs were sacrificed at 3, 4, and 5 months (stent degradation group) and the remaining 6 pigs at 6 months (survival group). All the pigs in the survival group survived for 6 months before being sacrificed. After 4 months the stent material had been completely broken down and the vein graft had been relined with bile duct epithelium. Thus, this new technique for bile duct reconstruction using an autologous vein graft with an endoluminal stent is simple to perform and reliable, and constitutes an interesting alternative to bilodigestive anastomosis due to the preservation of the papilla of Vateri.
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Affiliation(s)
- Hans-Peter Heistermann
- Chirurgische Universitätsklinik der Ruhr-Universität Bochum, Marienhospital Herne, Germany
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Simopoulos C, Botaitis S, Polychronidis A, Tripsianis G, Karayiannakis AJ. Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy. Surg Endosc 2005; 19:905-9. [PMID: 15868267 DOI: 10.1007/s00464-004-2197-0] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2004] [Accepted: 12/15/2004] [Indexed: 11/25/2022]
Abstract
BACKGROUND Conversion to open cholecystectomy is still required in some patients. The aim of this study was to evaluate preoperative factors associated with conversion to open cholecystectomy in elective cholecystectomy and acute cholecystitis. METHODS The records of 1,804 patients who underwent cholecystectomy from May 1992 to January 2004 were reviewed retrospectively. The demographics and preoperative data of patients who required conversion to laparotomy were compared to those with successful laparoscopic cholecystectomy. RESULTS Conversion to open cholecystectomy was needed in 94 patients (5.2%),of which 44 (2.8%) had no inflammation and 50 (18.4%) had acute inflammation of the gallbladder. Male gender, age older than 60 years, previous upper abdominal surgery, diabetes, and severity of inflammation were all significantly correlated with an increased conversion rate to laparotomy. Also, the conversion from laparoscopic to open cholecystectomy in acute cholecystitis patients was associated with greater white blood cell count, fever, elevated total bilirubin, aspartate transaminase, and alanine transaminase levels, and the various types of inflammation. CONCLUSIONS None of these risk factors were contraindications to laparoscopic cholecystectomy. This may help predict the difficulty of the procedure and permit the surgeon to better inform patients about the risk of conversion from laparoscopic to open cholecystectomy.
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Affiliation(s)
- C Simopoulos
- Second Department of Surgery, Democritus University of Thrace, 15 Kolokotroni Street, Alexandroupolis 68100, Greece
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Kohneh Shahri N, Lasnier C, Paineau J. [Bile duct injuries at laparoscopic cholecystectomy: early repair results]. ACTA ACUST UNITED AC 2005; 130:218-23. [PMID: 15847856 DOI: 10.1016/j.anchir.2004.12.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2004] [Accepted: 12/22/2004] [Indexed: 12/27/2022]
Abstract
STUDY AIM To compare the early repair results in bile duct injuries at laparoscopic cholecystectomy to a later repair and so the early reconstruction by an end-to-end anastomosis to a Roux-en-Y bypass. PATIENTS AND METHOD From 1990 to 2003, twelve patients were treated for bile duct injury, not diagnosed at the time of cholecystectomy and had an early repair within 30 days after the cholecystectomy. They had either a duct to duct anastomosis or a Roux-en-Y bypass at the time of the reconstruction. RESULTS The level of the injury was Bismuth II (N=7), III (N=1), IV (N=2) and V (N=1) referral to Bismuth classification and one isolated right sectoral duct injury. Four patients had an duct to duct anastomosis and eight an hepaticojejunostomy at a median of 15.3 days after cholecystectomy. With one patient lost to follow up, the overall success rate in this series was 81.8% after reconstruction with a mean 40 months follow up. The reconstruction by an end to end anastomosis was successful in 100% of patients (with a mean 31.2 months follow up) and in 71.4% of patients after a Roux-en-Y biliary reconstruction (with a mean 45 months follow up). CONCLUSION Good results may be performed, by an early repair in bile duct injuries at laparoscopic cholecystectomy, either by an duct to duct anastomosis or a Roux-en-Y bypass.
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Affiliation(s)
- N Kohneh Shahri
- Service de clinique chirurgicale, 1, centre hospitalier universitaire de Nantes, 4409 Nantes cedex 01, France.
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Chowbey PK, Soni V, Sharma A, Khullar R, Baijal M. Laparoscopic hepaticojejunostomy for biliary strictures: the experience of 10 patients. Surg Endosc 2004; 19:273-9. [PMID: 15580446 DOI: 10.1007/s00464-003-8288-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2003] [Accepted: 07/19/2004] [Indexed: 02/07/2023]
Abstract
Hepaticojejunostomy is performed to reestablish bilioenteric continuity. During a 5-year period between July 1998 and July 2003, the authors attempted hepaticojejunostomy by a total laparoscopic approach in 10 patients with benign stricture disorders of the extrahepatic biliary tree. Six of these patients had type 1 (extrahepatic, fusiform) choledochal cyst and presented with pain, fever, and jaundice. Four of the patients had iatrogenic biliary strictures after cholecystectomy (2 patients after laparoscopic cholecystectomy and 2 patients after open cholecystectomy). These patients had a variable presentation 1 to 3 weeks after the primary procedure, with peritonitis and/or cholangitis or only progressive jaundice. For nine of the patients (90%), the procedure was completed entirely laparoscopically. The mean operative time was 326.6 min for the patients with choledochal cysts and 268 min for the patients with iatrogenic strictures. One patient with stricture after open cholecystectomy underwent conversion to an open repair because of severe anatomic distortion and fibrosis. Four patients drained bile postoperatively for 5 to 7 days. One patient with iatrogenic biliary stricture after open cholecystectomy required open revision of the anastomosis 18 months after laparoscopic hepaticojejunostomy because of recurrent cholangitis. The remaining eight patients (80%) were doing well a mean follow-up period of 3.1 years (range, 3 months to 5 years). Total laparoscopic hepaticojejunostomy is feasible for a select group of patients, but requires advanced laparoscopic skills, including intracorporeal suturing. It must be attempted only in centers well versed in advanced laparoscopic surgery.
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Affiliation(s)
- P K Chowbey
- Department of Minimal Access Surgery, Sir Ganga Ram Hospital, New Delhi, 11060, India.
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