BACKGROUND: Several views are expressed by surgeons on biliary complications following laparoscopic cholecystectomy as follow: most are caused by trainees; complications occur in the presence of difficult anatomy/pathology; injuries occur more proximally than at open cholecystectomy; most injuries are recognised immediately and most can be managed non-operatively. The aim of our study was to determine if these views are substantiated in clinical practice. METHODS: The mode of presentation, management and outcome of thirty-two patients referred to a hepatobiliary unit over a seven year period were analysed. RESULTS: In 72% of cases the initial operator was a consultant. Five of the 32 complications (16%) occurred in the presence of difficult anatomy/pathology. Two patients had proximal biliary tree injuries, the only mortalities (two) occurring in this group. Only 41% of injuries were detected immediately; 87% required surgical intervention, hepaticojejunostomy being the most common procedure performed (75%). CONCLUSION: Our study shows that the majority of bile duct injuries are not caused by trainees, do not occur because of unusual anatomy/pathology, do not occur in the proximal biliary tree and are not recognised at the time of operation. Most injuries ultimately require major reconstructive surgery for definitive management.
BACKGROUND: Several views are expressed by surgeons on biliary complications following laparoscopic cholecystectomy as follow: most are caused by trainees; complications occur in the presence of difficult anatomy/pathology; injuries occur more proximally than at open cholecystectomy; most injuries are recognised immediately and most can be managed non-operatively. The aim of our study was to determine if these views are substantiated in clinical practice. METHODS: The mode of presentation, management and outcome of thirty-two patients referred to a hepatobiliary unit over a seven year period were analysed. RESULTS: In 72% of cases the initial operator was a consultant. Five of the 32 complications (16%) occurred in the presence of difficult anatomy/pathology. Two patients had proximal biliary tree injuries, the only mortalities (two) occurring in this group. Only 41% of injuries were detected immediately; 87% required surgical intervention, hepaticojejunostomy being the most common procedure performed (75%). CONCLUSION: Our study shows that the majority of bile duct injuries are not caused by trainees, do not occur because of unusual anatomy/pathology, do not occur in the proximal biliary tree and are not recognised at the time of operation. Most injuries ultimately require major reconstructive surgery for definitive management.
Authors: D R Fletcher; M S Hobbs; P Tan; L J Valinsky; R L Hockey; T J Pikora; M W Knuiman; H J Sheiner; A Edis Journal: Ann Surg Date: 1999-04 Impact factor: 12.969
Authors: G Branum; C Schmitt; J Baillie; P Suhocki; M Baker; A Davidoff; S Branch; R Chari; G Cucchiaro; E Murray Journal: Ann Surg Date: 1993-05 Impact factor: 12.969
Authors: A M Davidoff; T N Pappas; E A Murray; D J Hilleren; R D Johnson; M E Baker; G E Newman; P B Cotton; W C Meyers Journal: Ann Surg Date: 1992-03 Impact factor: 12.969
Authors: G M Larson; G C Vitale; J Casey; J S Evans; G Gilliam; L Heuser; G McGee; M Rao; M J Scherm; C R Voyles Journal: Am J Surg Date: 1992-02 Impact factor: 2.565
Authors: Paweł Bogacki; Jan Krzak; Katarzyna Gotfryd-Bugajska; Mirosław Szura Journal: Wideochir Inne Tech Maloinwazyjne Date: 2019-03-04 Impact factor: 1.195