INTRODUCTION: The objective of this study was to determine the outcome of on table repair of iatrogenic bile duct injuries (IBDIs) following laparoscopic cholecystectomy, by specialist hepatobiliary surgeons as an outreach service. PATIENTS AND METHODS: Prospectively collected data on IBDI managed as an outreach service, was analysed retrospectively. The Strasberg classification was used to define types of injury. RESULTS: There were 22 patients. Twenty (91%) had type E 'classical' excision injuries, two had types B and D. Two type E cases had co-existent vascular injury both with right hepatic artery injuries; one also had a co-existent portal vein injury. A Roux-en-Y hepaticojejunostomy was used to repair the IBDI in 21 (95%) patients. One type D injury had duct repair over a T-tube. No attempt was made to reconstruct the injured hepatic arteries, while the portal vein injury was primarily repaired. The median follow-up was 210 days (range, 47-1088 days). Two patients developed bile leak and cholangitis while another developed transient jaundice. There were no postoperative mortalities. All patients were followed up at our centre. CONCLUSIONS: Repair of IBDI as an outreach service by specialist surgeons is feasible and safe, with minimal disruption to the patient pathway. Prompt recognition and definitive management may help reduce complaints and medicolegal litigation.
INTRODUCTION: The objective of this study was to determine the outcome of on table repair of iatrogenic bile duct injuries (IBDIs) following laparoscopic cholecystectomy, by specialist hepatobiliary surgeons as an outreach service. PATIENTS AND METHODS: Prospectively collected data on IBDI managed as an outreach service, was analysed retrospectively. The Strasberg classification was used to define types of injury. RESULTS: There were 22 patients. Twenty (91%) had type E 'classical' excision injuries, two had types B and D. Two type E cases had co-existent vascular injury both with right hepatic artery injuries; one also had a co-existent portal vein injury. A Roux-en-Y hepaticojejunostomy was used to repair the IBDI in 21 (95%) patients. One type D injury had duct repair over a T-tube. No attempt was made to reconstruct the injured hepatic arteries, while the portal vein injury was primarily repaired. The median follow-up was 210 days (range, 47-1088 days). Two patients developed bile leak and cholangitis while another developed transient jaundice. There were no postoperative mortalities. All patients were followed up at our centre. CONCLUSIONS: Repair of IBDI as an outreach service by specialist surgeons is feasible and safe, with minimal disruption to the patient pathway. Prompt recognition and definitive management may help reduce complaints and medicolegal litigation.
Authors: S J Savader; K D Lillemoe; C A Prescott; A B Winick; A C Venbrux; G B Lund; S E Mitchell; J L Cameron; F A Osterman Journal: Ann Surg Date: 1997-03 Impact factor: 12.969
Authors: Andrea Frilling; Jun Li; Frank Weber; Nils Roman Frühauf; Jennifer Engel; Susanne Beckebaum; Andreas Paul; Thomas Zöpf; Massimo Malago; Christoph Erich Broelsch Journal: J Gastrointest Surg Date: 2004 Sep-Oct Impact factor: 3.267
Authors: M T P R Perera; M A Silva; A J Shah; R Hardstaff; S R Bramhall; J Issac; J A C Buckels; D F Mirza Journal: World J Surg Date: 2010-11 Impact factor: 3.352
Authors: M P Senthilkumar; N Battula; Mtpr Perera; R Marudanayagam; J Isaac; P Muiesan; S P Olliff; D F Mirza Journal: Ann R Coll Surg Engl Date: 2016-09 Impact factor: 1.891
Authors: M T P R Perera; A Monaco; M A Silva; S R Bramhall; A D Mayer; J A C Buckels; D F Mirza Journal: Surg Endosc Date: 2011-03-17 Impact factor: 4.584