Management of nonvascular postlaparoscopic bile duct injury
Al-Sawat, Abdullah; Al-Jiffry, BilalO; Al Saeed, Mohamed; Al-Mourgi, Majed; Badr, Samir; Abdel-Rahman, Tamer; Shweel, Abdel-Hafez; Younes, AlaaE; Abu-Duruk, Aseel; Al-Malki, Owaid; Hatem, Mohamed; El-Meteini, Mahmoud;
Abstract
Background and Aim of the Work: Early management of postlaparoscopic nonvascular biliary injuries by
an expert team is essential to achieve a good outcome. In this article, we would evaluate the results of
this prospective multicentric study in the management of postlaparoscopic nonvascular biliary injuries.
Patients and Methods: This prospective multicentric study enrolled 168 patients with iatrogenic nonvascular
bile duct injury (BDI). In all cases, endoscopic retrograde cholangiopancreatography (ERCP) was performed,
and further management was done according to Strasberg type of injury.
Results: Intra‑abdominal biliary collection was managed by ultrasound‑guided drainage. Type A (19%) was
diagnosed and treated by ERCP. Types B and C (20.2%) were treated by duct reconstruction of the isolated
segment and Roux‑en‑Y hepaticojejunostomy (RYHJ), respectively. Strasberg type D nondevascularized
partial injury (7.1%) was treated by primary repair around stent. In complete type D patients and E (10.7%
and 43%, respectively), Roux en-Y hepaticojejunostomy with lowering the hilar plate was performed. After
ERCP, 78% of patients developed hyperamylasemia and only 4.8% developed pancreatitis. After HJ, 9.7% of
patients developed stricture and were treated by percutaneous transhepatic cholangial dilatation.
Conclusion: This study proved the safety and efficacy of the management of iatrogenic BDI by an expert
team implementing different diagnostic and treatment modalities such as ultrasound, computed tomography
scan, and ERCP in addition to different surgical options, particularly the use of right end‑to‑side and left
side‑to‑side RYHJ, with lowering the hilar plate and anterior anastomosis.
an expert team is essential to achieve a good outcome. In this article, we would evaluate the results of
this prospective multicentric study in the management of postlaparoscopic nonvascular biliary injuries.
Patients and Methods: This prospective multicentric study enrolled 168 patients with iatrogenic nonvascular
bile duct injury (BDI). In all cases, endoscopic retrograde cholangiopancreatography (ERCP) was performed,
and further management was done according to Strasberg type of injury.
Results: Intra‑abdominal biliary collection was managed by ultrasound‑guided drainage. Type A (19%) was
diagnosed and treated by ERCP. Types B and C (20.2%) were treated by duct reconstruction of the isolated
segment and Roux‑en‑Y hepaticojejunostomy (RYHJ), respectively. Strasberg type D nondevascularized
partial injury (7.1%) was treated by primary repair around stent. In complete type D patients and E (10.7%
and 43%, respectively), Roux en-Y hepaticojejunostomy with lowering the hilar plate was performed. After
ERCP, 78% of patients developed hyperamylasemia and only 4.8% developed pancreatitis. After HJ, 9.7% of
patients developed stricture and were treated by percutaneous transhepatic cholangial dilatation.
Conclusion: This study proved the safety and efficacy of the management of iatrogenic BDI by an expert
team implementing different diagnostic and treatment modalities such as ultrasound, computed tomography
scan, and ERCP in addition to different surgical options, particularly the use of right end‑to‑side and left
side‑to‑side RYHJ, with lowering the hilar plate and anterior anastomosis.
Other data
Title | Management of nonvascular postlaparoscopic bile duct injury | Authors | Al-Sawat, Abdullah; Al-Jiffry, BilalO; Al Saeed, Mohamed; Al-Mourgi, Majed; Badr, Samir; Abdel-Rahman, Tamer; Shweel, Abdel-Hafez; Younes, AlaaE; Abu-Duruk, Aseel; Al-Malki, Owaid; Hatem, Mohamed; El-Meteini, Mahmoud | Keywords | Biliary tree injury;Hepaticojejunostomy;Laparoscopic cholecystectomy;left side‑to‑side;nonvascular;right end‑to‑side | Issue Date | 2019 | Journal | Saudi Surgical Journal | Volume | 7 | Start page | 95 | End page | 99 | ISSN | 2320-3846 | DOI | 10.4103/ssj.ssj_4_19 |
Recommend this item
Similar Items from Core Recommender Database
Items in Ain Shams Scholar are protected by copyright, with all rights reserved, unless otherwise indicated.