UPDATES IN MANAGEMENT OF IATROGENIC BILE DUCT INJURIES
Waleed Farag Abdulrazike Helwa;
Abstract
Cholecystectomy is the most frequently performed operation in abdominal surgery. LC replacing OC is now performed in more than 80% of surgically treated patients for symptomatic gall stones.
Despite the clear benefits of LC, the rate of iatrogenic bile duct injury has increased from a rate of 0.1% to 0.2% during the era of OC to between 0.4% and 0.6% during the era of LC. Unfortunately, iatrogenic bile duct injuries result in increased patient morbidity and mortality and impart a huge increased financial burden in hospital resource use and excessive malpractice litigation.
Recently, (MRCP) has emerged as a potentially valuable tool in evaluating proximal BDI. This non-invasive modality provides sticking images of the biliary tree, and yield anatomical information in a single study that was previously obtainable only with CT and PTC.
A multidisciplinary approach (gastroenterologist, radiologist and surgeon) is advocated not only for the diagnostic work-up, but also to decide on the optimal treatment modalities.
There are factors that influence the surgical success rate: preoperative diagnostic evaluation, notably cholangiography, the surgical technique, and the experience of the surgeon.
The management of these injuries requires good planning, preoperative preparation, highly sophisticated interventional techniques and advanced hepatobiliary surgical procedures. Coordinated efforts between radiologists, endoscopist, and surgeons are necessary to optimize the management of patients with major bile duct injury, suggesting that patients with biliary complications of LC should be referred to specialty centers for optimal care.
Despite the clear benefits of LC, the rate of iatrogenic bile duct injury has increased from a rate of 0.1% to 0.2% during the era of OC to between 0.4% and 0.6% during the era of LC. Unfortunately, iatrogenic bile duct injuries result in increased patient morbidity and mortality and impart a huge increased financial burden in hospital resource use and excessive malpractice litigation.
Recently, (MRCP) has emerged as a potentially valuable tool in evaluating proximal BDI. This non-invasive modality provides sticking images of the biliary tree, and yield anatomical information in a single study that was previously obtainable only with CT and PTC.
A multidisciplinary approach (gastroenterologist, radiologist and surgeon) is advocated not only for the diagnostic work-up, but also to decide on the optimal treatment modalities.
There are factors that influence the surgical success rate: preoperative diagnostic evaluation, notably cholangiography, the surgical technique, and the experience of the surgeon.
The management of these injuries requires good planning, preoperative preparation, highly sophisticated interventional techniques and advanced hepatobiliary surgical procedures. Coordinated efforts between radiologists, endoscopist, and surgeons are necessary to optimize the management of patients with major bile duct injury, suggesting that patients with biliary complications of LC should be referred to specialty centers for optimal care.
Other data
| Title | UPDATES IN MANAGEMENT OF IATROGENIC BILE DUCT INJURIES | Other Titles | الطرق المستحدثة فى علاج إصابات القنوات المرارية علاجية المنشأ | Authors | Waleed Farag Abdulrazike Helwa | Issue Date | 2015 |
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