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Repair of bile duct injuries

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Abstract

Twenty-two patients with surgical injury to the common hepatic duct or common bile duct were evaluated. In 20 patients the injury occurred during cholecystectomy and resulted from mistaken identification of the common duct for the cystic duct. Roux-en-Y hepaticojejunostomy was performed in 21 patients. Three of the anastomoses were end-to-side, while 18 were side-to-side. Choledochoduodenostomy was performed in 1 patient.

There were no operative deaths in the 22 patients. Four (18%) patients developed wound infections and in 2 (9%) patients there was a transient bile leak. Two patients died of liver failure due to irreversible biliary cirrhosis 2 and 3 years after the initial injury. All patients in whom side-to-side Roux-en-Y hepaticojejunostomy was performed as a first procedure (14 cases) had a successful long-term result with no signs of cholangitis or anastomotic stenosis. The 3 patients with end-to-side hepaticojejunostomy developed anastomotic stricture with repeated attacks of cholangitis and required secondary operations. The patient treated by choledochoduodenostomy had a satisfactory result. Patients with iatrogenic bile duct injury can be managed with a high degree of success if referred early and treated appropriately.

Résumé

Les lésions traumatiques iatrogènes des voies biliaires extra-hépatiques sont le fait le plus souvent des cholecystectomies mais elles peuvent s'observer également lors des cholédocotomies ou des gastrectomies difficiles pour ulcère duodénal postérieur térébrant. Il est capital de prévenir ces complications redoutables pour l'exposition méticuleuse de la voie biliaire principale au cours de la chirurgie biliaire ou de la chirurgie gastrique. La blessure des voies biliaires extra-hépatiques doit être traitée précocément avant la constitution de lésions irréversibles du parenchyme. Pour ce faire il convient d'adresser le blessé dans un centre spécialisé où sera pratiquée une hépatico-jéjunostomie sur une anse jéjunale longue montée en Y, l'anastose portant sur le moignon sain du canal hépatique commun et le canal hépatique gauche suivant la technique de Hepp.

Resumen

Veintidos pacientes con lesiones quirÚrgicas del canal hepático comÚn o del canal colédoco fueron evaluados. En 20 pacientes la lesión ocurrió en el curso de una colecistectomía y fue el resultado de error en la identificación del hepático comÚn o del cístico. Se realizó hepático-yeyunostomía de Roux-en-Y en 21 casos; tres de las anastomosis fueron término-laterales, mientras 18 fueron látero-laterales.

No se presentó mortalidad operatoria en los 22 pacientes. Cuatro (18%) casos desarrollaron infección de la herida y en 2 (9%) casos ocurrió escape transitorio de bilis. Dos pacientes murieron de falla hepática debida a cirrosis biliar irreversible, dos y très años después de la lesión inicial. Todos los pacientes en quienes se realizó hepático-yeyunosto-mía látero-lateral de Roux-en-Y como procedimiento primario (14 casos) presentaron un resultado exitoso a largo plazo, sin signos de colangitis o de estrechez de la anastomosis. Los 3 casos con hepático-yeyunostomía término-lateral desarrollaron estrechez de la anastomosis con ataques repetidos de colangitis que requirieron una segunda operación. El caso tratado con colédoco-duodenostomía tuvo un resultado satisfactorio.

Los pacientes con lesión iatrogénica del conducto biliar pueden ser manejados con un alto grado de éxito si son prontamente referidos y tratados en forma apropiada.

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Correspondence to Khairy Saber F.R.C.S..

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Saber, K., El-Manialawi, M. Repair of bile duct injuries. World J. Surg. 8, 82–88 (1984). https://doi.org/10.1007/BF01658372

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Keywords

  • Bile Duct
  • Common Bile Duct
  • Cholangitis
  • Como
  • Cystic Duct