Prevention of iatrogenic bile duct injuries in difficult laparoscopic cholecystectomies: is the naso-biliary drain the answer?
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Abstract
Background
Prevention of iatrogenic injuries is of paramount importance in difficult laparoscopic cholecystectomies (LC). The objective of this study was to analyze the effectiveness of cholangiography using a pre-inserted endoscopic naso-biliary drain (ENBD) for navigation during difficult cholecystectomies.
Methods
The study design was a retrospective case analysis. In 508 patients who underwent LC in a tertiary referral university hospital from 1996 through 2007, difficult cholecystectomy was anticipated in 26 patients due to possibly aberrant biliary anatomy (four patients), unclear cystic duct anatomy during magnetic resonance cholangiopancreatography (MRCP) and/or endoscopic retrograde cholangiopancreatography (ERCP) (three patients), and acute cholecystitis (19 patients). An ENBD was inserted during ERCP prior to LC for cholangiography (ENBDC) to facilitate safe dissection during LC. Prevalence of biliary complications was assessed as the main outcome measurement.
Results
The majority (68%) of the patients who underwent ENBDC had complicated cholecystitis. Advanced technical expertise was not required for insertion of an ENBD. In retrospect, ENBDC was useful in prevention of a possible catastrophe in 69% of cases. Open conversion was necessary in five patients and biliary complications occurred in five patients only in the non-ENBD group. There were no procedure-related complications. One limitation of the study was that it was not randomized and there was no comparison with patients without ENBDC.
Conclusions
ENBDC is a useful and safe tool in the prevention of iatrogenic bile duct injuries in LC.
Keywords
Endoscopic naso-biliary drainage Iatrogenic injury Endoscopic retrograde cholangiopancreatography Bile duct injury Laparoscopic cholecystectomyReferences
- 1.Schirmer BD, Edge SB, Dix J, Hyser MJ, Hanks JB, Jones RS. Laparoscopic cholecystectomy treatment of choice for symptomatic cholelithiasis. Ann Surg. 1991;213:665–77.PubMedCrossRefGoogle Scholar
- 2.Liyanage CAH, Sabaratnam VY, Deen KI. A structured training programme in laparoscopic cholecystectomy. Ceylon Med J. 2006;51:74–5.PubMedGoogle Scholar
- 3.Koperna T, Kisser M, Schulz F. Laparoscopic versus open treatment of patients with acute cholecystitis. Hepatogastroenterology. 1999;46:753–7.PubMedGoogle Scholar
- 4.Besser P. Nasobiliary drainage for biliary leaks after laparoscopic cholecystectomy. Med Sci Int. 2001;7:118–9.Google Scholar
- 5.Slater K, Strong RW, Wall DR, Lynch SV. Iatrogenic bile duct injury: the scourge of laparoscopic cholecystectomy. Aust N Z J Surg. 2002;72:83–8.CrossRefGoogle Scholar
- 6.Lipman JM, Claridge JA, Haridas M, Martin MD, Yao DC, Grimes KL, et al. Preoperative findings predict conversion from laparoscopic to open cholecystectomy. Surgery. 2007;142:556–65.PubMedCrossRefGoogle Scholar
- 7.Rosen M, Brody F, Ponsky J. Predictive factors for conversion of laparoscopic cholecystectomy. Am J Surg. 2002;184:254–8.PubMedCrossRefGoogle Scholar
- 8.Nagai N, Toki F, Oi I, Suzuki H, Kozu T. Continuous endoscopic pancreatocholedochal catheterization. Gastrointest Endosc. 1976;23:78–81.PubMedCrossRefGoogle Scholar
- 9.Itoi T, Sofuni A, Itokawa F, Tuchiya T, Kurihara T. Role of endoscopic nasobiliary drainage indication and basic technique. Digest Endosc. 2006;18:105–9.CrossRefGoogle Scholar
- 10.Lee WDH, Chan AC, Lam YH, Ng EK, Lau JY, Law BK, et al. Biliary decompression by nasobiliary catheter or biliary stent in acute suppurative cholangitis: a prospective randomized trial. Gastrointest Endosc. 2002;56:361–5.PubMedCrossRefGoogle Scholar
- 11.Chow S, Bosco JJ, Heiss FW, Shea JA, Qaseem T, Howell D. Successful treatment of post-cholecystectomy bile leaks using nasobiliary tube drainage and sphincterotomy. Am J Gastroenterol. 1997;92:1839–43.PubMedGoogle Scholar
- 12.Suter M, Meyer A. A 10-year experience with the use of laparoscopic cholecystectomy for acute cholecystitis: is it safe? Surg Endosc. 2001;10:1187–92.CrossRefGoogle Scholar
- 13.Gigot J, Etienne J, Aerts R, Wibin E, Dallemagne B, Deweer F, et al. The dramatic reality of biliary tract injury during laparoscopic cholecystectomy. An anonymous multicenter Belgian survey of 65 patients. Surg Endosc. 1997;11:1171–8.PubMedCrossRefGoogle Scholar