Abstract
Background
Bile duct injuries related to laparoscopic and/or open cholecystectomy are a frequent finding and require surgical treatment. Complete obstruction is due to either intentionally or unintentionally placed ligatures or clips. The intentional application is usually performed to “facilitate identification of the duct by bile duct dilation.” Considering that we are a national referral center for such injuries, we decided to analyze our cases of voluntary and involuntary duct ligation after iatrogenic bile duct injury.
Methods
We reviewed the files of patients with voluntary or involuntary bile duct ligation. Results of preoperative evaluation of the ducts, operative treatment, and postoperative results were analyzed.
Results
A total of 413 patients were included. Forty-five patients presented with complete obstruction. In 15 cases, the ligature was intentional, and in 30 cases, occlusion was involuntary. Bile duct dilation (>10 mm) was demonstrated in one case of voluntary (6%) and three cases of involuntary ligations (10%). The remaining cases in both groups had no duct dilation and developed necrosis at the blinded duct and leakage proximal to the ligature, with different degrees of bilioperitoneum and/or biloma. In all cases, a Roux-en-Y hepatojejunostomy was performed.
Conclusion
Bile duct ligature produces dilation in a very small number of patients (less than 10%) and usually produces necrosis of the blinded stump with subsequent bile leakage. Placement of a subhepatic drain and transference of the patient to a qualified center for reconstruction is the best approach if the primary surgeon is not able to do the repair.
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References
Chapman WC, Abecassis M, Jarnagin W, Mulvihill S, Strasberg SM. Bile duct injuries 12 tears after the introduction of laparoscopic cholecystectomy. J Gastrointest Surg 2003;7:412–416.
Flum DR, Cheadle A, Prela C, Dellinger EP, Chan L. Bile duct injury during cholecystectomy and survival in medicare beneficiaries. JAMA 2003;290:2168–2173.
Way LW, Stewart L, Gantert W, Liuk K, Lee CM, Hunter JG. Causes and prevention of laparoscopic bile duct injuries. Analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg 2003;237(4):460–469.
Strasberg SM, Herti M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995;180:101–125.
Stewart L, Way LW. Bile duct injuries during laparoscopic cholecystectomy. Factors that influence the results of treatment. Arch Surg 1995;130:1123–1128.
Bismuth H, Majno PE. Biliary stricture: classification based on the principles of surgical treatment. World J Surg 2001;25:1241–1244.
Mercado MA, Chan C, Orozco H, Barajas-Olivas A, Villalta JM, Domínguez I, Evans J, Poucel F. Bile duct injuries related to misplacement of T Tubes. Ann Hepatol 2006;5:44–48.
De Reuver P, Rauws E, Vermeulen M, Dijkgraaf M, Gouma D, Bruno M. Endoscopic treatment of post-surgical bile duct injuries: long term outcome and predictors of success. Gut 2007;56:1599–1605.
Thomson BN, Parks RW, Madhavan KK, Wigmore SJ, Garden OJ. Early specialist repair of biliary injury. Br J Surg 2006;93:216–220.
Mercado MA, Chan C, Orozco H, Villalta JM, Barajas-Olivas A, Eraña J, Dominguez I. Long term evaluation of biliary reconstruction after partial resection of segment IV and V in iatrogenic injuries. J Gastrointest Surg 2006;10:77–82.
Mercado MA. Early versus late repairs of bile duct injuries. Surg Endosc 2006;20:1644–1647.
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Mercado, M.A., Chan, C., Jacinto, J.C. et al. Voluntary and Involuntary Ligature of the Bile Duct in Iatrogenic Injuries: A Nonadvisable Approach. J Gastrointest Surg 12, 1029–1032 (2008). https://doi.org/10.1007/s11605-007-0434-2
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DOI: https://doi.org/10.1007/s11605-007-0434-2