Right hepatic artery injury associated with laparoscopic bile duct injury: Incidence, mechanism, and consequences
Because most bile duct injuries involve the common hepatic duct, the right hepatic artery, which is nearby, can also be injured. Reports on the frequency and significance of right hepatic artery injury (RHAI) associated with bile duct injury are sparse but suggest that RHAI increases mortality and decreases the success of the biliary repair. We studied the incidence, mechanism, and consequences of RHAI accompanying major bile duct injury. A total of 261 laparoscopic bile duct injuries were analyzed. Distribution was as follows: class I, 6%; class II, 22%; class III, 61%; and class IV, 11%. RHAI was present in 84 cases (32%): class I, 6%; class II, 17%; class III, 35% (P < 0.04 vs. class I/II); and class IV, 64% (P < 0.007 vs. class I/II/III). RHAI was more commonly associated with abscess, bleeding, hemobilia, right hepatic lobe ischemia, and subsequent hepatectomy (54% with RHAI vs. 11% without RHAI; P < 0.0001). RHAI had no infiuence on the success of the bile duct injury repair or on the mortality rate. Complications occurred more often with RHAI among cases repaired by the primary surgeon (41% RHAIvs.2%no RHAI; P < 0.0001) but not among repairs by a biliary surgeon (3%RHAIvs.2%no RHAI, P = NS; P < 0.0001 primary vs. biliary surgeon). RHAI increased morbidity, and occurred more often with class III and IV injuries refiecting the mechanisms of these injuries. RHAI did not increase the mortality rate or alter the success of biliary repair. Among biliary injuries repaired by the primary surgeon, RHAI was associated with a higher incidence of postoperative abscess, bleeding, hemobilia, hepatic ischemia, and the need for hepatic resection. A similar increase in the complication rate was not seen in patients treated by a biliary specialist.
Key wordsHepatic arterial injury bile duct injury laparoscopic biliary cholecystectomy
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