Author/Editor		Shamiyeh, A; Schrenk, P; Woisetschlaeger, R; Rieger, R; Wayand, W. U.
Title		Biliarytract complications following laparoscopic cholecystectomy - etiogy, diagnosis and management
Translated title		Poškodbe žolčnih izvodil po laparoskopski holecistektomiji - vzroki, diagnoza in zdravljenje
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 2, št. 4
Publication year		1997
Volume		str. 71-6
Language		eng
Abstract		Background. Bile leaks and injuries to the common bile duct (CBD) are rare but serious complications following laparoscopic cholecystectomy (LC). Patients and methods. From March 1990 to April 1997, 6 injuries to CBD and 13 bile leaks occurred followin LC in 2,380 patients (0.78%). There were 14 women and 5 men, their mean age was 49.7 years. Results. Five CBD injuries were diagnosed intraoperatively, one was discovered on the 16th postoperative day. Bile leaks were identified 3 to 25 days (mean 9.8 days) after LC, with abdominal pain, general discomfort and delayed recovery being the most common symptoms. CBD injuries occured due to misidentificatio of the cystic duct (5), and inadvertent injury produced by scissors (1). The cystic stump was the most common site of leakage (10); in the rest of the patients we found an aberrant bile duct (1), and leakage of the gallbladder remnant after incomplete excision of the gallbladder infundibulum (1). In one patient the etiology of the leakage remained unknown. CBD injuries were treated by the T-tube drainage and primary suture (4) and Roux-en-Y hepaticojejunostomy (2). The morbidity following direct suture was high (5%); postoperative complications included stricture of CBD (1 case), ileus (1 case) and herniation of the abdominal wall (1 case). ERCP was performed in 11 of 13 patients with bile leakage, and sphincterotomy was done in 8 of 12 patients. Laparotomy was required in 2 patients due to biliary peritonitis. Conclusion. CBD injuries are serious complications tht should be treated by an experienced hepato-biliary surgeon. For small CBD lacerations, treatment by the T-tube drainage and primary suture is recommended. In completely transected CBD or common hepatic duct, or large defects, biliodigestive anastomosis is the treatment of choice. Bile leaks after LC can be successfully managed by endoscopy. (Izvleček prekinjen pri 2000 znakih.)
Descriptors		CHOLECYSTECTOMY, LAPAROSCOPIC COMMON BILE DUCT DISEASES COMMON BILE DUCT BILE