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. 2014:2014:575136.
doi: 10.1155/2014/575136. Epub 2014 Nov 10.

Iatrogenic biliary injuries: multidisciplinary management in a major tertiary referral center

Ibrahim Abdelkader Salama  1 , Hany Abdelmeged Shoreem  1 , Sherif Mohamed Saleh  1 , Osama Hegazy  1 , Mohamed Housseni  2 , Mohamed Abbasy  3 , Gamal Badra  3 , Tarek Ibrahim  1
Affiliations

Iatrogenic biliary injuries: multidisciplinary management in a major tertiary referral center

Ibrahim Abdelkader Salama et al. HPB Surg. 2014.

Abstract

Background. Iatrogenic biliary injuries are considered as the most serious complications during cholecystectomy. Better outcomes of such injuries have been shown in cases managed in a specialized center. Objective. To evaluate biliary injuries management in major referral hepatobiliary center. Patients & Methods. Four hundred seventy-two consecutive patients with postcholecystectomy biliary injuries were managed with multidisciplinary team (hepatobiliary surgeon, gastroenterologist, and radiologist) at major Hepatobiliary Center in Egypt over 10-year period using endoscopy in 232 patients, percutaneous techniques in 42 patients, and surgery in 198 patients. Results. Endoscopy was very successful initial treatment of 232 patients (49%) with mild/moderate biliary leakage (68%) and biliary stricture (47%) with increased success by addition of percutaneous (Rendezvous technique) in 18 patients (3.8%). However, surgery was needed in 198 patients (42%) for major duct transection, ligation, major leakage, and massive stricture. Surgery was urgent in 62 patients and elective in 136 patients. Hepaticojejunostomy was done in most of cases with transanastomotic stents. There was one mortality after surgery due to biliary sepsis and postoperative stricture in 3 cases (1.5%) treated with percutaneous dilation and stenting. Conclusion. Management of biliary injuries was much better with multidisciplinary care team with initial minimal invasive technique to major surgery in major complex injury encouraging early referral to highly specialized hepatobiliary center.

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Figures

Figure 1
Figure 1
Endoscopic retrograde cholangiopancreatography showing minor biliary leakage from cystic duct stump and aberrant RHD radical, treated by sphincterotomy and stenting.
Figure 2
Figure 2
Endoscopic retrograde cholangiopancreatography showing a clipped, ligated common bile duct and a transection common bile duct with major biliary leakage.
Figure 3
Figure 3
Endoscopic retrograde cholangiopancreatography showing common bile duct stricture treated by dilation and stenting.
Figure 4
Figure 4
Rendezvous technique that followed PTC by dilatation and stenting of the CBD.
Figure 5
Figure 5
Rendezvous techniques with endoscopic stenting for common bile duct stricture.
Figure 6
Figure 6
Percutaneous transhepatic dilation and stenting of the postoperative anastomotic stricture.
Figure 7
Figure 7
Operative photograph of ligated common bile duct with ligature (open) and clip (Laparoscopic).
Figure 8
Figure 8
Operative photograph of meticulous dissection in porta hepatis to expose biliary injuries.
Figure 9
Figure 9
Operative dissections of hepatic ducts with Roux-en-Y loop hepaticojejunostomy anastomosis.
Figure 10
Figure 10
Operative hepaticojejunostomy and anastomosis of jejunum with single ostomy of both right and left hepatic ducts after operative stomaplasty.
See this image and copyright information in PMC

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