Iatrogenic Duct Injury Research Articles

The long-term results using an autologous vascularized pedicled flap of stomach tissues in the repair of traumatic bile duct strictures

Objective To study the long-term results of using an autologous vascularized pedicled flap of gastric tissues in the repair of traumatic bile duct strictures. Methods From 2002 to 2016, 38 patients with traumatic bile duct strictures underwent repair using an autologous vascularized pedicled flap of stomach tissues. The postoperative morbidity, mortality, long-term clinical results, liver function and the rate of biliary stricture recurrence were studied. Results The overall complication rate was 18.4%(7/38). A delay in healing of the incision wound occurred in 4 patients, biliary fistula in 2, and ascites in 1. Two patients died of malignant tumor. The median follow-up was 92 (61~107) months and the follow-up rate was 100%. Excellent results were obtained in 97.2% (35/36) of patients. Abnormal liver function was detected in 1 patient which improved with treatment using choleretic drugs. The remaining 35 patients had normal liver functions with absence of abdominal pain. Conclusions To repair traumatic bile duct strictures using an autologous vascularized pedicled flap of stomach tissues was safe and reliable, and good long-term outcomes are available. Key words: Benign biliary stricture; Iatrogenic bile duct injury; Long-term outcomes; Flap of stomach tissues; Tissue repair

Minimally invasive therapy for iatrogenic bile duct injury

Objective To investigate the type, clinical and imaging features of iatrogenic bile duct injury and the efficacy and safety of endoscopic and interventional radiology therapy. Methods A total of 48 patients with iatrogenic bile duct injury who have undergone endoscopic and/or interventional therapy from January 1st 2013 to June 30th 2016 were enrolled. Patients′ general information, causes of injury, clinical manifestations, treatment methods, efficacy and complications were retrospectively analyzed. Results The causes of iatrogenic bile duct injury were cholecystectomy(45.8%, 22/48), liver transplantation(35.4%, 17/48), transjugular intrahepatic portosystemic shunt (8.3%, 4/48), Roux-en-Y anastomosis(6.3%, 3/48) and endoscopic retrograde cholangiopancreatography(4.2%, 2/48). The most common type of iatrogenic bile duct injury was stenosis of intra/extra bile ducts(66.7%, 32/48). Other types included biliary fistula(18.8%, 9/48), hemobilia(10.4%, 5/48) and stenosis of anastomotic stoma(4.2%, 2/48). The most common clinical manifestations were jaundice(37.5%, 18/48) and abdominal pain(29.2%, 14/48). Other clinical manifestations were fever(14.6%, 7/48), hematemesis or melena (8.3%, 4/48) and abnormal drainage fluid (8.3%, 4/48). Diagnosis was confirmed by angiography, cholangiography or endoscopy. The overall effective rate of minimally invasive therapy was 91.7%(44/48) and the most common complications were fever (16.7%, 8/48) and pancreatitis (10.4%, 5/48). Other complications were hemobilia (2.1%, 1/48), cardia dilaceration(2.1%, 1/48) and biliary fistula caused by catheter shedding(2.1%, 1/48). Conclusion Iatrogenic bile duct injury could occur after upper abdominal surgeries, endoscopic or interventional procedures. Early diagnosis and treatment with endoscopic or vascular interventional methods can achieve satisfying efficacy and safety. Key words: Cholangiopancreatography, endoscopic retrograde; Portasystemic shunt, transjugular intrahepatic; Cholecystectomy; Iatrogenic bile duct injury

Modification of conventional basin-forming hepatic duct-jejunum Roux-en-Y choledochojejunostomy: report of 57 cases

Objective To describe a modified basin-forming hepatic duct-jejunum Roux-en-Y choledochojejunostomy and explore its clinical application. Methods We retrospectively reviewed clinical data on 57 patients receiving modified basin-forming hepatic duct-jejunum Roux-en-Y choledochojejunostomy in the Department of Hepatobiliary Surgery, People's Hospital of Hunan Province during the period from February 2016 to August 2016. Results Among 57 cases, 38 cases previously underwent conventional basin-forming hepatic duct-jejunum Roux-en-Y choledochojejunostomy for the reasons such as hepatolithiasis, iatrogenic proximal bile duct injury, congenital choledochal cyst (Todani type I), etc. The mean number of operation was 1-4(1.8±1.3). Errors during reoperation can be classified relevant to cholangiojejunostomy anastomosis, bridging jejunal loop and jejunum-bridging jejunal loop anastomosis. Among 57 cases, bile intestinal anastomotic leakage occurred in one patient, incision fat liquefaction in 3 patients, 2 patients experienced stress gastritis, all postoperative complications recovered under conservative management. No postoperative mortality happened. During mean (4.07±3.27)months follow-up period, only 4 patients complained of reflux cholangitis, which could be easily managed by antibiotics use. Conclusions By correcting errors in application of conventional Roux-en-Y choledochojejunostomy, a modified basin-forming hepatic duct-jejunum Roux-en-Y choledochojejunostomy proposed in this study demonstrated preliminary better results. Key words: Anastomosis, Roux-en-Y/MT

Death causes of iatrogenic bile duct injury

Death causes of iatrogenic bile duct injury

Case Series: Iatrogenic Bile Duct Injury Treatment at José Carrasco Arteaga Hospital

INTRODUCCION: Las lesiones iatrogenicas de la via biliar por laparoscopia son siempre catastrofes quirurgicas con una alta morbilidad y mortalidad, ventajosamente su frecuencia es cada vez menor pero requieren de estrategias quirurgicas agresivas para su resolucion. Mediante la presentacion de 3 casos se realiza un acercamiento al manejo de este tipo de lesiones. CASOS CLINICOS: Se trata de tres pacientes tratados en el servicio de Cirugia General del HJCA durante el ano 2015, cada uno de los casos tuvo presentacion clinica, tiempos de diagnostico y tratamiento diferentes; se individualizo el manejo segun el caso. En los tres pacientes se realizo Derivacion Bilio-digestiva en Y de Roux como tecnica quirurgica resolutiva. EVOLUCION: Los tres pacientes evolucionaron favorablemente, en un caso fue necesaria una segunda intervencion por fuga biliar de la anastomosis y la posterior colocacion de un cateter en la anastomosis bilio-enterica mediante enteroscopia para el control de la fuga. CONCLUSION: Los casos evidenciaron la diversidad en la presentacion clinica de esta patologia y la necesidad de contar siempre con un equipo multidisciplinario de cirugia para su manejo, es fundamental determinar el nivel de lesion para establecer la estrategia quirurgica mas apropiada tomando en cuenta la posibilidad de conversion a cirugia abierta o referencia a un centro mas especializado

Diagnosis and treatment of patients with bile duct injury after laparoscopic cholecystectomy

Objective To study the role of endoscopic retrograde cholangiopancreatography (ERCP) in diagnosing and treating iatrogenic bile duct injury after laparoscopic cholecystectomy (LC). Methods A retrospective study was conducted on 45 patients with iatrogenic bile duct injury after LC who were investigated and treated by ERCP from December 2002 to August 2015. Results Using the Strasberg-Bismuth classification, there were 14 patients with type A and 4 with type C who were managed successfully using endoscopic nasobiliary drainage (ENBD) and interventional ultrasound abdominal localized puncture and drainage; 7 patients with type D were managed successfully using endoscopic sphincterotomy (EST) and endoscopic retrograde biliary drainage (ERBD). For the 5 patients with type EⅠand 3 patients with type EⅡ who were treated by EST and ERBD, one patient who had common bile duct transection required cholangioenteric Roux-en-Y anastomosis. For the 6 patients with type EⅢ and 6 patients with type EⅣ who were treated by EST and ERBD, a patient required a cholangioenteric Roux-en-Y anastomosis to achieve good results. Conclusions When iatrogenic bile duct injury is suspected after LC, correct assessment with ERCP should be taken immediately. ERCP when combined with ENBD and (or) ERBD could reduce bile duct pressure and dilate stenotic bile ducts to avoid further operation. Key words: Laparoscopic cholecystectomy; Bile duct injury; Endoscopic retrograde cholangio-pancreatography; Stasberg-Bismuth classification

Diagnosis and surgical treatment of obstructive azoospermia due to iatrogenic vas duct injury

Objective The goal of this study was to analyze the diagnosis of azoospermia caused by iatrogenic vas duct injury and evaluate the outcomes of surgical treatment. Methods Eleven patients, whose age ranged from 23 to 37 years old (mean 27 years old), with azoospermia caused by iatrogenic vas duct injury were consecutively admitted in our single center between January 2010 and June 2014. The characters of those patients included 9 cases of bilateral vas duct injury, 2 cases of unilateral vas duct injury with contralateral cryptorchidism or orchiectomy. All patients accepted scrotal physical examination, semen analysis, seminal plasma test, seminal duct Doppler ultrasonography, serum sex hormone and then diagnosed as obstructive azoospermia. Except one patient with unilateral cryptorchidism had normal seminal nutral α-glucosidase, other 10 patients had significantly low nutral α-glucosidase, ranged from 2.4 to 7.4 mU/once ejaculate (mean 4.4 mU/ ejaculation). All patients accept the inguinal surgical exploration. The early 4 patients were unable to be treated with surgical reconstruction due to the large defect of vas duct, failure to find distal vasal stump and secondary epididymal obstruction. Meanwhile, laparoscopic equipments and microscopic techniques were not prepared preoperatively. In the late 7 cases, six underwent simple vasovasostomy, laparoscopic-assisted vasovasostomy, and modified vasoepididymostomy based on length and sites of vasal injuries and condition of secondary epididymal obstruction. One failed to be reconstructed due to pelvic vas atrophy. The definition of successful recanalization was the density of sperm more than 1×106/ml during the postoperative follow-up. Results All patients had iatrogenic vas duct injury. Among six treated patients, five patients achieved recanalization, except one case was still azoospermia. The duration of follow-up in those five patients ranged from 6 to 32 months (mean 18 months). During following-up, naturally achieved pregnancy was recorded in two couples. The others could be treated with assisted reproductive technology, such as ICSI. Conclusion Low seminal nutral α-glucosidase potentially indicates vas duct injury. Surgical reconstruction should be considered as the first choice for azoospermia caused by iatrogenic vas duct injury due to its favorable outcome. Laparoscopic equipment and microsurgical technique can play a crucial role in surgical repair of vas duct injury. Key words: Male infertility, Azoospermia; Iatrogenic injury; Laparoscopy; Microsurgery

Repairing bile duct defects while preserving the sphincter of oddi

In recent years,the incidence of iatrogenic bile duct injury has increased.The traditional treatment methods often cause severe complications,such as biliary-enteric anastomosis,which removes the sphincter of Oddi's function.With the development and potential translational use of engineered tissue,surgeons have focused on keeping normal physiological function after operations.In this manuscript,we review the strategy to repair bile duct defects without sacrificing the sphincter of Oddi' s function.This article may be referenced for clinical research. Key words: Biliary tract surgical procedures; Intraoperative complications ; Tissue engineering; Biocompatible materials

Hepaticojejunostomy for the treatment of iatrogenic bile duct injury and stricture

医源性胆管损伤是胆囊切除术严重的并发症之一.在LC迅速发展的今天,LC导致医源性胆管损伤的发生率较开腹胆囊切除术更高.2006年10月至2011年8月我中心采用肝管空肠吻合术治疗14例医源性胆管损伤患者,取得了良好的疗效,现报道如下.1 资料与方法1.1 一般资料本组医源性胆管损伤患者14例,男6例,女8例;年龄28～62岁,平均年龄46岁.5例胆管损伤发生于开腹胆囊切除术,9例发生于LC.14例患者中,修复手术距胆囊切除术时间4个月至6年.4例患者带有T管.所有患者有急、慢性胆管炎表现,包括腹痛,伴或不伴发热,症状发作时均伴有黄疸. 关键词：胆管损伤;胆管狭窄;肝管空肠吻合

Management and long-term efficacy of patients with iatrogenic bile duct injury

Objective To investigate the management of iatrogenic bile duct injury and evaluate the longterm efficacy.Methods The clinical data of 62 patients with iatrogenic bile duct injury who were admitted to the Peking Union Hospital from January 1982 to April 2012 were retrospectively analyzed.Of the 62 cases of iatrogenic bile duct injuries,24 were caused by laparoscopic cholecystectomy (LC) and 38 were caused by open cholecystectomy. Ten patients received non-surgical treatment, including 8 patients received percutaneous transhepatic cholangiography and drainage (PTCD) and 2 received endoscopic retrograde cholangiopancreatography (ERCP) + stent implantation. Fifty-two patients received surgical treatment,including 47 received cholecystojejunostomy,2 received cholecystoduodenostomy,3 received biliary end-to-end anastomosis. Thirty-six patients received PTCD preoperatively,and 42 received biliary stent implantation intraoperatively.Fifty patients received intraoperative peritoneal drainage to prevent postoperative peritoneal effusion or encapsulated bile collection.Results Of the 52 patients who received surgery,13 patients were complicated by more than 1 complication,including 1 case of wound infection,4 cases of cholangitis,2 cases of anastomotic leakage,2 cases of anastomotic bleeding,1 case of anastomotic occlusion, 1 case of biliary stent falling out and 3 cases of gastrointestinal diseases.Eighteen patients received cholangiography postoperatively,and 2 patients were diagnosed as with bile leakage.Fifteen patients received PTCD + biliary stent implantation,and 1 patient of them received percutaneous puncture drainage.Two patients received reoperation due to anastomotic bleeding.The mean time of peritoneal drainage for the 50 patients was (7.7 ± 2.6) days.No perioperative death was observed,and the mean operation time was (18 ± 12) days.Fifty-five patients were followed up (10 patients received non-surgical treatment,and 45 patients received surgical treatment),with a median time of 93 months.Of the 10 patients who received nonsurgical treatment,1 received reoperation due to bile leakage,3 received PTCD for the second time due to repeated cholangitis after PTCD. Of the 45 patients who received surgical treatment,6 patients had long-term complications,including 6 cases of fever,4 cases of jaundice,3 cases of choledocho-lithiasis and 1 case of bile duct canceration; 4 received reoperation at the second year after operation.Conclusions Early diagnosis of bile duct injury and operation carried out by experienced surgeons are important for a better short- and long-term prognosis.Surgical repair is the first line therapy for bile duct injury. Key words: Bile duct injury, iatrogenic; Cholecystectomy; Long-term efficacy

The management and prevention of stenosis after hepaticojejunostomy

Objective To review the management and prevention of stenosis after hepaticojejunostomy. Methods We retrospectively analyzed 133 patients who developed stenosis after hepaticojejunostomy carried out for iatrogenic bile duct injuries. Result Through our active reoperative protocol, we were able to achieve satisfactory results in 131 patients, although the results were still unsatisfactory in 2 patients. Conclusions Stenosis after hepaticojejunostomy is a severe complication which should actively be prevented. Once it happens, doctors should apply active, appropriate and effective measures to correct the stenosis. Key words: Iatrogenic bile duct injury; Stenosis after hepaticojejunostomy

Present status of the treatment of iatrogenic bile duct injury.

Iatrogenic bile duct injury (IBDI) is a severe complication in general surgery, especially during laparos-eopic cholecystectomy. Many factors may cause IBDi, in which the conscientiousness, skill and experience of the surgeons play a more important role than the abnormal anatomy and patholo-gical changes of the patient. The Bismuth's classification, which originated from the era of open surgery, does not cover the whole spectrum of bile duct injuries. Strasberg's classification made a supplement by including other types of extrahepatie bile duct injuries. The variation of opportunities leads to different thera-peutic strategies. When the injuries are diagnosed intraopera-tively, a conversion to open surgery is the option of choice, and the prosthesis should be performed by a more experienced surgeon. If the bile duct injury is diagnosed in the early stage after operation, therapeutic principles are as follows: biliary peritonitis often required an emergency reoperation, while extra-peritoneal drainage is taken for patients with simple biliary leak. The most serious postoperative complication after IBDI is steno-sis, sometimes followed by fistula. Sufficient preoperative prepa-ration is essential, which includes controlling the biliary tract infection, improving the liver and renal function and nutritional state of the patient. Key words: Bile duct injury; iatrogenic; Therapy

Curative effect of choledo-choledochostomy in different operations

Objective To discuss the curative effect of Choledo-choledochostomy by observing different means of biliary duct reconstruction in the iatrogenic bile duct damage and the liver trans-plant. Method The clinical data of 19 patients who were found to have iatrogenic bile duct injury dur-ing operation and immediately repaired and 66 patients receiving liver transplantation in our hospital in the past 10 years were retrospectively analyzed. Meanwhile, the means for bile duct reconstruction were discussed. Results The rate of curative effect of the Choledo-choledochostomy was 86.6% for iatrogenie bile duct injury. However, whether to leave the T-tube or not was not a determinant factor for the procedure in liver transplantation (P>0. 05). Conclusion Choledo-choledochostomy has good curative effect for iatrogenic bile duct injury and liver transplantation. During the operation, the bile duct may not be excessively freed to guarantee blood supply in at the anastomosis site to further en-hance the curative effect. Key words: Biliary tract surgery; Iatrogenic bile duct injury; Liver transplantation; Choledo- choledocbostomy

Randomized controlled study of safety and curative effect of the mini-incision exploration of common bile duct

Objective To evaluate the safety, feasibility and curative effect of mini-incision exploration of common bile duct. Methods In this study, 290 patients underwent min-incision exploration of common bile duct and 120 patients underwent open-incision exploration of common bile duct for bile duct stones and/or gallstones from 2005 to 2007. The iatrogenic bile duct injury, postoperative complication, residual stone, stone recurrence, therapeutic effect and clinical data were evaluated by randomized contrast analysis. Results Time of operation, bleeding, volume of drain pipe, time of recovery of intestinal peristalsis and average duration in hospital were significantly lower in the group of min-incision exploration(MCE) than in the group of open-incision exploration(OCE). The iatrogentic bile duct injury occurred in 5 cases(1.72%), residual stone in 10 cases(3.45%), stone recurrence in 15 cases(5.18%) in the group of MCE, and in 2 cases(1.67%), 4 cases(3. 33%) and 6 cases respectively in the group of OCE. There was no marked difference between the two groups. Howevert post-operative complications occurred in 17 cases(6.8%) and 16(13.3%) in the group of MCE and OCE, respectively. There was remarkable difference between the 2 groups(P<0. 05). Conclusion Mini-incision exploration of common bile duct is a feasible and safe method resulting in fewer complications of iatrogentic bile duct injury, stone recurrence and residual stone. Key words: Common bile duct diseases; Min-incision; iatrogentic bile duct injury; Stone recurrence and residual stone.

Diagnosis and treatment of iatrogenic bile duct injury

Objective To study the diagnosis and treatment of iatrogenic bile duct injury(IBDI).Methods The clinical data of 92 patients with IBDI who had been admitted to our hospital from January 1994 to December 2007 were retrospectively analyzed.Results The diagnosis of IBDI was based on the clinical findings,diagnostic abdominocentesis and imaging examination.Sixteen patients gave up treatment because of economic reasons,and 2 patients who were complicated with sepsis and multiple organ dysfunction syndrome died shortly after being transferred to our hospital.Forty-eight patients were treated by Roux-en-Y choledochojejunostomy,14 by endoscopic treatment.2 by bile duet repair+T tube drainage,3 by percutaneous catheter drainage,1 by choledochoduodenostomy,4 by percutaneous transhepatic cholangiodrainage,and 2 by ultrasound guided percutaneous puncture drainage.Sixty-two patients were followed up for 4 month to 10 years(mean,3.6 years),and satisfactory results were obtained.Conclusions Detection of IBDI during operation and prompt repair yield favorable outcome.Roux-en-Y choledochojejunostomy is the best choice for bile duct injury complicated with biliary stricture.Endoscopic and interventional treatments are important auxiliary measures in the treatment of bile duct injury. Key words: cholecystectomy; Iatrogenic injury; Bile duct injut

On prevention and management of iatrogenic bile duct injury again

一、医源性胆管损伤的现状值得注意 近年我国胆囊结石发病增多.胆囊切除等胆系手术普及,医源性胆管损伤的病例及文献大量增加.1995年1月至2000年1月5年间国内有关医源性胆管损伤168篇文献共计2742例[1].经检索2001-2005年间国内184篇相关文献报道共计有3148例,其中80%发生在比较基层的医院。

Current surgical management of iatrogenic bile duct injury and biliary stricture

Current surgical management of iatrogenic bile duct injury and biliary stricture

Classification of iatrogenic bile duct injury

医源性胆道损伤的原因很多,但最主要的还是胆囊切除引致的胆道损伤. 由传统的剖腹发展到腹腔镜胆囊切除,不但使胆道损伤的病例增多,而且病人的临床表现也有所改变,同时胆道损伤的类型也同以往常见的有所不同,因而一个新的胆道损伤分类变得十分重要。