TITLE:
Iatrogenic Bile Duct Injuries after Cholecystectomy, Is the Laparoscopic Approach a Good Idea?
AUTHORS:
Renam Tinoco, Augusto Tinoco, Matheus P. S. Netto, Luciana J. El-Kadre, Júlia M. L. C. Rocha
KEYWORDS:
Cholecystectomy, Bile Duct Injury, Iatrogenic Bile Duct Injury, Laparoscopic Hepaticojejunostomy
JOURNAL NAME:
Surgical Science,
Vol.13 No.7,
July
28,
2022
ABSTRACT: Objective: The treatment of iatrogenic bile duct injuries is
still a challenge for hepatobiliary and general surgeons. Roux-en-Y
hepaticojejunostomy, one of the most appropriate techniques for the treatment
of circumferential lesions, either occurring less than 2 cm from the
bifurcation or in the bifurcation of the common hepatic duct, requires
experience in advanced laparoscopy and hepatobiliary surgery. This study aims
to present the results of laparoscopic hepaticojejunostomy (LHJ) for the
treatment of iatrogenic bile duct injuries (IBDI). Methods: A
retrospective study analyzing the medical records of patients diagnosed with
IBDI and treated using LHJ of patients at the Hospital S?o José do Avaí
(HSJA). Sex, age, previous cholecystectomy technique, signs and symptoms,
postoperative complications, length of stay, injury classification, and time
elapsed from injury to diagnosis were analyzed. Magnetic resonance
cholangiography (MRC), endoscopic retrograde cholangiopancreatography (ERCP) or
intraoperative cholangiography. Results: From March 2006 to December
2018, six patients underwent LHJ. In five cases (83.33%), the primary operation
was a laparoscopic cholecystectomy (LC) and in one patient (13.66%) open
cholecystectomy. The most frequent clinical sign was jaundice. The mean
surgical time was 153.2 minutes (range: 115 to 206 minutes), and the hospital
stay was 3 to 7 days (mean: 4.16 days). One patient had infection of the
umbilical trocar incision and one patient presented with stenosis of the
hepaticojejunal anastomosis and was treated with radioscopic pneumatic
dilatation. Conclusion: LHJ for circumferential and total IBDI either
diagnosed early (during surgery) or late, may be a safe and effective option,
with similar results to the conventional technique, a low complication rate and all the known
advantages of minimally invasive surgery.