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Bile duct injuries during laparoscopic cholecystectomy: primary and long-term results from a single institution
- Source :
- Surgical Endoscopy. 21:1069-1073
- Publication Year :
- 2007
- Publisher :
- Springer Science and Business Media LLC, 2007.
-
Abstract
- Iatrogenic bile duct injury carries high morbidity. After the introduction of laparoscopic cholecystectomy the incidence of these injuries has at least doubled, and even after the learning curve, the incidence has plateaued at the level of 0.5%.A total of 32 patients sustained biliary tract injuries of the 3736 laparoscopic cholecystectomies performed in and around Turku University Central Hospital between January 1995 and April 2002. The data concerning primary treatment and long-term results were collected and analyzed retrospectively.The overall incidence for bile duct injuries, including all the minor injuries (cystic duct leaks and bile duct strictures), was 0.86%; for major injuries alone the incidence was 0.38%. Nineteen percent of the injuries were detected intraoperatively. All the cystic duct leaks were treated endoscopically with a 90% success rate. Of the bile duct strictures 88% were treated successfully with endoscopic techniques. Ninety-three percent of the major injuries, including tangential lesions of common bile duct and total transections, were treated operatively. The operation of choice was either hepaticojejunostomy or cholangiojejunostomy in 69% of the cases; the rest were treated with simple suturing over a T-tube or an endoscopically placed stent. The long-term results, with a median follow-up period of 7.5 years, are good in 79% of the operated patients and in 84% of the whole study population. Mortality rate was 3% and acute or chronic cholangitis was seen in 13% of the patients during follow-up.Most of the minor bile duct injuries, including cystic duct leaks and bile duct strictures, are well treatable with endoscopic techniques, whereas most of the major injuries require operative treatment, which at optimal circumstances gives good results.
- Subjects :
- Adult
Male
medicine.medical_specialty
Time Factors
Adolescent
medicine.medical_treatment
Cholecystitis, Acute
Iatrogenic Disease
Bile Duct Diseases
Risk Assessment
Hospitals, University
Age Distribution
Cholelithiasis
medicine
Humans
Sex Distribution
Intraoperative Complications
Finland
Aged
Retrospective Studies
Cholangiopancreatography, Endoscopic Retrograde
Endoscopic retrograde cholangiopancreatography
medicine.diagnostic_test
business.industry
Bile duct
Incidence
General surgery
Gallbladder
Middle Aged
medicine.disease
Surgery
medicine.anatomical_structure
Cholecystectomy, Laparoscopic
Biliary tract
Cholecystitis
Cystic duct
Female
Cholecystectomy
Bile Ducts
business
Follow-Up Studies
Abdominal surgery
Subjects
Details
- ISSN :
- 14322218 and 09302794
- Volume :
- 21
- Database :
- OpenAIRE
- Journal :
- Surgical Endoscopy
- Accession number :
- edsair.doi.dedup.....1dff453b8cad2ed5057fedf3186f6655