Common bile duct common bile duct injuries can occur during gallbladder operations or endoscopic interventions of the common bile duct. As a result of the injury, the bile duct no longer. The most common situation resulting in biliary injury during. The amsterdam classification proposed by bergman et al in 1996 9 is also very commonly used in many articles, especially among endoscopists. The goal of this study is to increase awareness of the problem and educate surgeons about the consequences of these injuries. They classified the injury by the width of bile duct injury. Bile duct injury in the era of laparoscopic cholecystectomy dkmic.
Common bile duct injuries represent a serious and challenging surgical complication. B bile duct injuries after other abdominal operations. Common bile duct injuries during laparoscopic cholecystectomy. However, the incidence rate of bile duct injury has not been. Management of bile duct problems treatment overview. Intrapancreatic common bile duct strictures have been reported in 2. These complex injuries are most often a consequence of laparoscopic cholecystectomy lc.
Aug 31, 2014 they classified the injury by the width of bile duct injury. Finally, repair of the biliary injury depends on the type and mechanism of injury. Bile duct injuries are reported to be higher during laparoscopic cholecystectomy than open surgery. During a gallbladder operation, the common bile duct can be injured or a clip placed on the cystic duct may fall off at a later time leading to bile leakage.
Bile duct injury during lc most often occurs as a result of misidentification of the common hepaticbile duct as the cystic duct 810. The clinical manifestations of bile duct injuries depend on the timing of injury recognition, type of injury, and presence of complications. This topic will focus on the surgical repair of common bile duct injuries. Proper management requires a skilled and experienced hepatobiliary surgical team. A bile duct injury is damage to the bile ducts that happens during gallbladder surgery. Intraoperative cholangiography and risk of common bile duct. Iatrogenic common bile duct injury is the worst complication of laparoscopic cholecystectomy. As a result of an injury, the bile duct will not be able to work right, leaking bile into the abdomen or blocking the normal flow of bile from the liver. Elimination of bile duct injury in cholecystectomy advances. The aim of this study was to analyze the presentation, characteristics, related investigation, and treatment results of major bile duct injuries after laparoscopic. Whereas, intact ttube retained in common bile duct cbd for years after bdi was very rare. It is formed by the union of the common hepatic duct and the cystic duct from the gall bladder. Cilostazol improved liver function, reduced inflammation, enhanced antioxidant status, ameliorated cholestatic liver injury and upregulated hepatic sirt1. Anatomic factors include bile duct variation, variation of the cystic duct, abnormal blood vessels, and hepatic portal rotation.
This complication can range from mild forms, which are easy to address during the operation, to more severe forms. Bile duct injuries lead to symptoms that can be painful. The vast majority of bile duct injuries is iatrogenic and occurs during abdominal surgeries or other interventions such as endoscopic or percutaneous cannulation of the biliary tree. Bile duct injury bdi, a major complication of cholecystectomy, usually needs hepaticojejunostomy or primary repair over ttube in severe cases. The common bile duct, sometimes abbreviated cbd, is a duct in the gastrointestinal tract of organisms that have a gall bladder. Obstruction of the biliary system can be caused by calculi gallstones, cancer, infection, cirrhosis, trauma, or other factors.
Recent classifications of the common bile duct injury. The management of bile duct injuries bdis is a critical knowledge base for surgeons performing laparoscopic cholecystectomy. Precise preoperative diagnosis and classification still remain a challenge. However, the incidence rate of bile duct injury has. Management of common bile duct injury springerlink. Common bile duct injury during laparoscopic cholecystectomy. Jan 31, 2009 bile duct injury is a severe and potentially lifethreatening complication of laparoscopic cholecystectomy.
Mcmahon et al7 proposed another classification by distinguishing major and minor biliary injuries. Management of major bile duct injury after laparoscopic. Pdf recent classifications of the common bile duct injury. The main reasons for intraoperative bile duct injury bile duct injury is a major complication of lc. The sages safe cholecystectomy program strategies for. Early reported rates of common bile duct cbd injury were 2 to 15 times 2,3 greater than those identified in historic series.
Open cholecystectomy with ttube common bile duct repair. Magnetic resonance cholangiography mrc revealed bile duct injury bdi, with right and left hepatic duct ligation and common bile duct crosssection. A bile duct obstruction is when one of the tubes that carries bile between the liver, gallbladder, and small intestine becomes blocked. Right and left partial iatrogenic injuries of the biliary. The surgeon sought the opinion of an expert biliary surgeon via telephone and discussed the possibility of an immediate endtoend bile duct repair. These complex injuries are most often a consequence of. The initial classification, levels and types of bile duct injury, and currently.
Initially, rates of injury were significantly more common in laparoscopic cholecystectomies. It has been suggested that the commonest cause of common bile duct injury is misidentification of biliary. A bile duct injury is damage to the bile duct during gallbladder surgery. An update on iatrogenic biliary injuries surgical clinics. Mar 06, 2019 mcmahon et al7 proposed another classification by distinguishing major and minor biliary injuries. If not addressed such injury can be debilitating and lead to considerable morbidity. The diagnosis of noniatrogenic traumatic bile duct injuries is challenging as current crosssectional imaging tests are. Iatrogenic bile duct injuries ibdi after laparoscopic cholecystectomy lc, being one of the most common performed surgical.
What are the signs and symptoms of bile duct injury in. The cystic duct joins with the common hepatic duct to form the common bile duct, which empties into the duodenum. It is the consequence of thermal damage and clamping the. Most often, a bile duct injury will be found by the doctor during surgery. An estimated 25%32% of bile duct injuries are recognized at laparoscopic cholecystectomy and may be repaired immediately if a surgeon with experience in bile duct repair is available 6. The clinical analysis of bile duct injury during laparoscopic. System approach to prevent common bile duct injury and enhance performance of laparoscopic cholecystectomy. Beneficial effects of cilostazol on liver injury induced by. Bile duct injury in the era of laparoscopic cholecystectomy. Most commonly occurring during laparoscopic cholecystectomy, and to the common bile duct on the biliary tree, bile ducts can get cut, burned, or pinched leading to painful and sometimes fatal symptoms if not treated.
If not, then the first sign of a bile duct injury will be failing to recover after a laparoscopic. Rats were subjected to common bile duct ligation then treated with cilostazol 9 mgkg or 27 mgkg in the presence or absence of specific sirt1 inhibitor ex527. Delphi consensus on bile duct injuries during laparoscopic. Management depends on the timing of recognition of injury, the extent of bile duct injury, the patients condition and the availability of experienced hepatobiliary surgeons. The incidence of bile duct injuries bdi has approximately doubled 0.
After cholecystectomy and common bile duct exploration, the two most common operations associated with bile duct injury are gastrectomy and hepatic resection. Accidental traumas are responsible only for 15% of the total number of biliary injuries. Iatrogenic bile duct injury with a retained ttube in common. A partial injury of the common bile duct in its medial side characterizes this type. It is later joined by the pancreatic duct to form the ampulla of vater. Classification and management of bile duct injuries. Bile drains from the gallbladder through the cystic duct. No complete loss of bile duct continuity is present. Jun 11, 2018 a bile duct obstruction is when one of the tubes that carries bile between the liver, gallbladder, and small intestine becomes blocked. There were few cases about retained fragments of ttube. Iatrogenic bile duct injuries ibdi after laparoscopic cholecystectomy lc, being.
Bile duct injury can also occur during other operative procedures. Jan 02, 2008 there are anatomical variations of bile ducts and blood vessels which may excuse the occurrence of a bile duct injury in a given case, but in general, an injury to the bile duct occurring during the course of a laparoscopic cholecystectomy, which injury results in recurring problems with the potential for permanent liver damage should be considered a case of possible medical negligence until. A 42yearold woman sustained complete transection of common hepatic duct during routine laparoscopic cholecystectomy. The first aspect is proper identification of when an injury has occurred. In patients with peripheral leakages, the most common localization of bile leakages was the cystic duct stump 25 patients, followed by the accessory bile duct 735 patients and the bed of. Creating a culture of safety in cholecystectomy during the sages 2016 annual meeting. If a small injury with no devascularization is present, a 50 absorbable monofilament suture to close the defect is adequate. Classification and management of bile duct injuries ncbi. A special classification for bile duct injuries was. Complications of laparoscopic cholecystectomy uptodate. Common bile duct injuries are a source of significant morbidity for patients who have suffered from this complication. This can lead to severe complications if left untreated and.
From initial classification published by bismuth, there have been many classifications of common bile duct injury. Iatrogenic bile duct injuries bdis after laparoscopic cholecystectomy, being one of the most common performed surgical procedures, remain a. Serious complications that occur with laparoscopic cholecystectomy, including bile duct injury, bile leaks, bleeding, and bowel injury, result in part from patient selection, surgical inexperience, and the technical constraints that are inherent to the minimally invasive approach 3,59. Bile duct injury rates have increased since the introduction of laparoscopic cholecystectomy, occurring in about 3 per 1,000 procedures performed. The incidence of cbd injury appeared to be highest during the introduction of lc and was related to early experience with lc, the socalled learning curve. This classification includes four types of ductal injury. The surgery was being performed at a rural setting, and the injury was identified intraoperatively. Pdf laparoscopic cholecystectomy is now a gold standard treatment modality for gallstone diseases. In a 20year period, 510 complex circumferential injuries have been.
Pdf classification and management of bile duct injuries. Laparoscopic cholecystectomy is now a gold standard treatment modality for gallstone diseases. Longterm outcomes of patients with common bile duct injury following laparoscopic cholecystectomy. Based on the mcmahon classification, lacerations under 25% of the common bile duct cbd diameter or cysticcbd junction was classified as minor injury, whereas transection or laceration over 25% of cbd diameter and postoperative bile duct stricture were classified as major injury. Surgeon negligently severs common bile duct during. Anatomical anomalies, local pathology, and poor surgical techniques are the main factors responsible4. Duplicated common bile duct, often associated with conditions like lithiasis, biliary cysts and pancreatobiliary maljunction, could result in highly morbid and potentially fatal biliary injuries. A prospective endoscopic study of 94 patients with injuries and strictures of the common bile duct cbd after laparoscopic cholecystectomy. There are several methods of confirming the presence of an injury. Class ii is a lateral injury of the common hepatic duct that leads to stenosis or bile leak.