Iatrogenic injury to the bile duct. Who, how, where?
We reviewed 81 patients with bile duct injuries that occurred at cholecystectomy and/or common bile duct exploration. Thirty-two of the strictures were recurrent. The median follow-up was 9 years. High injuries were inflicted during the performance of cholecystectomy while low injuries were related to common bile duct exploration. Mitigating circumstances appear to be as follows: (1) inadequate access, exposure, and assistance; (2) absence of operative cholangiogram; (3) patient's obesity; and (4) early dissection of Calot's triangle. Noncontributory factors include the following: (1) level of training of surgeon, and (2) type of institution where the operation was performed. Following repair, 15 patients eventually died and 8 suffered intermittent cholangitis and/or cirrhosis. Mortality and morbidity were related to the following: (1) level of stricture; (2) number of previous attempts at repair; and (3) adequacy of reconstruction. Mucosa-to-mucosa anastomosis without tension is essential for optimal results.
Moossa
A R
AR
Department of Surgery, University of California San Diego Medical Center 92103.
Mayer
A D
AD
Stabile
B
B
D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries* / Q000473:pathology; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002758:Cholangiography; D002763:Cholecystectomy / Q000009:adverse effects* / Q000379:methods; D003251:Constriction, Pathologic / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control*; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies