Surgical therapy of iatrogenic lesions of biliary tract.
Iatrogenic injuries of the biliary tract have increased in incidence over the past decade with the introduction of laparoscopic cholecystectomy. Although a number of factors have been identified with a higher risk of injury (male gender, complicated gallstone disease, aberrant anatomy) and a number of technical steps have been emphasized to avoid these injuries, the incidence of bile duct injuries has reached a steady-state at least double the rate observed with open cholecystectomy. Most patients sustaining a bile duct injury are recognized in the weeks following laparoscopic cholecystectomy. Careful preoperative preparation should include control of sepsis by draining any bile collections or fistulas and complete cholangiography. Long-term results are best achieved in specialized hepatobiliary centers performing biliary reconstruction with a Roux-en-Y hepaticojejunostomy. Success rates over 90% have been reported from several centers to date with intermediate follow-up.
Ahrendt
S A
SA
Department of Surgery, The Medical College of Wisconsin, Milwaukee 53226, USA. steven_ahrendt@urmc.rochester.edu
Pitt
H A
HA
D001652:Bile Ducts / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000209:etiology / Q000601:surgery; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003251:Constriction, Pathologic; D006801:Humans; D007049:Iatrogenic Disease; D007431:Intraoperative Complications / Q000517:prevention & control / Q000601:surgery*; D007582:Jejunostomy; D008026:Ligation; D011184:Postoperative Period