Biliary complications of cholecystectomy.
Biliary complications occur because of causes such as obscure or variant anatomy, predisposing conditions such as fibrosis or severe inflammation, equipment failure, and surgeon factors. The aim of this study was to review the optimal surgical treatment. Analysis of 81 patients with bile duct injuries treated in a single referral unit over an 8.5-year period was done. Time of detection of biliary injury and its presentation were ascertained as well as the level of injury (Strasburg's). In 8 patients, injury was detected intraoperatively, and 41 were detected in the early postoperative period with bile leak (n = 25) or obstructive jaundice (n = 10). Those diagnosed in the delayed postoperative period (n = 32) presented with recurrent cholangitis (n = 9), obstructive jaundice (n = 16), and a cholestatic enzymatic profile (n = 1). Roux-en-Y hepatico-jejunostomy was the preferred option (n = 64). One patient died because of biliary peritonitis. Improper treatment is associated with disastrous results, but early recognition and correct management can lead to a successful outcome and good prognosis.
Joshi
Rajeev M
RM
Department of Surgery, T N Medical College, B Y L Nair Ch Hospital, Mumbai, India.
Shetty
Tilakdas S
TS
Singh
Rajinder
R
Adhikari
Devbrata R
DR
Patil
Bhushan P
BP
Bhange
Snehal A
SA
D000714:Anastomosis, Surgical; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery; D002763:Cholecystectomy / Q000009:adverse effects*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D006801:Humans; D007432:Intraoperative Period; D007582:Jejunostomy; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D015607:Stents