Impact of concomitant arterial injury on the outcome of laparoscopic bile duct injury.
BACKGROUND
Concomitant injury to the bile duct and hepatic artery is an increasingly recognized complication of laparoscopic cholecystectomy (LC). The impact of a concomitant arterial injury in patients with a bile duct injury (BDI) remains debatable. Early reports described a high incidence of septic complications, difficulty of biliary repair, and increased the risk of recurrent stricture.


METHODS
A literature search on the clinical significance and management of a concomitant hepatic artery injury (HAI) to the outcome of biliary-enteric reconstruction following BDI was reviewed. Relevant articles were extracted through MEDLINE, with secondary references obtained from key articles.


CONCLUSIONS
The association between failure of biliary repair and concomitant arterial injuries is not confirmed by the largest studies, which showed no difference in anastomotic stricture rate between patients who had an isolated BDI and those who had a combined HAI and BDI. However, right arterial injury associated with liver necrosis or damage to the right hepatic duct may require right hepatectomy.
Department of Clinical and Surgical Sciences, Royal Infirmary of Edinburgh, University of Edinburgh, UK.
Carlo
C
Pulitanò
Rowan W
RW
Parks
Hamish
H
Ireland
Stephen J
SJ
Wigmore
O James
OJ
Garden
D000465:Algorithms; D000714:Anastomosis, Surgical; D000818:Animals; D001158:Arteries / Q000293:injuries* / Q000601:surgery*; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000401:mortality; D006499:Hepatic Artery / Q000293:injuries / Q000601:surgery; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D057772:Vascular System Injuries / Q000150:complications / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control