title: The value of cholangiography through Jackson-Pratt drains in the management of postoperative biliary injuries.
abstract: Iatrogenic biliary injury is the most significant complication after laparoscopic cholecystectomy. We present our experience with an alternative diagnostic approach using transcatheter cholangiography (TCC) through a Jackson-Pratt (JP) drain and discuss potential benefits and limitations of the technique. From March 2002 to February 2012, 40 patients with major postoperative biliary injury underwent biliary reconstruction at our institution. Mean age was 51.7 ± 18.1 years (range, 19 to 86 years) with 30 (75%) females. Seventeen (42.5%) injuries were detected intraoperatively and in 13 (32.5%) cases, JP drains were placed for biliary drainage. Lesions were classified according to Bismuth grade: I (10 patients [25%]), II (10 patients [25%]), III (six patients [15%]), IV (10 patients [25%]), and V (four patients [10%]). TCC was performed in seven patients with JP drains (53.8%). It fully defined the injury site in three cases of limited magnetic resonance cholangiopancreatography (MRCP) such as common hepatic duct and common bile duct leaks and in four cases (57.1%) that endoscopic retrograde cholangiopancreatography (ERCP) was limited as a result of clipping of the distal common bile duct. TCC showed promising results in cases of limited MRCP and ERCP such as fistulous orifices or leakage. It may represent an alternative adjunct in the diagnostic armamentarium of complex biliary injuries.
authors.affiliation: Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center/Jackson Memorial Hospital, Miami, Florida, USA.
authors.forename: Francisco Igor B
authors.initials: FI
authors.lastname: Macedo
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Casillas
authors.forename: James S
authors.initials: JS
authors.lastname: Davis
authors.forename: Joe U
authors.initials: JU
authors.lastname: Levi
authors.forename: Danny
authors.initials: D
authors.lastname: Sleeman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery; D002408:Catheters, Indwelling; D002758:Cholangiography / Q000379:methods*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000295:instrumentation; D004322:Drainage / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008099:Liver / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome