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Management of Biliary Injuries after Open and Laparoscopic Cholecystectomies

Authors: Salah Obaid Hamad --- Basher Abbas Abdulhassan --- Mohammad Yaseen Alkhoja --- Raafat Rauof Ahmed Alturfi
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2017 Volume: 14 Issue: 1 Pages: 57-67
Publisher: Babylon University جامعة بابل

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Abstract

Bile duct injuries during laparoscopic and open cholecystectomy are still serious problems which may cause secondary biliary cirrhosis resulting in chronic liver failure. Injuries occur as a result of technical errors or misidentification of biliary ducts. BDIs are major cause of patient morbidity and litigation. This study aimed to evaluate the management of bile duct injuries (radiological, endoscopic or surgical management) following open and laparoscopic cholecystectomy in a tertiary referral hospital. A prospective clinical study was conducted 50 patients (9 males and 41 females) who sustained bile duct injuries during open and laparoscopic cholecystectomy. Patients were thoroughly investigated to decide the final management, and they were followed up to two years post operation to find out short- and long-term complications. The most common presentations of those patients were biliary fistula, 18 (36%) and jaundice, 14 (28%). After resuscitation, the definite managements were percutaneous drain under ultrasound guide for one patient (2%), Endoscopic retrograde cholangio pancreatographystenting or sphinectrotomy for 5 patients (10%) andhepaticojejunostomy for complete common hepatic duct transection for 43 patients (86%), most of which were done 8weeks after the primary operation. One patient succumbs before any intervention.According to the results of this study, patients with bile duct injuries are preferably treated in hepato-biliary department, where all radiological, endoscopic and experience surgeon available. Roux-en-hepaticojejunostomy is the procedure of choice for the management of patients sustaining complete transaction injury of common hepatic duct, while percutaneous drain is an excellent option for the drainage of intraperitoneal bile collection, without need for open drainage.


Article
Methylene Blue Coloration to Eliminate Bile Duct Injuries During Laparoscopic Cholecystectomy

Author: Sajid Hameed Abd Al-Helfy
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 2 Pages: 316 -322
Publisher: Babylon University جامعة بابل

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Abstract

Laparoscopic cholecystectomy has superiority over classical cholecystectomy in surgical management of gallbladder diseases. The main disadvantage of LC is an increased number of bile duct injuries. Many techniques have been used to eliminate this complication; however, most of these need specific equipment or expert specialists to interpret the results. The current study aimed to evaluate the efficiency of gallbladder coloration with methylene blue during laparoscopic cholecystectomy in reduction of bile duct injuries.A total of 98-symptomatic cholelithiasis patients were undergone laparoscopic cholecystectomy using methylene blue for delineation of the gallbladder. The gallbladder fundus was grasped and held tight towards the anterior abdominal wall. All the bile was aspirated and 50% or more methylene blue was injected slowly into the gallbladder which was then removed from the abdominal cavity. Operation time, hospital stay and complications, if any, were recorded. In addition, the coloration of different parts in different status of gallbladder was also evaluated.The results showed that mean operation time and hospital stay were 55min and 26hrs respectively. No bile duct injury was recorded, and coloration with MB was visible in four main anatomical parts of the gallbladder (gallbladder, cystic-Hartmann's pouch, junction, cystic duct and common bile duct). In uncomplicated gallstone, almost all parts of the gallbladder colored well; however, a noticeable reduction in coloration was observed especially in cystic duct and common bile duct in complicated cases.Based on these results, it can be concluded that injection of MB could be considered as safe, effective and cheap technique to reduce or even eliminate BDIs during LC.

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