OUTCOME OF 49 REPAIRS OF BILE-DUCT INJURIES AFTER LAPAROSCOPIC CHOLECYSTECTOMY

被引:52
作者
SCHOL, FPG
GO, PMNYH
GOUMA, DJ
机构
[1] UNIV LIMBURG HOSP,DEPT SURG,6202 AZ MAASTRICHT,NETHERLANDS
[2] UNIV AMSTERDAM,ACAD MED CTR,DEPT SURG,1105 AZ AMSTERDAM,NETHERLANDS
关键词
D O I
10.1007/BF00295923
中图分类号
R61 [外科手术学];
学科分类号
摘要
Treatment of bile duct injuries after laparoscopic cholecystectomy is still under discussion. The aim of this study was to evaluate the results of end-to-end or biliodigestive anastomosis for various types of bile duct injury. Patient charts of 49 (0.81%) classified bile duct injuries from a national survey of 6076 laparoscopic cholecystectomies in The Netherlands were analyzed. The median follow up after repair was 183 days (range 14-570 days). Statistical analysis showed that an end-to-end anastomosis was preferred by the surgeons for less severe bile duct injuries and a biliodigestive repair for more severe injuries. Three patients died owing to a delayed detected bile duct injury. Twelve bile duct strictures occurred after repair, leading to a stricture rate of 25%. The time elapsed between repair and occurrence of a stricture was 134 days (range 13-270 days). The type of repair or the severity of the bile duct injury did not determine the outcome of the repair. Histologically proved cholecystitis predisposed a stricture at the repair site. It was concluded that treatment of bile duct injuries is associated with a high stricture rate at the repair site of the anastomosis. End-to-end anastomosis is mostly successful for the less severe injury detected during laparoscopic cholecystectomy. For all other cases this repair can at least be considered a temporary internal drainage procedure. The biliodigestive anastomosis can best be considered a delayed repair after a drainage procedure has resolved the local inflammatory status.
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页码:753 / 757
页数:5
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