Surgical Treatment of Iatrogenic Biliary Injuries - Early Complications

摘要

Surgical Treatment of Iatrogenic Biliary Injuries - Early ComplicationsThe aim of the study was the analysis of early complications following different methods of surgical treatment for iatrogenic biliary injury (IBI).Material and methods. From January 1990 to March 2005, 138 patients with iatrogenic biliary injuries were operated on in the Department of Gastrointestinal Surgery of Silesian Medical University in Katowice. The most frequent iatrogenic biliary injuries were caused by open and laparoscopic cholecystectomy. Clinical symptoms in patients included the following: pain, jaundice, pruritus, nausea, vomitus and cholangitis signs. The following diagnostic examinations were performed before surgical procedures: laboratory investigations and radiological examinations - including ultrasonography of the abdominal cavity, cholangiography, endoscopic retrograde cholangiopancreatography, computed tomography and magnetic resonance-cholangiography. The level of biliary injury was classified according to Bismuth. The following reconstruction methods were performed: Roux-Y hepaticojejunostomy in 49 patients, end-to-end ductal anastomosis in 45 patients, jejunal interposition hepaticoduodenostomy in 27 patients, bile duct plastic reconstruction in 6 patients, choledochoduodenostomy in 2 patients and other methods in 8 patients.Results. The mean duration of hospitalization was 31 days. The mean duration of operation was 4.5 hours. Early complications were observed in 22 (16%) patients. The following early complications were noted: bile collection in 11 patients, intra-abdominal abscess in 4, wound infection in 13, peritonitis in 2, cholangitis in 2, eventeration in 1, pneumonia in 7 and acute circulatory insufficiency in 3 patients. Seven (5%) early re-operations were performed: 2 due to biliary-enteric anastomosis dehiscence, 1 due to eventeration, and 4 due to bile collection or intra-abdominal abscess. Three (2%) hospital deaths were noted: 1 due to due acute circulatory insufficiency, 1 due to liver necrosis and acute respiratory and circulatory insufficiency, and 1 due to biliary-enteric anastomosis dehiscence, bile collection, peritonitis, and acute circulatory and respiratory insufficiency.Conclusions. Surgical reconstructions of iatrogenic biliary injuries are procedures that require maximal precision and knowledge of different methods of reconstruction of biliary tract continuity. The choice of the method depends on the situation in the operation area. In treatment centers experienced in iatrogenic biliary injuries, early complications occur in 16% of surgical patients. Mortality does not exceed 2% of surgical patients.