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Initial management of suspected biliary injury after laparoscopic cholecystectomy

World Journal of Gastrointestinal Surgery 2023年第4期15卷 592-599页

作者： Antti Siiki Reea Ahola YrjöVaalavuo anne antila Johanna Laukkarinen Department of Gastroenterology and Alimentary Tract Surgery Tampere University HospitalTampere 33521Finland Faculty of Medicine and Health Technology University of TampereTampere 33521Finland

Although rare,iatrogenic bile duct injury(BDI)after laparoscopic cholecystectomy may be devastating to the *** cornerstones for the initial management of BDI are early recognition,followed by modern imaging and evaluation of injury *** hepato-biliary centre care with a multidisciplinary approach is *** diagnostics of BDI commences with a multiphase abdominal computed tomography scan,and when the biloma is drained or a surgical drain is put in place,the diagnosis is set with the help of bile drain *** visualize the leak site and biliary anatomy,the diagnostics is supplemented with contrast enhanced magnetic resonance *** location and severity of the bile duct lesion and concomitant injuries to the hepatic vascular system are *** often,a combination of percutaneous and endoscopic methods is used for control of contamination and bile ***,the next step is endoscopic retrograde cholangiography(ERC)for downstream control of the bile *** with insertion of a stent is the treatment of choice in most mild bile *** surgical option of re-operation and its timing should be discussed in cases where an endoscopic and percutaneous approach is not *** patient's failure to recover properly in the first days after laparoscopic cholecystectomy should immediately raise suspicion of BDI and this merits immediate *** consultation and referral to a dedicated hepatobiliary unit are essential for the best outcome.

关键词： Cholecystectomy Laparoscopy Bile duct injury Iatrogenic Adverse event Complication

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