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ORIGINAL ARTICLE
Year : 2018  |  Volume : 2  |  Issue : 1  |  Page : 11-14

Iatrogenic biliary injuries in patients who underwent laparoscopic cholecystectomy


Department of General Surgery, Faculty of Medicine for Girls Al-Aazhar University, Cairo, Egypt

Correspondence Address:
Hazem A.M Bader
Nozha, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjamf.sjamf_6_18

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Background The rate of biliary injuries (BIs) is more common after laparoscopic cholecystectomy (LC) than open surgery especially in the case of acute cholecysititis. Aim The present work was performed to study the causes, clinical presentation, diagnosis, and treatment of BIs after LC. Patients and methods The study was carried out on 60 patients presented with BIs after LC, the rate being more common after LC than open surgery especially in the case of acute cholecysititis and complicated cases. The BIs in patients who underwent an LC was classified according to the site of injury as follows: (a) partial transection of the common bile duct, (b) injury to common hepatic duct due to clips or cautery, (c) cystic duct stump leaks, and (d) bile leaks from bile duct or radicals in the liver bed. The main causes were misapplication of clip at the cystic duct. Results The results of this study has shown that the symptoms and signs appeared between the fifth and seventh postoperative days. The clinical presentation is in accordance with the magnitude of the bile leak and the time of diagnosis. The guarding and rebound tenderness is the principal manifestation with abdominal bile collection. The endoscopic retrograde cholangiopancreatography gives the most definitive information of the status of the biliary system and allows visualization of retained common duct stones. Conclusion The ideal treatment in these cases is a minimally invasive procedure, but since the diagnosis is frequently delayed, open surgery was done. The endoscopic retrograde cholangiopancreatography with internal stent has become the treatment of choice in patients with bile leak after LC.


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