Management of concomitant hepatic artery injury in patients with iatrogenic major bile duct injury after laparoscopic cholecystectomy

TY - JOUR

T1 - Management of concomitant hepatic artery injury in patients with iatrogenic major bile duct injury after laparoscopic cholecystectomy

AU - Frilling, A

AU - Nadalin, S

AU - Paul, A

AU - Malagò, M

AU - Broelsch, C E

N1 - 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

PY - 2008/4

Y1 - 2008/4

N2 - BACKGROUND: Concomitant hepatic artery injury is a rare but severe complication associated with bile duct injury during laparoscopic cholecystectomy (LC).METHODS: Sixty patients referred with biliary injury after LC between April 1998 and December 2005 were divided into two groups according to the time elapsed between injury and definitive surgical revision; patients in group 1 were referred early (within 4 days) after operation and those in group 2 were referred later. Hepatic rearterialization was performed in addition to biliary reconstruction when technically possible.RESULTS: Damage to the hepatic artery was detected in ten patients. Hepatic rearterialization was carried out in five patients by end-to-end anastomosis (one), or by using an autologous graft (three) or allogeneic vascular graft (one). Three patients in group 2 underwent right hemihepatectomy without arterial reconstruction owing to liver necrosis or lobar atrophy. Three of ten patients died from postoperative complications.CONCLUSION: Combined bile duct and hepatic artery injury during LC led to a complicated clinical course, with a high mortality rate. Reconstruction of the right hepatic artery might be helpful in reducing hepatic ischaemia, but is usually feasible only if the injury is identified early.

AB - BACKGROUND: Concomitant hepatic artery injury is a rare but severe complication associated with bile duct injury during laparoscopic cholecystectomy (LC).METHODS: Sixty patients referred with biliary injury after LC between April 1998 and December 2005 were divided into two groups according to the time elapsed between injury and definitive surgical revision; patients in group 1 were referred early (within 4 days) after operation and those in group 2 were referred later. Hepatic rearterialization was performed in addition to biliary reconstruction when technically possible.RESULTS: Damage to the hepatic artery was detected in ten patients. Hepatic rearterialization was carried out in five patients by end-to-end anastomosis (one), or by using an autologous graft (three) or allogeneic vascular graft (one). Three patients in group 2 underwent right hemihepatectomy without arterial reconstruction owing to liver necrosis or lobar atrophy. Three of ten patients died from postoperative complications.CONCLUSION: Combined bile duct and hepatic artery injury during LC led to a complicated clinical course, with a high mortality rate. Reconstruction of the right hepatic artery might be helpful in reducing hepatic ischaemia, but is usually feasible only if the injury is identified early.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Bile Ducts

KW - Cholecystectomy, Laparoscopic

KW - Female

KW - Hepatic Artery

KW - Humans

KW - Intraoperative Complications

KW - Magnetic Resonance Angiography

KW - Male

KW - Middle Aged

KW - Prognosis

KW - Tomography, X-Ray Computed

KW - Ultrasonography, Doppler

KW - Journal Article

U2 - 10.1002/bjs.6022

DO - 10.1002/bjs.6022

M3 - SCORING: Journal article

C2 - 18161898

VL - 95

SP - 460

EP - 465

JO - BRIT J SURG

JF - BRIT J SURG

SN - 0007-1323

IS - 4

ER -