Management of concomitant hepatic artery injury in patients with iatrogenic major bile duct injury after laparoscopic cholecystectomy
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Management of concomitant hepatic artery injury in patients with iatrogenic major bile duct injury after laparoscopic cholecystectomy. / Frilling, A; Nadalin, S; Paul, A; Malagò, M; Broelsch, C E.
In: BRIT J SURG, Vol. 95, No. 4, 04.2008, p. 460-5.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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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 -