ABSTRACT
BACKGROUND/AIMS: Laparoscopic cholecystectomy is characterized by a higher incidence of iatrogenic biliary lesions. The Authors evaluate the role of hepaticojejunostomy in the treatment of iatrogenic biliary lesions following laparoscopic cholecystectomy in 51 patients observed in the Campania region, Italy from 1991 to 2003. METHODOLOGY: The Authors report the data of a retrospective multicentric study of 51 patients -39 women (76.47%), 12 men (13.53%)-reoperated on for major biliary lesions following laparoscopic cholecystectomy. Hepaticojejunostomy in 20 cases (39.21%) and T-Tube plasty in 20 cases (39.21%) were performed. RESULTS: The mean follow-up was 25.01 months. The mean hospital stay was 25.7 days. 1/51 patients (1.9%) died from intraoperative incontrollable hemorrhage while cumulative postoperative mortality was 9.8% (5/51 patients). Therapeutic success rate of hepaticojejunostomy was 70% with a T-Tube plasty success rate of 65%. 9/51 patients (17.64%) were reoperated while in 4/51 (7.84%) a biliary stent was positioned. In 1/51 patients (1.9%) a biliary cirrhosis and in 3/51 (5.7%) a bioumoral cholestasis was observed. CONCLUSIONS: Laparoscopic cholecystectomy causes a higher incidence of iatrogenic biliary lesions. Hepaticojejunostomy gives better long-term results and lower morbidity compared to T-Tube plasty. Management of septic complications in patients with iatrogenic biliary lesions represents the first therapeutic step.
Subject(s)
Bile Ducts/injuries , Cholecystectomy, Laparoscopic/adverse effects , Intraoperative Complications/surgery , Jejunostomy , Adolescent , Adult , Aged , Female , Health Care Surveys , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
An higher incidence rate of iatrogenic bile duct injuries is reported in cholecystectomy performed with the laparoscopy than with the laparotomy approach. The aim of this study was to provide a multicentre report on surgical treatment and the outcome of biliary complications during and following laparoscopic cholecystectomy. A questionnaire was mailed to all surgeons with experience in laparoscopic cholecystectomy in the Campania region. Data were collected from January 1991 to December 2003. Each patient was requested to indicate age, gender, associated diseases, site and type of lesion, surgical experience, diagnosis, treatment and complications. Twenty-six surgeons answered the questionnaire. Fifty-one patients (36 F/15 M; mean age: 42.5 +/- 11.9, range 13-91 years) with bile duct injuries following laparoscopic cholecystectomy were reported. The most frequent lesions were main bile duct partial or total transection. The intraoperative mortality rate was 1/51 (1.9%) due to a complex biliary and vascular injury. The postoperative mortality rate of revision surgery was 5/50 (10%). T-tube positioning (n = 20) and Roux-en-Y hepato-jejunostomy (n = 20) were the procedures most frequently performed. The complication rate in patients treated with the T-tube was significantly higher than in those treated with hepatico-jejunostomy. Surgical treatment of biliary injuries following laparoscopic cholecystectomy was characterized by unusually high mortality and morbidity for a non-neoplastic disease. Roux-en-Y hepato-jejunostomy remains the procedure of choice for these injuries.
Subject(s)
Bile Ducts/injuries , Bile Ducts/surgery , Cholecystectomy, Laparoscopic/adverse effects , Iatrogenic Disease , Adolescent , Adult , Aged , Aged, 80 and over , Anastomosis, Roux-en-Y , Cholecystectomy, Laparoscopic/mortality , Drainage , Female , Humans , Male , Middle Aged , Reoperation , Retrospective Studies , Surveys and Questionnaires , Survival AnalysisABSTRACT
The purpose of this experimental study was to evaluate the efficacy of five synthetic absorbable suture materials in intestinal anastomoses in rats together with their interference with the normal physiopathological cicatrization process. The materials analysed were polyglycolic acid (Dexon), polygluconate (Maxon), polydioxanone (PDS), polygalactic acid (Vycril) and Glycomer 631 (Byosin). An anatomopathological study, performed in three groups of rats undergoing postmortem examinations after 6, 20 and 90 days showed that the least interference was caused by Glycomer 631, while polyglycolic acid and polygluconate yielded very good results though giving rise to a greater fibrous component. Polydioxanone and polygalactic acid yielded less satisfactory results. In addition, immunohistochemical techniques were applied to Glycomer 631. The evaluation of the surgical characteristics enabled us to divide the materials studied into two different groups, one in which characteristics such as smoothness and elasticity (Glycomer 631, polygluconate and polydioxanone) prevailed, and the second in which ease of knotting, stitch resistance, memory and lower cost (polyglycolic acid, polygalactic acid and Glycomer 63) prevailed. A general assessment showed better results for polyglycolic acid and Glycomer 631, while the other three materials presented slightly inferior performance, particularly polygalactic acid (inferior stitch resistance).
