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General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
What is the risk of biliary injury during cholecystectomy?The risk with laparoscopic cholecystectomy is 0.3%–0.7%.The risk with open cholecystectomy is 0.13%.It occurs in elective straightforward cases as well as after pancreatitis/cholangitis and emergency cases.The main cause is misinterpretation of biliary anatomy − CBD confused with cystic duct.Associated injury to the right hepatic artery can occur if it is mistaken for the cystic artery.Partial injury to the CBD can occur from a diathermy burn or after rigorous traction on the cystic duct, avulsing it from the CBD.
Immunopathogenesis of Vanishing Bile Duct Syndromes
Published in Gianfranco Alpini, Domenico Alvaro, Marco Marzioni, Gene LeSage, Nicholas LaRusso, The Pathophysiology of Biliary Epithelia, 2020
John M. Vierling, Marius Braun, Haimei Wang
There are three important physiological consequences of the anatomic bile duct unit. First, intrahepatic bile ducts are supplied by well-oxygenated arterial blood, and focal arterial or capillary ischemia can initiate and/or aggravate biliary injury. Second, BECs transport substances in bile that are taken up by peribiliary capillaries and delivered distally to proximal (small) bile ducts and the hepatic lobules (referred to as the cholehepatic circulation). The role of this circulation in health and disease is incompletely understood, but its disruption can result in biliary sclerosis. Third, lymph flowing retrograde from the space of Disse likely exerts physiologic effects on the homeostasis of both biliary epithelia and peribiliary capillaries, and adverse consequences would be anticipated with lymph containing cytokines or bacterial cell wall products, such as lipopolysaccharide (LPS, endotoxin).
The Gallbladder and Bile Ducts
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The operative mortality for cholecystectomy is less than 1%. Factors increasing the risk for postoperative mortality include advanced age, comorbid conditions and acute presentation. Complications can occur in 10-15% of cases. Serious complications of laparoscopic cholecystectomy fall into two major areas: access complications and bile duct injuries. The latter are rare, occurring in approximately 0.5% of cases. In the main, biliary injury results from poor dissection and failure to define the surgical anatomy adequately. Controversy exists as to whether or not the use of operative cholangiography reduces the incidence of bile duct injury. The majority of surgeons use cholangiography only in selected cases.
Open hepatic artery flow with portal vein clamping protects against bile duct injury compared to pringles maneuver
Published in Scandinavian Journal of Gastroenterology, 2023
Siliang Zhang, Pingli Cao, Pinduan Bi, Fu Yang, Ming Wu, Ding Luo, Bin Yang
The ducts were affected and representative images of each group were shown in Figure 2(A). Severe bile duct injury occurred in the PM-treated animals and was weak in HAFO-treated animals in the ischemia injury. The number of edematous, necrotic and deciduous biliary epithelial cells in the HAFO groups was significantly decreased compared to the PM group at 24 h (Figure 2(A)). In the CPM group, necrotic cholangiocytes and disrupted tight junctions were observed under TEM. Compared with those in the HAFO group, more extensive and more serious mitochondria swelling in cholangiocytes and tight junction rupture were observed in the IPM group (Figure 2(B)). The BDISS scores of bile duct histology of the HAFO group were significantly lower than those of the PM group (p < .05, Figure 2(C)). In addition to the histological scoring, LDH leakage into bile was measured as a biomarker of biliary injury. PM induced a transient increase in bile LDH levels in the following 24 h of reperfusion, and no significant difference was found between the HAFO and sham groups (Figure 2(D)). Overall, more serious ischemic injury to the bile duct were noted in the PM (either CPM or IPM) groups than in the HAFO (either IHAFO or CHAFO) groups.
Long-term results of secondary biliary repair for cholecystectomy-related bile duct injury: results of a tertiary referral center
Published in Acta Chirurgica Belgica, 2020
Julie Navez, Jean-François Gigot, Pierre H. Deprez, Pierre Goffette, Laurence Annet, Francis Zech, Catherine Hubert
From 1968 to 2016, 120 consecutive patients were managed for cholecystectomy-related BDI either as referred patients (Group A) or as local patients (Group B) by the Hepato-Biliary and Pancreatic Surgical Unit of Cliniques universitaires Saint-Luc (Brussels, Belgium). Medical records of those patients were retrospectively reviewed. Patients directly addressed to the Gastro-Enterology department for successful endoscopic treatment were not included in the present study. BDI was defined as any extrahepatic biliary tree damage occurring during cholecystectomy. Trauma-related biliary injury and stricture, common bile duct stone choledochotomy, chronic pancreatitis, malignant disease, hepatectomy, liver transplantation and digestive surgery other than cholecystectomy were excluded. Routine preoperative diagnostic procedures included, when available, abdominal ultrasound, abdominal computed tomography, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiography and intraoperative cholangiography (IOC), to define biliary anatomy, detect concomitant vascular injuries and exclude intraabdominal fluid collections.
Biliary complications and efficacy after ablation of peribiliary tumors using irreversible electroporation (IRE) or radiofrequency ablation (RFA)
Published in International Journal of Hyperthermia, 2022
Somrach Thamtorawat, Rujira Patanawanitkul, Satit Rojwatcharapibarn, Walailak Chaiyasoot, Trongtum Tongdee, Jirawadee Yodying, Sukrit Sorotpinya
RFA is considered a promising alternative to standard surgery for the treatment of small liver cancer. However, RFA can cause mechanical and thermal injuries to the bile ducts and major vessels. Moreover, the heat-sink effect may contribute to local tumor recurrence [17]. IRE has a major role in peribiliary tumors based on its mechanism of action. Non-thermal ablation using high-current electrical pulses leads to nanopore formation and apoptotic cell death. Thus, the adjacent organ damage and heat sink effect are thought to be less than thermal ablation procedures [18]. However, one study reported a risk of biliary injury after high-intensity IRE causing local heating and inducing bile duct injury [11].