STRATEGIES AND PROGNOSIS OF INTRAOPERATIVE BILIARY INJURY IN LAPAROSCOPIC CHOLECYSTECTOMY

  • MIYASATO Hiroshi
    First Department of Surgery, School of Medicine, University of the Ryukyus
  • NAKACHI Atsushi
    First Department of Surgery, School of Medicine, University of the Ryukyus
  • SHIMOJI Hideaki
    First Department of Surgery, School of Medicine, University of the Ryukyus
  • ISA Tsutomu
    First Department of Surgery, School of Medicine, University of the Ryukyus
  • SHIRAISHI Hiroyuki
    First Department of Surgery, School of Medicine, University of the Ryukyus
  • KUSANO Toshiomi
    First Department of Surgery, School of Medicine, University of the Ryukyus
  • MUTO Yoshihiro
    First Department of Surgery, School of Medicine, University of the Ryukyus

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Other Title
  • 腹腔鏡下胆嚢摘出術における術中胆管損傷に対する対策と予後

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Abstract

Biliary injuries in laparoscopic cholecystectomy (LC) have etiological factors, type of injury, and clinical course caused by specific characteristics of LC. This paper deals with clinical characteristics and appropriate therapies of seven cases of biliary injury in LC, including three cases of amputation, three cases of laceration, and one case of clipping. The diagnosis of injury was made in four cases during surgery, and each one case on the first, third and 29th postoperative day. For these injuries, operative repairs were performed in six cases, including cholangiojejunostomy in one case, end-to-end anastomosis of the bile duct in two cases, primary suture in two cases, and removal of a clip in one case. Postoperative biliary narrowing occurred in one case of end-to-end anastomosis for amputation of the bile duct and one case of primary suture for rupture of the bile duct. RTBD tube had been indwelt for 19 and 37 days respectively and the narrowing appeared 8 and 14 months later respectively. So long-term observation including indwelling time of a stent tube would be mandatory in LC cases undergone end-to-end anastomosis of the bile duct or primary suture.

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