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Management of major postcholecystectomy biliary injuries: An analysis of surgical results in 62 patients
Shetty, Sushruth; Desai, Premal R; Vora, Hasmukh B; Bhavsar, Mahendra S; Khiria, Lakshman S; Yadav, Ajay; Jillawar, Nikhil.
Afiliación
  • Shetty, Sushruth; s.af
  • Desai, Premal R; s.af
  • Vora, Hasmukh B; s.af
  • Bhavsar, Mahendra S; s.af
  • Khiria, Lakshman S; s.af
  • Yadav, Ajay; s.af
  • Jillawar, Nikhil; s.af
Niger. j. surg. (Online) ; 25(1): 91-96, 2019. ilus
Article en En | AIM | ID: biblio-1267538
Biblioteca responsable: CG1.1
ABSTRACT

Background:

Management of injuries sustained during cholecystectomy requires expertise and involves a patient who is troubled, usually drained of personal resources. There has been an increase in incidence with laparoscopic cholecystectomy. The standard surgical management done for major biliary injuries is Roux-en-Y Hepaticojejunostomy (R-en-Y HJ). Materials and

Methods:

Patients managed surgically for definitive management of biliary injuries in the form of R-en-Y HJ were included. Data were collected from prospectively maintained records and through outpatient follow-up. Demographic data, early and late surgical complications, long-term outcomes, and follow-up results were analyzed.

Results:

Among the 62 patients, 26 were males, with a mean age of 37.4 ± 13.5 years. A total of 24 patients presented with ongoing biliary fistula. The Strasberg­Bismuth type of injury included types E1 in 8 (13%), E2 in 31 (50%), E3 in 19 (30.6%), and E4 in four patients (6.4%). There were no postoperative mortality and morbidity in 27.4% of patients. Atrophy­hypertrophy complex was seen in four patients, vascular injury in six patients, and an internal fistulisation with duodenum in two patients. Presence of comorbidities (P = 0.05), male gender (P = 0.03), tobacco use (P = 0.04), low albumin (P = 0.016), and more proximal (E4-E1) type of injury (P = 0.008) were independent predictors of postoperative morbidity (P < 0.05). The mean duration of patient follow-up was 26.2 ± 21.1 months.

Conclusion:

Optimization of preoperative nutrition, avoidance of intraoperative blood transfusion, proper timing of repair, and tension-free R-en-Y HJ draining all the ducts which is done at an experienced hepatobiliary center provide the best

outcome:

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Base de datos: AIM Asunto principal: Procedimientos Quirúrgicos Operativos / Colecistectomía / India / Cirrosis Hepática Biliar Tipo de estudio: Prognostic_studies País/Región como asunto: Asia Idioma: En Revista: Niger. j. surg. (Online) Año: 2019 Tipo del documento: Article
Buscar en Google
Añadir a Mi BVS
Imprimir
XML
Base de datos: AIM Asunto principal: Procedimientos Quirúrgicos Operativos / Colecistectomía / India / Cirrosis Hepática Biliar Tipo de estudio: Prognostic_studies País/Región como asunto: Asia Idioma: En Revista: Niger. j. surg. (Online) Año: 2019 Tipo del documento: Article