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Comparison between biliary stricture after laparoscopic and open cholecystectomy

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Comparison of biliary strictures after laparoscopic and open cholecystectomy

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Home Page > Health > Diseases and Conditions comparison> between biliary strictures after laparoscopic and open cholecystectomy

Comparison of biliary strictures after laparoscopic and open cholecystectomy

Posted: 20 June 2010 | Comments: 0
| Views: 175 |

Background This is a retrospective study comparing benign biliary strictures after laparoscopic and open cholecystectomy.

METHODS: Patients with post-cholecystectomy biliary stricture in the Department of General Surgery in SSKM Hospital, a tertiary referral & IPGMER hospitalized, which were between October 2007 to November 2009 included in the study. Risk factors, etiology, associated factors, the type of stenosis, results and preventive approach, the parameters were examined. The above parameters were then compared with the worldwide data.

ResultsThirty cases of benign biliary strictures after cholecystectomy, of which 19 () had a stricture after laparoscopic cholecystectomy and 11 () to open to. 8 () had a stricture after chlolecystectomy for acute cholelithiasis, of whom 5 had laparoscopic cholecystectomy and three had open carried out. Biliary stenosis was associated with Biloma fistulas in 10 cases and in 12 cases. There were 10 cases of Bismuth type 1 stenosis of 10 patients with type 2, type 3 and 7 at three biliary strictures in patients with type 4.

Conclusion Biliary strictures after laparoscopic cholecystectomy are of a much higher grade than that after open cholecystectomy. Biliary strictures after laparoscopy are also more incidence of injuries such as fistula and Biloma. Prevention of biliary strictures by simply sticking to the common principles of cholecystectomy.

Keywords biliary stenosis. laparoscopic cholecystectomy. Open cholecystectomy

Introduction

Cholecystectomy is probably the most commonly performed abdominal operation choice and has a high degree of safety. Among the various causes of benign biliary stricture, iatrogenic injuries after cholecystectomy, the most commonly reported. With the introduction of laparoscopic cholecystectomy, the concept is still important because the learning curve in managing the process.

Materials and methods

A retrospective study comparing benign biliary strictures after laparoscopic and open cholecystectomy in the Department of General Surgery in SSKM Hospital & IPGMER between October 2007 and November 2009. The patients were thoroughly scan through various tests such as liver function tests, routine blood tests, ultrasonography, CT, ERCP, MRCP, HIDA, evaluated PTC.

All patients were optimized before the definitive surgical Roux-en-Y hepaticojejunostomy for sepsis, Biloma, malnutrition. Surgical biliary-intestinal bypass in the form of Roux-en-Y hepaticojejunostomy was done in all cases regardless of the type of biliary strictures and stenosis was performed after a period of at least 6-8 weeks after cholecystectomy.

The data was then grouped according to etiology was, for the cholecystectomy was associated factors, the type of stenosis and the results achieved.

Results

From October 2007 to November 2009 of benign biliary strictures thirty cases after cholecystectomy were enrolled in the study. 26 of the 30 case were transfer. 19 patients have biliary strictures after laparoscopic cholecystectomy and 11 had to be open to.

8 had stricture after cholecystectomy for acute cholelithiasis, of whom 5 had laparoscopic cholecystectomy and three had open done done. Remaining 22 had cholecystectomy for chronic cholelithiasis, 14 of which laparoscopic and 8 open done.

Table 1 Number of cases of biliary strictures

Open cholecystectomy Laparoscopic cholecystectomy

Acute Cholecystitis 3 5

Chronic cholecystitis 8 14

Stricture was the case with Biloma in 10, 7 laparoscopic group and 3 assigned to the open group. Fistula was associated in 12 cases, eight laparoscopic group and 4 open group. 1 patient had pseudoaneurysm of the right hepatic artery after laparoscopic cholecystectomy.

Table 2 Association stricture

Type of cholecystectomy Biloma fistula pseudoaneurysm

Laparoscopic 7 8 1

Open 3 4 –

The mean duration of presentation was 4.5 months as biliary stenosis (3-11 months).

Bismuth type 1 stenosis in 10 cases was 6 under laparoscopic group and 4 in the open group, Bismuth type 2 in 10 for each 5 in the laparoscopic and open group, Bismuth type 3 in 7 cases, 6 in the laparoscopic and open group found one in . While bismuth was type 4 in 3 cases in the laparoscopic group 2 and 1 seen in open group.

Table 3 Bismuth type pattern stricture

Bismuth type up to 1 to 2 to 3-4

Open 4 5 1 1

Laparoscopic 6 5 6 2

Patients who had acute stricture after cholecystectomy, we had Bismuth type 1, type 2 and type 3 stricture, which were seen in 2 cases, 1 each in the laparoscopic and open group. There were 2 cases of Bismuth type 2 stricture in both the laparoscopic group.

Table 4 cases after acute cholecystectomy

Bismuth type up to 1 to 2 to 3-4

Open 1 1 1 –

Laparoscopic 1 1 1 2

Discussion

Could biliary strictures after cholecystectomy is one of the worst complication of surgeons. Investigations are needed to fully define the nature, extent of the stricture and the coexistence comorbities.

Completion

A narrowing of the bile ducts, one of the most difficult Chalange that a surgeon could face after cholecystectomy. Stricture after laparoscopic cholecystectomy, which are much heavier than after open cholecystectomy, as shown by the fact that stricture after laparoscopic cholecystectomy were more Bismuth type 3 and 4 compared to in open group, it was also associated with a higher incidence of other problems such as Biloma, fistulas, pseudoaneurysm.

The results of our study obtained similar results in several other studies in this area do time to time.

The only way to reduce this complication, the basic principles of cholecystectomy, they are either open or laparoscopically a stick.

Conflict of interest: The author has no disclosable interest.

References

Bismuth H, 1982: Postoperative strictures of the biliary tract. In Blumgart LH (ed.): The bile ducts: Clinical Surgery International. Edinburgh, Churchill Livingstone, pp 209-218.
Blumgart LH, et al, 1984: Benign biliary stricture following cholecystectomy: critical factors in management. Br J Surg 71: 836-843.
Chapman WC, et al, 1995. Postcholecystectomy bile duct. Arch Surg 130: 597-604
Lillemoe KD, 1997: benign postoperative bile duct strictures. Baillie'res Clin Gastroenterol 11: 749-779
WODS MS, Traverso LW Kozarec RA et al, which are characteristic of biliary tract complications during laparoscopic cholecystectomy, an institutional study. Am J Surg 1994; 167:27-34
Strasberg SM, Herti, Soper NJ, an analysis of the problem of the bile duct laparoscopic injuries durying cholectstectomy. . J Am Coll Surg 1995, 180:101-125 Way LW, Dunphy JE, 1972: biliary stenosis. Am J Surg 124: 287-295.
Asbun HJ, et al, 1993: Bile duct injury during cholecystectomy: mechanism of injury, prevention and management. World-JS

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Shivam Vatsal –
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Dr. Vatsal Shivam MBBS, MS

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Article tags:
Biliary strictures laparoscopic cholecystectomy open cholecystectomy

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