Imaging of Postoperative Biliary Complications
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GASTROINTESTINAL IMAGING (J OLPIN, SECTION EDITOR)
Imaging of Postoperative Biliary Complications Laura Linstroth1 • Akram Shaaban1 • Sherry S. Wang1
Accepted: 31 August 2020 Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Over the past several decades, the number of hepatobiliary surgeries performed has increased, with laparoscopic cholecystectomy now the most frequently performed abdominal surgery in the United States. Due to the increase in surgeries performed, medicolegal concerns, and the availability of different types of imaging, radiologists are increasingly requested to evaluate for complications following hepatobiliary surgery. Recent Findings Early radiologic identification and assessment of the extent of biliary injuries allows prompt diagnosis and management of postoperative biliary complications. A wide variety of imaging modalities can be utilized, including computed tomography, nuclear medicine, and magnetic resonance imaging. Summary This article provides a review of the broad spectrum of biliary injuries following hepatobiliary surgery, with an emphasis on postcholecystectomy imaging findings. Keywords Cholecystectomy Surgical complications Biliary injury Dropped gallstones This article is part of the Topical collection on Gastrointestinal Imaging. & Sherry S. Wang [email protected] Laura Linstroth [email protected] Akram Shaaban [email protected] 1
Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East #1A71, Salt Lake City, UT 84132, USA
Introduction The number of cholecystectomies performed has drastically increased with the introduction of laparoscopic technique. It is estimated that over 750,000 cholecystectomies are performed each year [1•, 2] and the majority are performed laparoscopically. Laparoscopic technique is associated with less postoperative pain, better cosmetic results, and earlier return to normal activities. The advantage of a laparoscopic technique has been demonstrated for both symptomatic cholelithiasis and acute cholecystitis, with reduction of postoperative morbidity, mortality, and hospital stay using a laparoscopic technique [3]. Despite these advantages, laparoscopic cholecystectomy is not without risks and can be associated with morbidity as well as occasional mortality. In particular, multiple studies have demonstrated an increased risk of biliary injury following laparoscopic cholecystectomy compared to open cholecystectomy, with bile duct injury rates after elective laparoscopic cholecystectomy ranging from 0.3% to 0.5%, compared to 0.1 to 0.2% after open cholecystectomy [4–6•, 7–9]. While more recent series demonstrate lower rates of biliary injury, as low as 0.2% [10], another study following patients after single-incision laparoscopic cholecystectomy noted an injury rate of 0.7% [11]. In addition to morbidity and mortality, biliary complications have been noted to be a common cause of medicolegal claims and t
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