Revisional surgery for recurrent benign bile duct strictures
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Eur Surg https://doi.org/10.1007/s10353-020-00667-8
Revisional surgery for recurrent benign bile duct strictures Timucin Erol
· Ahmet Dogrul · Osman Abbasoglu
Received: 20 August 2020 / Accepted: 1 September 2020 © Springer-Verlag GmbH Austria, part of Springer Nature 2020
Summary Background Bile duct injuries during cholecystectomy are not rare and may have significant long-term morbidity. Treatment of these injuries is complex and needs a multidisciplinary approach. This study aims to evaluate the results of revisional surgery performed for recurrent biliary strictures that developed after a prior repair. Methods Patients who had been surgically treated for a major biliary injury during open or laparoscopic cholecystectomy and operated on for recurrent stricture in our institute were reviewed retrospectively. A total of 11 patients who were referred to the surgery clinic were included. Results The median length of stay after revisional surgery was 9 days (range 5–30 days). Five patients (45%) had experienced at least one postoperative complication. The median follow-up period was 36 months (range 5–69 months). Terblanche clinical scores of all patients were 1 or 2 at their last clinical visit. None of the 11 patients required reoperation and no mortality was seen during the postoperative period. Conclusion Although revisional biliary surgery for recurrent biliary strictures is a challenging procedure, these revisions can be performed with favorable results. Meticulous preoperative evaluation and imple-
T. Erol () · Ass. Prof. A. Dogrul · Prof. O. Abbasoglu Department of General Surgery, Hacettepe University Faculty of Medicine, Sihhiye, 06100 Ankara, Turkey [email protected] Ass. Prof. A. Dogrul [email protected] Prof. O. Abbasoglu [email protected]
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mentation of precise surgical technique are essential to achieve long-term success. Keywords Bile duct injury · Bile duct stricture · Cholecystectomy · Hepaticojejunostomy · Revisional surgery Abbreviations BDI Bile duct injury CT Computed tomography ERCP Endoscopic retrograde cholangiopancreatography HPB Hepatopancreaticobiliary MRCP Magnetic resonance cholangiopancreatography PTC Percutaneous transhepatic cholangiography RFA Radiofrequency ablation US Ultrasonography
Introduction Cholecystectomy is one of the most common operations of the gastrointestinal tract. After initiation of the laparoscopic approach in the late 1980s, this technique gained wide acceptance. Unfortunately, the iatrogenic bile duct injury (BDI) rate, which is a rare complication of open cholecystectomy, increased during the learning curve era of this technique [1]. Although iatrogenic biliary injuries decreased worldwide with increasing experience and the establishment of new safety measures such as the “Critical view of safety”, these injuries are still a major health problem. Large studies report a bile duct injury rate of 0.2 to 0.8% after cholecystectomy and the risk is slightly higher with the laparoscopic approach [1–3]. Bile duct injuries (BDI) carry a high risk
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