Percutaneous management of bile duct strictures and injuries associated with laparoscopic cholecystectomy: A decade of experience

Sanjay Misra, Genevieve B. Melton, J. F. Geschwind, Anthony C. Venbrux, John L Cameron, Keith D. Lillemoe

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The 1990s were associated with a dramatic increase in bile duct injuries with the widespread use of laparoscopic cholecystectomy (LC). Interventional radiology has an integral role in diagnosing and managing these injuries. Definitive percutaneous management with balloon dilatation might be possible in select patients with intact biliary-enteric continuity, but longterm data are limited. STUDY DESIGN: Data were collected prospectively on 51 consecutive patients with major bile duct stricture or injury associated with LC, treated with percutaneous management, January 1, 1990, to December 31, 1999. Percutaneous transhepatic cholangiography and biliary catheter placement were followed by balloon dilatation and stenting. Outcomes were assessed with direct patient contact or hospital records. RESULTS: All patients completed treatment, and 50 (98%) were stent free at mean followup of 76 months. The success rate of percutaneous management was 58.8%, without need for subsequent intervention. Presenting symptoms, level of injury, and number of stents or dilatations did not predict outcomes. Percutaneous treatment was more likely to fail in patients stented for less than 4 months (p <0.001). Operative repair at Hopkins before percutaneous management was predictive of a successful outcome (p <0.05). Including subsequent operations or percutaneous management, successful outcomes were achieved in 98% of patients. CONCLUSIONS: Major bile duct injuries after LC remain a clinical challenge. Although surgical reconstruction is the treatment cornerstone, selected patients with biliary-enteric continuity can achieve successful long-term results with definitive percutaneous management. The combination of percutaneous management and surgical reconstruction results in successful outcomes in virtually all patients.

Original languageEnglish (US)
Pages (from-to)218-226
Number of pages9
JournalJournal of the American College of Surgeons
Volume198
Issue number2
DOIs
StatePublished - Feb 2004

Fingerprint

Laparoscopic Cholecystectomy
Bile Ducts
Pathologic Constriction
Wounds and Injuries
Dilatation
Stents
Interventional Radiology
Cholangiography
Hospital Records
Therapeutics
Catheters

ASJC Scopus subject areas

  • Surgery

Cite this

Percutaneous management of bile duct strictures and injuries associated with laparoscopic cholecystectomy : A decade of experience. / Misra, Sanjay; Melton, Genevieve B.; Geschwind, J. F.; Venbrux, Anthony C.; Cameron, John L; Lillemoe, Keith D.

In: Journal of the American College of Surgeons, Vol. 198, No. 2, 02.2004, p. 218-226.

Research output: Contribution to journalArticle

Misra, Sanjay ; Melton, Genevieve B. ; Geschwind, J. F. ; Venbrux, Anthony C. ; Cameron, John L ; Lillemoe, Keith D. / Percutaneous management of bile duct strictures and injuries associated with laparoscopic cholecystectomy : A decade of experience. In: Journal of the American College of Surgeons. 2004 ; Vol. 198, No. 2. pp. 218-226.
@article{d0fa20a7ce124bdb8dffdd3a2bca272f,
title = "Percutaneous management of bile duct strictures and injuries associated with laparoscopic cholecystectomy: A decade of experience",
abstract = "BACKGROUND: The 1990s were associated with a dramatic increase in bile duct injuries with the widespread use of laparoscopic cholecystectomy (LC). Interventional radiology has an integral role in diagnosing and managing these injuries. Definitive percutaneous management with balloon dilatation might be possible in select patients with intact biliary-enteric continuity, but longterm data are limited. STUDY DESIGN: Data were collected prospectively on 51 consecutive patients with major bile duct stricture or injury associated with LC, treated with percutaneous management, January 1, 1990, to December 31, 1999. Percutaneous transhepatic cholangiography and biliary catheter placement were followed by balloon dilatation and stenting. Outcomes were assessed with direct patient contact or hospital records. RESULTS: All patients completed treatment, and 50 (98{\%}) were stent free at mean followup of 76 months. The success rate of percutaneous management was 58.8{\%}, without need for subsequent intervention. Presenting symptoms, level of injury, and number of stents or dilatations did not predict outcomes. Percutaneous treatment was more likely to fail in patients stented for less than 4 months (p <0.001). Operative repair at Hopkins before percutaneous management was predictive of a successful outcome (p <0.05). Including subsequent operations or percutaneous management, successful outcomes were achieved in 98{\%} of patients. CONCLUSIONS: Major bile duct injuries after LC remain a clinical challenge. Although surgical reconstruction is the treatment cornerstone, selected patients with biliary-enteric continuity can achieve successful long-term results with definitive percutaneous management. The combination of percutaneous management and surgical reconstruction results in successful outcomes in virtually all patients.",
author = "Sanjay Misra and Melton, {Genevieve B.} and Geschwind, {J. F.} and Venbrux, {Anthony C.} and Cameron, {John L} and Lillemoe, {Keith D.}",
year = "2004",
month = "2",
doi = "10.1016/j.jamcollsurg.2003.09.020",
language = "English (US)",
volume = "198",
pages = "218--226",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Percutaneous management of bile duct strictures and injuries associated with laparoscopic cholecystectomy

T2 - A decade of experience

AU - Misra, Sanjay

AU - Melton, Genevieve B.

AU - Geschwind, J. F.

AU - Venbrux, Anthony C.

AU - Cameron, John L

AU - Lillemoe, Keith D.

PY - 2004/2

Y1 - 2004/2

N2 - BACKGROUND: The 1990s were associated with a dramatic increase in bile duct injuries with the widespread use of laparoscopic cholecystectomy (LC). Interventional radiology has an integral role in diagnosing and managing these injuries. Definitive percutaneous management with balloon dilatation might be possible in select patients with intact biliary-enteric continuity, but longterm data are limited. STUDY DESIGN: Data were collected prospectively on 51 consecutive patients with major bile duct stricture or injury associated with LC, treated with percutaneous management, January 1, 1990, to December 31, 1999. Percutaneous transhepatic cholangiography and biliary catheter placement were followed by balloon dilatation and stenting. Outcomes were assessed with direct patient contact or hospital records. RESULTS: All patients completed treatment, and 50 (98%) were stent free at mean followup of 76 months. The success rate of percutaneous management was 58.8%, without need for subsequent intervention. Presenting symptoms, level of injury, and number of stents or dilatations did not predict outcomes. Percutaneous treatment was more likely to fail in patients stented for less than 4 months (p <0.001). Operative repair at Hopkins before percutaneous management was predictive of a successful outcome (p <0.05). Including subsequent operations or percutaneous management, successful outcomes were achieved in 98% of patients. CONCLUSIONS: Major bile duct injuries after LC remain a clinical challenge. Although surgical reconstruction is the treatment cornerstone, selected patients with biliary-enteric continuity can achieve successful long-term results with definitive percutaneous management. The combination of percutaneous management and surgical reconstruction results in successful outcomes in virtually all patients.

AB - BACKGROUND: The 1990s were associated with a dramatic increase in bile duct injuries with the widespread use of laparoscopic cholecystectomy (LC). Interventional radiology has an integral role in diagnosing and managing these injuries. Definitive percutaneous management with balloon dilatation might be possible in select patients with intact biliary-enteric continuity, but longterm data are limited. STUDY DESIGN: Data were collected prospectively on 51 consecutive patients with major bile duct stricture or injury associated with LC, treated with percutaneous management, January 1, 1990, to December 31, 1999. Percutaneous transhepatic cholangiography and biliary catheter placement were followed by balloon dilatation and stenting. Outcomes were assessed with direct patient contact or hospital records. RESULTS: All patients completed treatment, and 50 (98%) were stent free at mean followup of 76 months. The success rate of percutaneous management was 58.8%, without need for subsequent intervention. Presenting symptoms, level of injury, and number of stents or dilatations did not predict outcomes. Percutaneous treatment was more likely to fail in patients stented for less than 4 months (p <0.001). Operative repair at Hopkins before percutaneous management was predictive of a successful outcome (p <0.05). Including subsequent operations or percutaneous management, successful outcomes were achieved in 98% of patients. CONCLUSIONS: Major bile duct injuries after LC remain a clinical challenge. Although surgical reconstruction is the treatment cornerstone, selected patients with biliary-enteric continuity can achieve successful long-term results with definitive percutaneous management. The combination of percutaneous management and surgical reconstruction results in successful outcomes in virtually all patients.

UR - http://www.scopus.com/inward/record.url?scp=0842308069&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0842308069&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2003.09.020

DO - 10.1016/j.jamcollsurg.2003.09.020

M3 - Article

C2 - 14759778

AN - SCOPUS:0842308069

VL - 198

SP - 218

EP - 226

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 2

ER -