Professional Documents
Culture Documents
Duct Injury
April 28, 2005
OHSU, Department of Diagnostic Radiology
Kan Hwee, MS4
Content
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History
Open cholecystectomy standard practice until late
1980s when laparoscopic cholecystectomy
became more common
Currently approx. 500,000 cholecystectomy
performed per year in the U.S.
Laparoscopic cholecystectomy
General advantages
Reduced post-op recovery, shorter hosp stay
Reduced pain, less surgical trauma
Improved cosmesis
Bismuth Classification
Left
Hepatic
Duct
Right
Hepatic
Duct
Common
Hepatic
Duct
Biliary Anatomy
Common variants: A. Low cystic duct insertion, (10%); B. Parallel at least 2-cm with
common hepatic duct (15-25%); F,G,H. Medial cystic duct insertion (10-17%).
Uncommon variants: C. High fusion with hepatic duct; D. Fusion at right hepatic duct;
F. No cystic duct.
Schwartzs Principles of Surgery, 8th Ed.,McGraw-Hill Companies, 2005.
Mortele, Koenradd et al., Am J of Roent, August 2001.
Bile Leak
Excisional Injury
Excision injury with ligation in 35-y/o woman who presented 1 week
after laparoscopic cholecystectomy with right upper quadrant pain and
jaundice.
Hepatobiliary scintigram
obtained 90 min after
injection of iminodiacetic
acid, 2 months after
MRCP, shows photondefect area (arrows) in
right lobe of liver.
Bismuth I Injury
39-y/o man with Bismuth type I injury 1 week after laparoscopic cholecystectomy.
Bismuth IV Injury
63-y/o man with Bismuth type IV injury 10 days after laparoscopic cholecystectomy.
Bismuth V Injury
54-year-old woman with Bismuth type V injury 12 days after laparoscopic cholecystectomy.
Corrective Treatment
Balloon dilation for minor strictures or endoscopic stenting
for strictures
T-tube placement for minor lacerations
Primary duct-to-duct repair only if tension free anastomosis
available
Biliary anastomosis with jejunal loop for major excisional
injuries
Schwartzs Principles of Surgery, 8th Ed.,McGraw-Hill Companies, 2005.
Wudel, James et al., Am Surg, June 2001.
Bibliography
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