Ectopic right anterior inferior segmental bile duct and iatrogenic proximal bile duct injury: report of eight patients
10.3760/cma.j.issn.1007-8118.2019.11.009
- VernacularTitle: 右肝前叶下段胆管异位与医源性近段胆管损伤修复八例
- Author:
Jinshu WU
1
,
2
;
Jianhui YANG
;
Weizhi GONG
;
Jia LI
;
Weimin YI
;
Fahui CHENG
;
Changjun LIU
;
Xianhai MAO
Author Information
1. Department of Hepatological Surgery, Hunan Provincial People’s Hospital
2. The First Affiliated Hospital of Hunan Normal University, Changsha 410002, China
- Publication Type:Journal Article
- Keywords:
Cholecystectomy;
Biliary duct injury;
Bile duct variation;
Right lower anterior lobe;
Repair strategy
- From:
Chinese Journal of Hepatobiliary Surgery
2019;25(11):834-837
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize our clinical experience and management of an anomalous proximal bile duct joining the cystic duct in laparoscopic cholecystectomy (LC).
Methods:A retrospective study was conducted on 8 patients who had an anomalous right anterior bile duct joining the cystic duct who were treated at the Hunan Provincial People's Hospital from March 2003 to January 2019.
Results:All the 8 patients were diagnosed to have gallstones cholecystitis on preoperative CT, MRI and abdominal ultrasound. There were no suggestions of an anomalous bile duct. A total of 6 patients underwent reoperation after LC due to abdominal pain and biliary peritonitis. These 6 patients were treated with drainage and T-tube insertion. In the other 2 patients, the anomalous bile duct opening which joined the cystic duct were detected during LC. There was one patient converted to open laparotomy with preservation of the cystic duct and underwent common bile duct T-tube drainage. The other patients continued with laparoscopic surgery. The cystic duct was partially resected with removal of gallbladder, followed by common bile duct drainage. The average follow-up period was 3.4 years and the results were satisfactory.
Conclusions:Biliary duct anomaly is the main cause of iatrogenic proximal bile duct injury during laparoscopic cholecystectomy. It is not uncommon to have the anomaly of insertion of right anterior segmental bile duct to the cystic duct. To avoid iatrogenic biliary tract injury, careful preoperative study of X-ray films, accurate identification of the intraoperative gallbladder triangle anatomical structures. Strict adherence to carry out the three-word procedure of " discrimination, cut, identify" will help to reduce the incidence of biliary tract complications in laparoscopic cholecystectomy.
