Bile duct injuries(BDIs)are difficult to avoid absolutely when the biliary tract has a malformation,such as accessory hepatic duct.Here,we investigated the management strategies for BDI combined with accessory hepatic...Bile duct injuries(BDIs)are difficult to avoid absolutely when the biliary tract has a malformation,such as accessory hepatic duct.Here,we investigated the management strategies for BDI combined with accessory hepatic duct during laparoscopic cholecystectomy.展开更多
BACKGROUND Laparoscopic cholecystectomy is considered the gold standard for the treatment of patients with gallstones.However,bile duct injury is one of the most serious complications of this surgery,with an incidence...BACKGROUND Laparoscopic cholecystectomy is considered the gold standard for the treatment of patients with gallstones.However,bile duct injury is one of the most serious complications of this surgery,with an incidence rate of 0.3%-0.7%.Variations in anatomical structures are one of the main reasons for such injuries.CASE SUMMARY We report a 26-year-old male patient who presented with repeated upper abdominal pain for 1 year.Ultrasound examination and blood tests indicated gallstones accompanied by chronic cholecystitis.The patient underwent laparo-scopic cholecystectomy.During the surgery,a communicating bile duct connec-ting the gallbladder neck and the right hepatic duct was discovered and injured.Meticulous dissection identified it as a communicating accessory hepatic duct,which was then definitively ligated.Postoperatively,the patient recovered well,magnetic resonance imaging and magnetic resonance cholangiopancreatography showed no intrahepatic or extrahepatic bile duct strictures.The pathology report showed chronic cholecystitis with gallstones.CONCLUSION Carefully manage communicating accessory bile ducts in cholecystectomy using cholangiography or meticulous separation,followed by ligation is effective.展开更多
Objective: To investigate the incidence of aberrant bile duct and its management during laparoscopic cholecystectomy (LC). Methods: In 10 000 patients undergoing laparoscopic cholecystectomy from 1992 to July 2001, 3 ...Objective: To investigate the incidence of aberrant bile duct and its management during laparoscopic cholecystectomy (LC). Methods: In 10 000 patients undergoing laparoscopic cholecystectomy from 1992 to July 2001, 3 had the involvement of the right accessory hepatic duct. In patient 1, the aberrant duct drained into the cystic duct was confirmed by open operation. In patient 2, the aberrant duct, which drained to the common bile duct (CBD), was injured and treated with suture and ligature under laparoscopy. In patient 3, the ab- errant duct, which also drained to the CBD, was confirmed and preserved. Results: All patients recovered well except patient 1 who had a transient elevation of ALT. No bile leak- age or other complication occurred. Conclusions: Only variation near the confluence and the entrance of the cystic duct into the bile duct is discovered during laparoscopic cholecystectomy. Right accessory hepatic duct is common and should be preserved during the operation. The accidentally injured small accessory hepatic duct can be treated with ligature without severe disturbance to liver func- tion.展开更多
基金Supported by Zhejiang Provincial Public Welfare Technology Application Research Projects under Grant,No.2013C33214Zhejiang Provincial Natural Science Foundation of China under Grant,No.LQ14H160001
文摘Bile duct injuries(BDIs)are difficult to avoid absolutely when the biliary tract has a malformation,such as accessory hepatic duct.Here,we investigated the management strategies for BDI combined with accessory hepatic duct during laparoscopic cholecystectomy.
文摘BACKGROUND Laparoscopic cholecystectomy is considered the gold standard for the treatment of patients with gallstones.However,bile duct injury is one of the most serious complications of this surgery,with an incidence rate of 0.3%-0.7%.Variations in anatomical structures are one of the main reasons for such injuries.CASE SUMMARY We report a 26-year-old male patient who presented with repeated upper abdominal pain for 1 year.Ultrasound examination and blood tests indicated gallstones accompanied by chronic cholecystitis.The patient underwent laparo-scopic cholecystectomy.During the surgery,a communicating bile duct connec-ting the gallbladder neck and the right hepatic duct was discovered and injured.Meticulous dissection identified it as a communicating accessory hepatic duct,which was then definitively ligated.Postoperatively,the patient recovered well,magnetic resonance imaging and magnetic resonance cholangiopancreatography showed no intrahepatic or extrahepatic bile duct strictures.The pathology report showed chronic cholecystitis with gallstones.CONCLUSION Carefully manage communicating accessory bile ducts in cholecystectomy using cholangiography or meticulous separation,followed by ligation is effective.
文摘Objective: To investigate the incidence of aberrant bile duct and its management during laparoscopic cholecystectomy (LC). Methods: In 10 000 patients undergoing laparoscopic cholecystectomy from 1992 to July 2001, 3 had the involvement of the right accessory hepatic duct. In patient 1, the aberrant duct drained into the cystic duct was confirmed by open operation. In patient 2, the aberrant duct, which drained to the common bile duct (CBD), was injured and treated with suture and ligature under laparoscopy. In patient 3, the ab- errant duct, which also drained to the CBD, was confirmed and preserved. Results: All patients recovered well except patient 1 who had a transient elevation of ALT. No bile leak- age or other complication occurred. Conclusions: Only variation near the confluence and the entrance of the cystic duct into the bile duct is discovered during laparoscopic cholecystectomy. Right accessory hepatic duct is common and should be preserved during the operation. The accidentally injured small accessory hepatic duct can be treated with ligature without severe disturbance to liver func- tion.
