Poranění žlučových cest při cholecystektomii


Autoři: V. K. Kapoor
Působiště autorů: Sanjay Gandhi Post-graduate Institute of Medical Sciences (SGPGIMS), Lucknow India
Vyšlo v časopise: Rozhl. Chir., 2015, roč. 94, č. 8, s. 312-315.
Kategorie: Souhrnné sdělení

Souhrn

Laparoscopic cholecystectomy (LC) is the treatment of choice for gall stones but is associated with an increased risk of bile duct injury (BDI). A BDI detected during LC may be repaired if a biliary surgeon is available but the easiest and safest option for a general surgeon is to place drains in the subhepatic fossa to covert the acute BDI into a controlled external biliary fistula (EBF). Most BDIs are diagnosed in the postoperative period and result in bile leak. Treatment is with percutaneous catheter drainage and endoscopic stenting of the bile duct; early repair is not recommended. Repair, in the form of hepatico-jejunostomy (HJ), should be performed by a biliary surgeon after a delay of 4−6 weeks when the EBF has closed. BDI is a common cause of medico-legal suit and a large burden on healthcare costs. Most BDIs can be prevented by adhering to the principles of safe cholecystectomy.

Key words:
bile duct injury − bile leak − biliary fistula − biliary stricture – cholecystectomy − hepatico-jejunostomy


Zdroje

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Suggested Readings

1. Kapoor VK. Bile duct injury repair – When? What? Who? Journal of HBP Surgery 2007;14:476−9.

2. Kapoor VK. Management of bile duct injuries: a practical approach. American Surgeon 2009;75:1157−60.

3. Kapoor VK. Safe Cholecystectomy – A to Z (Foreword by John G Hunter). Lucknow: Shubham 2010: 1-128. ISBN 978-81-910315-0-8. Available for free download at http://vkkapoor-india.weebly.com/uploads/1/4/6/7/1467272/safe_chole_a_to_z.pdf.pdf

Štítky
Chirurgie všeobecná Ortopedie Urgentní medicína

Článek vyšel v časopise

Rozhledy v chirurgii

Číslo 8

2015 Číslo 8

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