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OPERATIVE INJURIES OF THE BILE DUCTS
Author(s) -
Kune Gabriel A.,
Hardy Kenneth J.,
Brown Grayton,
McKenzie Graham
Publication year - 1969
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1969.tb114669.x
Subject(s) - medicine , anastomosis , biliary ducts , surgery , bile duct , roux en y anastomosis , cholecystectomy , common bile duct , fibrous joint , obstructive jaundice , general surgery , gastric bypass , weight loss , obesity
Operative injuries of the bile ducts are commonest after cholecystectomy, but they may occur during exploration of the bile duct or during gastrectomy. Incomplete demonstration of the anatomy of the bile duct, the presence of an unusual arrangement of ducts, unexpected hæmorrhage and “fundusdown” cholecystectomy were some of the causative factors in this series. In only a few cases was the injury recognized at operation, whilst others presented in the early postoperative period with excessive biliary drainage, obstructive jaundice or with an intra‐abdominal biliary collection. A number presented some months later with cholangitis or obstructive Jaundice. Injuries recognized at the time of operation may be treated by direct suture, but if a significant loss of length occurs an immediate Roux hepaticojejunostomy “en‐Y” is advocated. Injuries presenting some time after operation may be treated by end‐to‐end ductal anastomosis or by some type of biliary‐intestinal anastomosis of which hepaticojejunostomy Roux‐en‐Y is favoured. In the reconstruction of these established strictures, the use of an internal splint across the anastomosis, such as a T‐tube, is essential, and this tube must be left in place for at least six months, and, in difficult cases, for 12 months. The serious nature of operative injuries of the bile ducts is reflected by the tendency for recurrent stricture formation following reconstruction, ultimately leading to a fatal outcome in about 30% of cases. In the present series, a satisfactory final result was obtained in 60% of cases.