Erik A Rauws

Long-term Results of a Primary End-to-end Anastomosis in Peroperative Detected Bile Duct Injury

The management of a bile duct injury detected during laparoscopic cholecystectomy is still under discussion. An end-to-end anastomosis (with or without T-tube drainage) in peroperative detected bile duct injury has been reported to be associated with stricture formation of the anastomosis area and recurrent jaundice. Between 1991 and 2005, 56 of a total of 500 bile duct injury patients were referred for treating complications after a primary end-to-end anastomosis. After referral, 43 (77%) patients were initially treated endoscopically or by percutaneous transhepatic stent placement (nu2009=u20093; 5%). After a mean follow-up of 7u2009±u20093.3xa0years, 37 patients (66%) were successfully treated with dilatation and endoscopically placed stents. One patient died due to a treatment-related complication. A total of 18 patients (32%) underwent a hepaticojejunostomy. Postoperative complications occurred in three patients (5%) without hospital mortality. These data confirm that end-to-end anastomosis might be considered as a primary treatment for peroperative detected transection of the bile duct without extensive tissue loss. Complications (stricture or leakage) can be adequately managed by endoscopic or percutaneous drainage the majority of patients (66%) and reconstructive surgery after complicated end-to-end anastomosis is a procedure with relative low morbidity and no mortality.

Critical Evaluation of the Different Imaging Modalities for Preoperative Staging of Bile Duct Carcinoma

As the various radiological techniques improve, the radiologist is assuming a more active role in the diagnosis and management of patients with bile duct malignancies (Foley et al. 1980;Moore and Clark 1984;Mueller and Simeone 1984; May et al. 1986). The rapid radiological developments have permitted more complete and detailed evaluation of the entire biliary tree, so that the accuracy with which tumor resectability can be predicted has increased considerably (Baron et al. 1982). The variety of techniques employed illustrates the fact that apparently no single imaging technique is the best or is adequate on its own. Techniques are often complementary to each other. Human, medical, and economic considerations should prompt the clinician to adopt a critical approach (van Leeuwen and Reeders 1989) towards the different imaging modalities for preoperative staging of bile duct carcinoma.