0
Correspondence |

Timing of Repair of Bile Duct Injuries Associated With Laparoscopic Cholecystectomy

Gennaro Nuzzo, MD; Felice Giuliante, MD; Ivo Giovannini, MD
Arch Surg. 2011;146(1):117. doi:10.1001/archsurg.2010.290.
Text Size: A A A
Published online

Extract

We read with great interest the article by Sahajpal et al1 on laparoscopic cholecystectomy–associated bile duct injuries (LC-BDIs). It conveys a wise message that early repair (≤72 hours after LC-BDI) and late repair (>6 weeks after LC-BDI) offer the best outcomes. A minor comment is that an interval between 0 and 72 hours after LC-BDI has an unclear meaning: 0 hours suggests intraoperative repair, which was never performed. Most important, within the intermediate timing of repair (from 72 hours to 6 weeks after LC-BDI), a critical distinction should be made between the presence of a clean surgical field (ie, complete common bile duct stenosis with obstructive jaundice, without bile spillage) and a field that is inflamed or infected by bile. We believe that in the former case, surgical repair would occur in an ideal condition within 2 weeks following LC-BDI, even facilitated by the biliary dilation caused by obstruction. Of note, this ideal condition may dismally be turned into biliary peritonitis by unsuccessful nonsurgical attempts at bile duct recanalization. Conversely, in an inflamed or infected field, repair is less smooth because of edema, friability of tissues, and bleeding.2 Our policy is to resolve biliary peritonitis percutaneously or by laparoscopy or laparotomy without approaching the subhepatic area except to position drainages, postponing repair after complete recovery from sepsis. Finally, Sahajpal and colleagues correctly highlight the importance of early LC-BDI repair in specialized multidisciplinary centers.3 In reality, however, referral is still often delayed, LC-BDI is compounded by unsuccessful treatments, and there are still suboptimal opportunities for early repairs.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

January 1, 2011
Alice C. Wei, MD, MSc, FRCSC
Arch Surg. 2011;146(1):117-118. doi:10.1001/archsurg.2010.291.
CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Jobs
brightcove.createExperiences();