ROLE OF MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY IN THE MANAGEMENT OF MAJOR BILE DUCT INJURY AFTER LAPAROSCOPIC CHOLECYSTECTOMY | ||
| The Egyptian Journal of Surgery | ||
| Volume 21, Issue 1, January 2002, Pages 846-850 PDF (273.07 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejsur.2002.375161 | ||
| Authors | ||
| Abou El-Ella K* 1; Abou Gabal A2; El-Abed Osama3 | ||
| 1Department of Surgery, Menoufeya University, Egypt | ||
| 2Endoscopy, Menoufeya University, Egypt | ||
| 3Radiology, Liver Institute, Menoufeya University, Egypt . | ||
| Abstract | ||
| Background: Traditionally, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) have been the most reliable method for recognition of bile duct injuries after laparoscopic cholecystectomy. However, these procedures are invasive and carries a risk of complications. This study describes the role of magnetic resonance cholangiopancreatography (MRCP) in the management of patients with bile duct injury after laparoscopic cholecystectomy. Methods: From January 1999 to July 2001, 15 patients (14 females and one male) with average age 41 (range 22-60) years where referred to our unit with bile duct injury after laparoscopic cholecystectomy. MRCP was performed within 24 hours before ERCP or PTC or both. The findings of MRCP and conventional cholangiography were compared. Results: The diagnosis of biliary injury was made 4-14 days after laparoscopic cholecystectomy in all but three diagnosed 30-45 days after the initial procedure. The presentation of these patients was pain, jaundice and with or without cholangitis ( in 12 patients) and bile leakage & development of biliary peritonitis (in 2 patients), and development of external biliary fistula ( in one patient) . The Bismuth levels of bile duct injuries were type I in one, type II in 5, type III in 8 and type IV in one. The MRCP images were of higher diagnostic value than conventional cholangiographic images in 12 patients with frank bile duct injury, as MRCP demonstrated the entire biliary system proximal and distal to amputated or stenotic sites simultaneously . The technique of the repair was by utilizing Roux-en-y hepaticojejunostomy with establishment of mucosato-mucosa anastomosis. Early outcome of therapy for these bile duct injuries has been favorable. All patients are alive and well, no complications occurred in the immediate postoperative period. Only 2 patients developed stricture 4 months after surgery, treated conservatively in one and repeated dilatation and stenting in another. Summary: MRCP is an ideal diagnostic test when bile duct injury following laparoscopic cholecystectomy is suspected. Hepaticojejunostomy is the procedure of choice for repair of bile duct injuries and provides adequate biliary drainage. | ||
| Keywords | ||
| Bile duct injury; Laparoscopic cholecystectomy; Magnetic resonance cholangiopancreatography | ||
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