Prevention of iatrogenic bile duct injuries in difficult laparoscopic cholecystectomies: is the naso-biliary drain the answer?

• Published in: Journal of Hepato‐Biliary‐Pancreatic Surgery Vol. 16; no. 4; pp. 458 - 462
• Main Authors: Liyanage, Chandika A. H., Sadakari, Yoshihiko, Kitada, Hidehisa, Ienaga, Jun, Tanabe, Reiko, Takahata, Shunichi, Nabae, Toshinaga, Tanaka, Masao
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.07.2009
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; bile duct injury; Bile Ducts - injuries; Cholangiopancreatography, Endoscopic Retrograde; Cholangiopancreatography, Magnetic Resonance; Cholecystectomy, Laparoscopic; Cholecystitis - surgery; Cystic Duct - diagnostic imaging; Drainage - methods; endoscopic naso‐biliary drainage; endoscopic retrograde cholangiopancreatography; Female; Gastroenterology; Hepatology; Humans; iatrogenic injury; Intraoperative Complications - prevention & control; laparoscopic cholecystectomy; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Retrospective Studies; Surgical Oncology; Young Adult; Endoscopic retrograde cholangiopancreatography; Endoscopic naso-biliary drainage; Laparoscopic cholecystectomy; Bile duct injury; Iatrogenic injury
• ISSN: 0944-1166; 1436-0691; 1868-6982
• DOI: 10.1007/s00534-009-0071-0

Background Prevention of iatrogenic injuries is of paramount importance in difficult laparoscopic cholecystectomies (LC). The objective of this study was to analyze the effectiveness of cholangiography using a pre-inserted endoscopic naso-biliary drain (ENBD) for navigation during difficult cholecystectomies. Methods The study design was a retrospective case analysis. In 508 patients who underwent LC in a tertiary referral university hospital from 1996 through 2007, difficult cholecystectomy was anticipated in 26 patients due to possibly aberrant biliary anatomy (four patients), unclear cystic duct anatomy during magnetic resonance cholangiopancreatography (MRCP) and/or endoscopic retrograde cholangiopancreatography (ERCP) (three patients), and acute cholecystitis (19 patients). An ENBD was inserted during ERCP prior to LC for cholangiography (ENBDC) to facilitate safe dissection during LC. Prevalence of biliary complications was assessed as the main outcome measurement. Results The majority (68%) of the patients who underwent ENBDC had complicated cholecystitis. Advanced technical expertise was not required for insertion of an ENBD. In retrospect, ENBDC was useful in prevention of a possible catastrophe in 69% of cases. Open conversion was necessary in five patients and biliary complications occurred in five patients only in the non-ENBD group. There were no procedure-related complications. One limitation of the study was that it was not randomized and there was no comparison with patients without ENBDC. Conclusions ENBDC is a useful and safe tool in the prevention of iatrogenic bile duct injuries in LC.