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

Show simple item record Liyanage, C.A.H. en_US Sadakari, Y. en_US Kitada, H. en_US Ienaga, J. en_US Tanabe, R. en_US Takahata, S. en_US Nabae, T. en_US Tanaka, M. en_US 2014-10-29T09:27:51Z 2014-10-29T09:27:51Z 2009 en_US
dc.identifier.citation Journal of Hepatobiliary Pancreatic Surgery. 2009; 16(4): pp.458-62 en_US
dc.identifier.issn 0944-1166 (Print) en_US
dc.identifier.issn 1436-0691 (Electronic) en_US
dc.description Indexed in MEDLINE
dc.description.abstract 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 percent) 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 percent 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. en_US
dc.publisher Springer International en_US
dc.subject Cholecystectomy, Laparoscopic
dc.title Prevention of iatrogenic bile duct injuries in difficult laparoscopic cholecystectomies: is the naso-biliary drain the answer? en_US
dc.type Article en_US
dc.identifier.department Surgery en_US
dc.creator.corporateauthor Japanese Association of Hepato-Biliary-Pancreatic Surgery en_US

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