Abstract
Background: The purpose of this study was to investigate the possibility of detecting bile duct injuries using laparoscopic intraoperative ultrasound (LIOU).
Methods: Fifty bile duct injuries were created using laparoscopic techniques in ten farmer pigs. The lesions created were: (1) partial occlusion, (2) complete occlusion (1 clip), (3) complete occlusion (2 clips), (4) transection between clips, (5) excision between clips.
Results: All injuries were easily visualized using LIOU. The relation of clips impinging upon or occluding the bile duct was readily visualized on LIOU in all cases. In some cases it was difficult to distinguish between partial and complete occlusion. It was also difficult to distinguish between transection and excision due to retraction of the severed bile duct.
Conclusions: In cases of iatrogenic occlusion of the bile duct involving hemoclips (including transection or excision between clips), LIOU is a potentially useful modality that may allow earlier recognition and repair. Further studies are needed to evaluate the efficacy of LIOU in detection of bile duct injuries that do not involve hemoclips.
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References
Asbun HJ, Rossi RL, Lowell JA, Munson JL (1993) Management of major biliary complications after laparoscopic cholecystectomy. Ann Surg 217: 532–541
Birth M, Delinikolas K, Klärner H-G, Weiser H-F (1994) Laparoskopische Ultraschalldiagnostik der Gallenwege—eine Alternative zur intraoperativen Cholangiographie? Min Inv Chir 4: 162–168
Castro D, Arregui ME, Brueggemann A (1995) Laparoscopic ultrasound: principles and techniques. In: Arregui ME, Fitzgibbons RJ Jr, Katkhouda N, McKernan JB, Reich H (eds) Principles of laparoscopic surgery. Springer-Verlag, New York pp 489–505
Catess JA, Tompkins RK, Busuttil RW, Kallmann C, Roslyn JJ (1993) Biliary complications of laparoscopic cholecystectomy. Am Surg 59: 243–247
Jakimowicz JJ, Rutten H, Jurgens PJ, Carol EJ (1987) Comparison of operative ultrasonography and radiology in screening of the common bile duct for calculi. World J Surg 11: 628–634
Jakimowicz JJ (1991) Intraoperative and postoperative biliary endoscopy: intraoperative ultrasonography and sonography during laparoscopic cholecystectomy. Probl Gen Surg 8: 442–457
Jakimowicz JJ (1994) Technical and clinical aspects of intraoperative ultrasound applicable to laparoscopic ultrasound. End Surg 2: 119–126
Lane RJ, Glazer G (1980) Intraoperative B-mode ultrasound scanning of the extrahepatic biliary system and pancreas. Lancet 16:334
McMahon AJ, Fullarton G, Baxter JN, Dwyer PJ (1995) Bile duct injury and bile leakage in laparoscopic cholecystectomy. Br J Surg 82: 307–313
Millis MJ, Tompkins RK, Zinner MJ, Longmire WP, Roslyn JJ (1992) Management of bile duct strictures. An evolving strategy. Arch Surg 127: 1077–1084
Morgenstern L, McGrath MF, Carroll BJ, Paz-Partlow M, Berci G (1996) Continuing hazards of the learning curve in laparoscopic cholecystectomy. Am Surg 61: 914–918
Mossa AR, Mayer AD, Stabile B (1990) Iatrogenic injury to the bile duct. Who, how, where? Arch Surg 125: 1028–1030
Okita K, Kodoma T, Oda M, Takemoto T (1984) Laparoscopic ultrasonography. Diagnosis of liver and pancreatic cancer. Scand J Gastroenterol 19: 91–100
Phillips EH (1993) Routine versus selective intraoperative cholangiography. Am J Surg 165: 505–507
Rosenthal RJ, Steigerwald SD, Imig R, Bockhorn H (1994) Role of intraoperative cholangiography during endoscopic cholecystectomy. Surg Laparosc Endosc 4: 171–174
Röthlin M, Largiader F (1994) New, mobil-tip ultrasound probe for laparoscopic sonography. Surg Endosc 8: 805–808
Röthlin M (1995) Laparoscopic ultrasound of the biliary tree. In: Arregui ME, Fitzgibbons RJ Jr, Katkhouda N, McKernan JB, Reich H (eds) Principles of laparoscopic surgery. Springer-Verlag, New York
Sackier JM, Berci G, Phillips E, Carroll B, Shapiro S, Paz-Partlow M (1991) The role of cholangiography in laparoscopic cholecystectomy. Arch Surg 126: 1021–1026
Sigel B, Machi J, Beitler C, Donahue PE, Bombech T, Baker RJ, Duarte B (1983) Comparative accuracy of operative ultrasonography and cholangiography in detecting common bile duct calculi. Surgery 94: 715–720
Stiegman GV, McIntyre RC, Pearlman NW (1994) Laparoscopic intracorporeal ultrasound. An alternative to cholangiography? Surg Endosc 8: 167–172
Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180: 101–125
Yamakawa K, Naito S, Azuma K, Wagai T (1958) Laparoscopic diagnosis of the intraabdominal organs. Kpn J Gastroenterol 55: 741–747
Yamashita Y, Kurohiji T, Kimitsuki H, Hiraki M, Isomoto H, Kakegawa T (1991) A clinical experience of intraoperative ultrasound at laparoscopic cholecystectomy. Rinsho Kenkyu 11: 259–264
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Birth, M., Carroll, B.J., Delinikolas, K. et al. Recognition of laparoscopic bile duct injuries by intraoperative ultrasonography. Surg Endosc 10, 794–797 (1996). https://doi.org/10.1007/BF00189535
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DOI: https://doi.org/10.1007/BF00189535