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Isolated Right Segmental Hepatic Duct Injury Following Laparoscopic Cholecystectomy

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Abstract

Purpose

Laparoscopic cholecystectomy (LC) is the treatment of choice for gallstones. There is an increased incidence of bile duct injuries in LC compared with the open technique. Isolated right segmental hepatic duct injury (IRSHDI) represents a challenge not only for management but also for diagnosis. We present our experience in the management of IRSHDI, with long-term follow-up after treatment by a multidisciplinary approach.

Methods

Twelve consecutive patients (9 women, mean age 48 years) were identified as having IRSHDI. Patients’ demographics, clinical presentation, management and outcome were collected for analysis. The mean follow-up was 44 months (range 2–90 months).

Results

Three patients had the LC immediately converted to open surgery without repair of the biliary injury before referral. Treatments before referral included endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage and surgery, isolated or in combination. The median interval from LC to referral was 32 days. Eleven patients presented with biliary leak and biloma, one with obstruction of an isolated right hepatic segment. Post-referral management of the biliary lesion used a combination of ERCP stenting, percutaneous drainage and stent placement and surgery. In 6 of 12 patients ERCP was the first procedure, and in only one case was IRSHDI identified. In 6 patients, percutaneous transhepatic cholangiography (PTC) was performed first and an isolated right hepatic segment was demonstrated in all. The final treatment modality was endoscopic management and/or percutaneous drainage and stenting in 6 patients, and surgery in 6. The mean follow-up was 44 months. No mortality or significant morbidity was observed.

Conclusion

Successful management of IRSHDI after LC requires adequate identification of the lesion, and multidisciplinary treatment is necessary. Half of the patients can be treated successfully by nonsurgical procedures.

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Authors and Affiliations

  1. Division of Gastroenterology, Medical University of South Carolina, Charleston, South Carolina, USA

    Rafael F. Perini & John T. Cunningham

  2. Division of Interventional Radiology, University of South Carolina, Charleston, South Carolina, USA

    Renan Uflacker & J. Bayne Selby

  3. Division of GI Surgery, University of South Carolina, Charleston, South Carolina, USA

    David Adams

  4. Interventional Radiology, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC, 29464, USA

    Renan Uflacker

Authors
  1. Rafael F. Perini
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  2. Renan Uflacker
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  3. John T. Cunningham
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  4. J. Bayne Selby
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  5. David Adams
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Corresponding author

Correspondence to Renan Uflacker.

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Perini, R.F., Uflacker, R., Cunningham, J.T. et al. Isolated Right Segmental Hepatic Duct Injury Following Laparoscopic Cholecystectomy. Cardiovasc Intervent Radiol 28, 185–195 (2005). https://doi.org/10.1007/s00270-004-2678-5

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