Factors affecting Surgical outcomes of Post Laparoscopic Cholecystectomy Bile Duct Strictures.

Saravanan, J (2014) Factors affecting Surgical outcomes of Post Laparoscopic Cholecystectomy Bile Duct Strictures. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION : Cholecystectomy is one of the commonest abdominal operations. Bile duct injury is uncommon but have far-reaching consequences with increased morbidity and mortality. The profile of bile duct injury has changed since the introduction of laparoscopic cholecystectomy. Apart from increasing morbidity and mortality and decreasing the quality of life and survival of individual patients, it comes at an enormous cost to society. Bile duct injury is the most common cause for litigation in laparoscopic gastrointestinal surgery. It is not only the experience with the surgical procedure that accounts for the problem, but possible also inexperience with the management of the complications. The problem seems to be more acute in developing nations such as India. While objective data may be lacking, the most tertiary care institutions are seeing a larger number of patients with bile duct injuries. In the open cholecystectomy era the incidence of bile duct injury was 0.1% to 0.2%. An increase in iatrogenic bile duct injury from 0.1% to 0.2% up to 0.4% to 0.7% paralleled the rise of laparoscopic cholecystectomy in recent times. Laparoscopic cholecystectomy was introduced in the late 1980s and was adopted by several institutions throughout the 1990s. Through the early 1990s it was thought that the high rate of this complications was because of a learning curve associated with laparoscopic procedures. However , this high rate has reached a plateau instead of declining , and subsequent publications have shown that a high rate of bile duct injury is an inherent problem of the laparoscopic procedure. To be aware of the presence of postoperative benign biliary strictures and find a best approach for treatment, we have analyzed the outcome of surgical treatment of 41 patients by classified according to Bismuth Classification Systems . The Present Study also Evaluated Clinicopatholgical Factors Influencing Surgical Outcomes following Hepaticojejunostomy following Laparoscopic Cholecystectomy. AIMS AND OBJECTIVES : This study was undertaken with the following aims and objectives : 1.To evaluate the clinico-patholgical factors- influencing surgical outcomes following biliojejunostomy for bile duct injury following cholecystectomy. 2. To evaluate the factors affecting the perioperative outcomes following hepatojejunostomy for various types of post laparoscopic cholecystectomy bile duct injury. MATERIALS AND METHODS : Between august 2009 and December 2013 , 42 consecutive patient underwent bilioenteric anastomosis for post laparoscopic bile duct stricture in the Institute of Surgical Gastroenterology and Liver Transplantation at Government Stanley Medical College and Hospital. Of these one died of myocardial infarction in the immediate post operativeperiod. 41 consecutive patients were included in the study. All Cases of post laparoscopic cholecystectomy bile duct strictures presenting to the Institute of Surgical Gastroenterology & Liver Transplantation for treatment were included in this study. Patients with stricture due to choledochal cyst ,lithiasis, sclerosing cholangitis, chronic pancreatitis or ampullary disease were excluded. CONCLUSION : Bile duct injury and stricuture formation following cholecystectomy can lead to significant morbidity, mortality and financial burden, and a diminution in quality of life .Failure to recognize and correctly manage can lead to lengthy and expensive litigation. Factors arrived after univariate analysis like bismuth type of biliary stricture , bile duct dilatation, bilioma drained, bilirubin, albumin especially multivariate analytic factors like type of biliary stricture and bile duct dilatation are assessed critically for excellent results . Hence , careful preoperative assessment of above risk factors, good preoperative preparation ,adherence to basic tenets of surgical prinicples helps to achieve good surgical outcome.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Surgical outcomes ; Post Laparoscopic Cholecystectomy ; Bile Duct Strictures.
Subjects: MEDICAL > Surgical Gastroenterology and Proctology
Depositing User: Kambaraman B
Date Deposited: 28 Jul 2017 02:56
Last Modified: 28 Jul 2017 02:56
URI: http://repository-tnmgrmu.ac.in/id/eprint/2260

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