Management and perspective of biliary duct injuries for laparoscopic cholecystectomy

Ricardo Mondragón-Sánchez; Alejandro Mondragón-Sánchez; Elvira Gómez-Gómez; Ana Lilia Garduño-López; Rigoberto Bernal-Maldonado

2002, Number 1

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Rev Mex Cir Endoscop 2002; 3 (1)

Management and perspective of biliary duct injuries for laparoscopic cholecystectomy

Mondragón-Sánchez R, Mondragón-Sánchez A, Gómez-Gómez E, Garduño-López AL, Bernal-Maldonado R

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Language: Spanish
References: 21
Page: 28-33
PDF size: 123.13 Kb.

ABSTRACT

Objective: The authors present their experience with three different techniques, laparoscopic, open fenestration and liver resection, for the management of benign cystic liver lesions. The aim of this study was to analyze short and long-term outcome with these procedures. Background data: Laparoscopic fenestration has become the management of choice for the most of non-parasitic liver disease (NPLD) and some cases of polycystic liver disease (PLD). However, the indications for open fenestration and liver resection in a laparoscopic era remain undefined. Methods: A retrospective review of the surgical management of patients with hepatic cysts between May 1992 to June 2001 was undertaken to determine short and long-term outcome. Comparative study among three different techniques was performed. Results: Thirty-two patients were operated for NPLD or PLD. Ten patients were treated by laparoscopic fenestration, 15 by open fenestration and 7 by formal liver resection. Twenty-three patients had NPLD and nine patients had PLD. Symptomatic recurrence rate after laparoscopic, open fenestration and resection in NPLD was 20%, 10% and 0% respectively and for PLD 50%, 20% and 0% respectively. Operative morbidity in laparoscopic, open fenestration and liver resection was 10, 13 and 14%, respectively and no operative mortality was recorded. Median hospital stay was 2, 6 and 6 days for laparoscopic, open fenestration and resection. Conclusions: Laparoscopic fenestration is the treatment of choice for symptomatic NPLD and selected patients with PLD who present predominantly large anteriorly located cysts. Open fenestration is indicated for deep-sited lesions that are not visualized through the laparoscope, patients with previous upper abdominal surgical procedures with dense adhesions or symptomatic recurrence. Liver resection in NPLD is reserved for symptomatic recurrences. suspicion of malignancy or lesions in continuity with a malignant tumor. In PLD open fenestration in combination or not with resection is the management of choice for patients with large multiple posterior or intrahepatic lesions.

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