Management of Postcholecystectomy Obstructive Jaundice | ||
| The Egyptian Journal of Hospital Medicine | ||
| Article 14, Volume 74, Issue 7, January 2019, Pages 1566-1576 PDF (232.87 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejhm.2019.28115 | ||
| Authors | ||
| Mohammad Mohsen Salem; Yasser Hussein Hassan; Abdou Ibrahim Zeyada* | ||
| Department of General Surgery, Faculty of Medicine, Al-Azhar University | ||
| Abstract | ||
| Background: Although laparoscopic cholecystectomy (LC) has many unquestionable advantages, this type of surgery has a higher incidence of complications than those of open cholecystectomy including biliary tract injury or stricture causing hyperbillirubinaemia and jaundice and subsequently a lot of complications as acute peritonitis or acute cholangitis as well as complications of jaundice that may be so severe causing hepatorenal failure. Objective: To find the proper method of management of postcholecystectomy obstructive jaundice. Patients and Methods: A retrospective study of 20 patients who were presented with postcholecystectomy obstructive jaundice within 2 years from the date of surgery were selected for this study. Patients were subclassified according to the cause of postcholecystectomy jaundice into 4 groups: Group A: patients presented with jaundice due to missed common bile duct (CBD) stones. Group B: patients presented with jaundice due to biliary injury. Group C: patients presented with jaundice due to biliary stricture. Group D: patients presented with jaundice due to medical causes. Results: ERCP should only be attempted when there is biliary contiuity evident by MRCP. Roux en Y hepaticojejunostomy is the most used modality in management. The best treatment of post-cholecystectomy obstructive jaundice is undoubtedly prevention of bile duct injury during cholecystectomy. Conclusion: The classic pattern of laparoscopic injury appears to be misidentification of the common duct for the cystic duct, resection of a portion of the common and hepatic ducts, and an associated right hepatic arterial injury. | ||
| Keywords | ||
| Cholecystectomy; Obstructive jaundice; bismuth classification | ||
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