Salem, M., Hassan, Y., Zeyada, A. (2019). Management of Postcholecystectomy Obstructive Jaundice. The Egyptian Journal of Hospital Medicine, 74(7), 1566-1576. doi: 10.21608/ejhm.2019.28115
Mohammad Mohsen Salem; Yasser Hussein Hassan; Abdou Ibrahim Zeyada. "Management of Postcholecystectomy Obstructive Jaundice". The Egyptian Journal of Hospital Medicine, 74, 7, 2019, 1566-1576. doi: 10.21608/ejhm.2019.28115
Salem, M., Hassan, Y., Zeyada, A. (2019). 'Management of Postcholecystectomy Obstructive Jaundice', The Egyptian Journal of Hospital Medicine, 74(7), pp. 1566-1576. doi: 10.21608/ejhm.2019.28115
Salem, M., Hassan, Y., Zeyada, A. Management of Postcholecystectomy Obstructive Jaundice. The Egyptian Journal of Hospital Medicine, 2019; 74(7): 1566-1576. doi: 10.21608/ejhm.2019.28115
Management of Postcholecystectomy Obstructive Jaundice
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.