Therapeutic strategies of iatrogenic portal vein injury after cholecystectomy

• Published in: The Journal of surgical research 2013-12, Vol.185 (2), p.934-939
• Main Authors: Wang, Zheng, MD, PhD, Yu, Liang, MD, PhD, Wang, Wanli, MD, Xia, Jianmin, MD, Li, Dai, MD, Lu, Yi, MD, PhD, Wang, Bo, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anticoagulants - therapeutic use; Cholecystectomy; Cholecystectomy - adverse effects; Cholecystectomy, Laparoscopic - adverse effects; Female; Hepatic Artery - diagnostic imaging; Hepatic Artery - injuries; Hepatic Artery - surgery; Humans; Iatrogenic Disease; Intraoperative Complications - diagnostic imaging; Intraoperative Complications - etiology; Intraoperative Complications - therapy; Liver Transplantation; Male; Middle Aged; Portal Vein - diagnostic imaging; Portal Vein - injuries; Portal Vein - surgery; Portal vein injury; Postoperative Complications - diagnostic imaging; Postoperative Complications - etiology; Postoperative Complications - therapy; Referral and Consultation; Retrospective Studies; Surgery; Suture Techniques; Tomography, X-Ray Computed; Treatment strategy; Vasculobiliary injury
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2013.06.032

Abstract Background The incidence of vascular injury after a cholecystectomy is often underestimated. Although injuries to the portal vein are rare, they are devastating. The aim of the present study was to analyze suitable therapeutic strategies regarding portal vein injury in the absence of biliary injury. Materials and methods Eleven patients with portal vein injuries after laparoscopic or open cholecystectomy were referred to our hospital between 2004 and 2010. The clinical presentation, diagnosis, and management of patients with severe portal vein injuries were reviewed. All the patients were discharged without outstanding clinical conditions. During retrospective analysis, these patients were divided into early, middle, and late stages. Results All the 11 patients had a portal vein and/or right hepatic artery injury, but no biliary injuries were observed. Among these patients, different management strategies were managed according to the stage of the injury. Eight patients received a direct suture at the time of injury by an experienced hepatobiliary surgeon. Two patients received thrombolytic and anticoagulation therapy after cholecystectomy, without additional surgery. One patient received a liver transplant 3 mo after the injury. After long-term follow-up, these patients had no clinical conditions. Conclusions Direct repair or suture is important during the early stage of portal vein injury. Conservative thrombolytic and anticoagulation therapy may serve an important role in the treatment of acute massive thrombus in portal vein injury during the middle stage. Liver transplantation is a salvage therapy that should be used during the late stage.