Assessment of the Relaparotomy Results
Fifty-one LLDs (2.4 %) with a median age 27 years (min-max: 20-51
years) underwent 53 relaparotomy due to various biliary complications. A
sum of 107 relaparotomy procedures were performed and 53 of them were
related with various biliary complications. Median time from LDH to
relaparotomy was 20 days (min-max: 1-97 days). Thirteen of the
relaparotomies received HJ (one LLD had twice relaparotomy for a second
HJ). Only two LLDs underwent HJ during relaparotomy for acute biliary
peritonitis. One of these two LLDs underwent early relaparotomy due to a
bilioma which was 10 cm in diameter resulted in peritonitis. An ischemic
section consisting right ductal stump of the main bile duct was
diagnosed, and a HJ was performed between the ischemic section of the
bile duct and a jejunal Roux limb, preserving the continuity of bile
flow via common bile duct. Although external-internal PTBD catheter was
inserted in another LLD to prevent postoperative bile leaks, bile leaks
persisted and acute abdomen findings developed. Therefore, PTBD catheter
assisted HJ was performed in the laparotomy performed for acute abdomen
findings. Remaining 40 patients that underwent re-laparotomy, the
indications were biliary peritonitis, drainage of fluid/bilioma, high
output bile leaks in the early postoperative period (≥300 cc pure bile
leaks) and duodenal perforation due to ERCP. A biliary drainage catheter
extending from the cystic duct stump to the intrahepatic bile ducts was
placed in 13 LLDs for bile leaks from cut surface or bile duct stump.
Procedure for repair of bile leaks was mentioned above. Following
bilioma drainage and a drainage tube placement, surgical procedure was
finalized in 26 LLDs. Remaining one LLD underwent relaparotomy due to
duodenal perforation following ERCP.