ArticleHPB : the official journal of the International Hepato Pancreato Biliary Association2012
'Extreme' vasculobiliary injuries: association with fundus-down cholecystectomy in severely inflamed gallbladders.
Article in HPB : the official journal of the International Hepato Pancreato Biliary Association, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 52 papers, 3 of them syntheses that pooled it.
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Who cites it
52 citing papers in PubMed, 3 syntheses or guidelines pooled it, 146 citations in OpenAlex.
- A systematic review on laparoscopic subtotal cholecystectomy for difficult gallbladders: a lifesaving bailout or an incomplete operation?Annals of the Royal College of Surgeons of England · 2024Pooled it
- 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy.World journal of emergency surgery : WJES · 2021Guideline
- Safe cholecystectomy multi-society practice guideline and state-of-the-art consensus conference on prevention of bile duct injury during cholecystectomy.Surgical endoscopy · 2020Guideline
- Ultrasonic dissection versus electrocautery dissection in laparoscopic cholecystectomy for acute cholecystitis: a randomized controlled trial (SONOCHOL-trial).World journal of emergency surgery : WJES · 2024Trial
- Fundus-first dissection: a salvage technique for the difficult laparoscopic cholecystectomy.Surgical endoscopy · 2026Article
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- Article
- Navigating the Impossible Gallbladder: Bailout Strategies and Culture of Safety in Laparoscopic Cholecystectomy.Cureus · 2026Review
- Difficult gall bladder? 'Divide and rule'!Journal of minimal access surgery · 2026Article
- Surgical outcomes of conventional versus indocyanine green fluorescence-guided laparoscopic cholecystectomy in acute cholecystitis: a propensity score-matched analysis.Surgical endoscopy · 2025Article
- The difficult laparoscopic cholecystectomy: a narrative review.BMC surgery · 2025Review
- Portal vein reconstruction in iatrogenic portal vein ligation.CVIR endovascular · 2025Article
- Acute cholecystitis treated with urgent cholecystectomy achieves higher rate of critical view of safety when compared to interval cholecystectomy after tube cholecystostomy.Surgical endoscopy · 2025Article
- Factors affecting early and late period outcomes in patients undergoing surgical repair due to biliary tract injury.Frontiers in surgery · 2025Article
- Article
- Utilization of the modified Kama scoring system for predicting bail-out cholecystectomy: a valuable tool in the era of rising laparoscopic surgery prevalence.Surgery today · 2024Article
- Application of three-dimensional visualization technology in early surgical repair of bile duct injury during laparoscopic cholecystectomy.BMC surgery · 2024Article
- Bile Duct Injuries after Cholecystectomy: An Individual Patient Data Systematic Review.Journal of clinical medicine · 2024Review
- Safety of cholecystectomy performed by surgeons who prefer fundus first versus surgeons who prefer a standard laparoscopic approach.Surgery open science · 2024Article
- Liver pucker sign: predictor of difficult laparoscopic cholecystectomy: a case series.Annals of medicine and surgery (2012) · 2024Article
Corrections and comments
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Authors and funding
2 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesExtreme vasculobiliary injuries usually involve major hepatic arteries and portal veins. They are rare, but have severe consequences, including rapid infarction of the liver. The pathogenesis of these injuries is not well understood. The purpose of this study was to elucidate the mechanism of injury through an analysis of clinical records, particularly the operative notes of the index procedure.
methodsBiliary injury databases in two institutions were searched for data on extreme vasculobiliary injuries. Operative notes for the index procedure (cholecystectomy) were requested from the primary institutions. These notes and the treatment records of the tertiary centres to which the patients had been referred were examined. Radiographs from the primary institutions, when available, as well as those from the tertiary centres, were studied.
resultsEight patients with extreme vasculobiliary injuries were found. Most had the following features in common. The operation had been started laparoscopically and converted to an open procedure because of severe chronic or acute inflammation. Fundus-down cholecystectomy had been attempted. Severe bleeding had been encountered as a result of injury to a major portal vein and hepatic artery. Four patients have required right hepatectomy and one had required an orthotopic liver transplant. Four of the eight patients have died and one remains under treatment.
conclusionsExtreme vasculobiliary injuries tend to occur when fundus-down cholecystectomy is performed in the presence of severe inflammation. Contractive inflammation thickens and shortens the cystic plate, making separation of the gallbladder from the liver hazardous.
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