Therapeutic strategies of iatrogenic portal vein injury after cholecystectomy



      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.


      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.


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Surgical Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sarno G.
        • Al-Sarira A.A.
        • Ghaneh P.
        • Fenwick S.W.
        • Malik H.Z.
        • Poston G.J.
        Cholecystectomy-related bile duct and vasculobiliary injuries.
        Br J Surg. 2012; 99: 1129
        • Gholson C.F.
        • Dungan C.
        • Neff G.
        • et al.
        Suspected biliary complications after laparoscopic and open cholecystectomy leading to endoscopic cholangiography: a retrospective comparison.
        Dig Dis Sci. 1998; 43: 534
        • Keleman A.M.
        • Imagawa D.K.
        • Findeiss L.
        • et al.
        Associated vascular injury in patients with bile duct injury during cholecystectomy.
        Am Surg. 2011; 77: 1330
        • Cantù P.
        • Tenca A.
        • Caparello C.
        • et al.
        Role of symptoms, trend of liver tests, and endotherapy in management of post-cholecystectomy biliary leak.
        Dig Dis Sci. 2011; 56: 1565
        • Strasberg S.M.
        • Helton W.S.
        An analytical review of vasculobiliary injury in laparoscopic and open cholecystectomy.
        HPB (Oxford). 2011; 13: 1
        • Deziel D.J.
        • Millikan K.W.
        • Economou S.G.
        • Doolas A.
        • Ko S.T.
        • Airan M.C.
        Complications of laparoscopic cholecystectomy: a national survey of 4292 hospitals and an analysis of 77,704 cases.
        Am J Surg. 1993; 165: 9
        • Li J.
        • Frilling A.
        • Nadalin S.
        • Paul A.
        • Malagò M.
        • Broelsch C.E.
        Management of concomitant hepatic artery injury in patients with iatrogenic major bile duct injury after laparoscopic cholecystectomy.
        Br J Surg. 2008; 95: 460
        • Chang C.W.
        • Chen M.J.
        • Shih S.C.
        • Chang W.H.
        • Yang W.J.
        • Chu C.H.
        Hepatic subcapsular hematoma secondary to intrahepatic pseudoaneurysm following cholecystectomy.
        Dig Dis Sci. 2007; 52: 3303
        • Nishio H.
        • Kamiya J.
        • Nagino M.
        • et al.
        Right hepatic lobectomy for bile duct injury associated with major vascular occlusion after laparoscopic cholecystectomy.
        J Hepatobiliary Pancreat Surg. 1999; 6: 427
        • Halasz N.A.
        Cholecystectomy and hepatic artery injury.
        Arch Surg. 1991; 126: 137
        • Wudel Jr., L.J.
        • Wright J.K.
        • Pinson C.W.
        • et al.
        Bile duct injury following laparoscopic cholecystectomy: a cause for continued concern.
        Am Surg. 2001; 67: 557
        • Stewart L.
        • Robinson T.N.
        • Lee C.M.
        • Liu K.
        • Whang K.
        • Way L.W.
        Right hepatic artery injury associated with laparoscopic bile duct injury: incidence, mechanism, and consequences.
        J Gastrointest Surg. 2004; 8: 523
        • Tzovaras G.
        • Dervenis C.
        Vascular injuries in laparoscopic cholecystectomy: an underestimated problem.
        Dig Surg. 2006; 23: 370
        • de Franchis R.
        Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension.
        J Hepatol. 2005; 43: 167
        • Sarin S.K.
        • Sollano J.D.
        • Chawla Y.K.
        • et al.
        Consensus on extra-hepatic portal vein obstruction.
        Liver Int. 2006; 26: 512
        • Amitrano L.
        • Guardascione M.A.
        • Scaglione M.
        • et al.
        Prognostic factors in noncirrhotic patients with splanchnic vein thromboses.
        Am J Gastroenterol. 2007; 102: 2464
        • Baril N.
        • Wren S.
        • Radin R.
        • Ralls P.
        • Stain S.
        The role of anticoagulation in pylephlebitis.
        Am J Surg. 1996; 172: 449
        • Frilling A.
        • Li J.
        • Weber F.
        • et al.
        Major bile duct injuries after laparoscopic cholecystectomy: a tertiary center experience.
        J Gastrointest Surg. 2004; 8: 679