Management of bile duct injuries and strictures following cholecystectomy

Abstract

During 7057 conventional cholecystectomies (1972-1991), 16 bile duct injuries occurred, amounting to a risk of 0.22%. A total of 1022 laparoscopic cholecystectomies were performed without such a complication since April 1990. In a retrospective study, 64 patients (16 of our patients and 48 referrals) with an injury or stricture due to conventional cholecystectomy were investigated. In 14 of our 16 patients the injury was recognized and immediately repaired with a good long-term result of 93%, including one successful repair of a subsequent stricture. Two cases of unrecognized injury were managed by nonoperative means. The group of 48 referred patients comprised 10 early postoperative complications (21%) and 38 strictures after an "uneventful" cholecystectomy. Of the 64 total patients, 10 (16%) underwent nonoperative treatment, and 54 required surgery. The mean follow-up period after surgery was 7.4 +/- 4.9 years. Most cases (93%) were repaired by bilioenteric anastomosis (i.e., foremost hepaticojejunostomy) with an 18% restricture rate. Including second and third repairs for restricture, a total of 60 operations (14 primary and 46 secondary reconstructions) were performed without hospital mortality. A good long-term result after stricture repair was achieved in 75% of the patients, whereas 17% had a poor outcome owing to restricture or death (10% had related mortality within 10 years). The other 8% had a moderate result due to recurrent cholangitis. Thus immediate repair of a bile duct injury offers the better chance of a favorable prognosis compared to secondary stricture repair.

Iatrogenic Biliary Strictures: Surgical Experience with 39 Patients

“…Recent studies show that accidental surgical lesions of the biliary ducts occur in 0.2% of open cholecystectomies [1,2] and that this percentage is higher with the laparoscopic technique [3,4]. These lesions can result in bile peritonitis, biliary fistula, biliary tract strictures or an association of these complications.…”

Management of iatrogenic bile duct injury in cholecystectomy: a single centre experience

“…In a study by Raute et al of the 16% observed mortality rate 7% was related to surgery and 9% unrelated to surgery. 22 Helmy et al and Buanes et al reported 8.7% mortality rate as a result of postoperative complication. 23,24 Mean follow up for our patient was 24.5 months (1-60 months).…”

Laparoscopic cholecystectomy at the Aga Khan Hospital, Nairobi

“…The first case of bile duct injury was recorded by Mayo in 1905(22). Reported cases of common bile duct injuries during laparoscopic cholecystectomy have ranged from 0.2% to 3.4%, this being much higher than the 0.1% to 0.2% encountered during open cholecystectomy (16,(22)(23)(24)(25)(26). The rate of bile duct injuries appears to be decreasing as experience is gained with this new technique.…”