Surgical management of bile duct injuries following laparoscopic cholecystectomy: analysis and follow-up of 28 cases

Abstract

Major iatrogenic bile duct injuries are associated with high morbidity and prolonged hospitalization. Interdisciplinary cooperation and early referral to an experienced center is crucial in the management of patients suffering from this affliction. Cholangitis is a marked problem in the follow-up.

Hepatic resection for patients with cholecystectomy related complex bile duct injury

“…The outcome of surgical reconstruction is influenced by several factors, including the time of reconstruction, the availability of a preoperative complete delineation of the injury by cholangiography, the level of injury, the presence of local inflammation, associated vascular injury, previous attempts at repair as well as technical details of reconstructive procedures and the experience of the surgeon [3,6,14,15]. Despite reported long-term success rates in up to 90% of patients [15,16], failure of the primary repair of bile duct injury is associated with a significant mortality, high morbidity and reduced quality of live [13,18,19]. The time interval from initial repair to stricture is reported to vary from 5 months to 8 years [20,21], but about 80% of the strictures occur within 2 years after surgery [22].…”

Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy

“…Laparoscopic cholecystectomy (LC) is accepted as the gold standard treatment for symptomatic cholelithiasis [4,24], shown to have a lower morbidity, a less painful postoperative, course a shorter hospital stay, earlier recovery, quicker resumption of normal activities, and improved cosmesis compared to open cholecystectomy [6,15,25]. More recently, LC has gained acceptance as the surgical treatment for acute cholecystitis [13,16,17,19,26].…”

“…Laparoscopic cholecystectomy (LC) has become the treatment of choice for gallstones [24]. However, technical difficulties can make the conversion to open cholecystectomy inevitable, the consequences of which may overshadow all advantages of the laparoscopic procedure, making this approach unsafe, uneconomical and inefficient.…”

Proposal of a new technique for bile duct reconstruction after iatrogenic injury: study in dogs and review of the literature

“…In these cases, endoscopic retrograde cholangiopancreatography is performed in combination with papillotomy and placement of a nasobiliary catheter or biliary prosthesis 7,12,13 . Extensive lateral lesions, complete sectioning or ligation of the bile duct and long strictures require laparoscopic or laparotomic surgical treatment 14,15,16,17,18,19 . When the loss of bile substance is small, endto-end reconstruction can be performed as long as the suture can be placed without tension.…”