The Role of Hepatic Resection in the Management of Bile Duct Injuries following Laparoscopic Cholecystectomy

Abstract

The creation of a specialized hepatobiliary surgery unit at our medical center has resulted in referral of 16 patients with bile duct complications following laparoscopic cholecystectomy over the last 18 months. No patient required conversion to open cholecystectomy. Although no injury was recognized at the time of surgery, 15 of 16 patients became symptomatic within the first 30 days. Two patients died from sepsis and multisystem organ failure after protracted hospital courses. Endoscopic retrograde cholangiopancreatography and/or percutaneous transhepatic cholangiography determined diagnosis and level of injury. Six of seven patients with cystic duct leak underwent successful endoscopic stent placement and one patient sealed spontaneously after percutaneous drainage of a large biloma. Nine patients required surgery that included hepaticojejunostomy (five), T-tube insertion and drainage of abscess (two), or segmental hepatic resection (two). Timely recognition of bile duct complications following laparoscopic cholecystectomy is critical to a successful long-term outcome. Although the majority of cystic duct leaks can be managed with endoscopic stenting, patients with ductal injuries require hepaticojejunostomy. Segmental liver resection may serve an important role in the management of carefully selected patients with high intrahepatic injuries to avoid long-term transhepatic stenting and complications such as episodic cholangitis and late stricture formation.

Liver Resection and Transplantation in the Management of Iatrogenic Biliary Injury

“…The literature contains a further three reports of bisegmental resections in the management of sectoral hepatic duct injury [6, 13]. Unrecognized injury to a right posterior or anterior sectoral duct with subsequent biliary fistula or sepsis may be best managed with right hepatectomy or bisegmentectomy if reconstruction is not possible.…”

“…Only a very small number of patients have been reported in the literature as requiring liver resection [2][3][4][5][6][7][8][9][10][11][12][13]o r transplantation [10-12, 14, 15] in the management of bile duct injury following cholecystectomy. The commonest indication for liver resection in the treatment of ongoing biliary sepsis or atrophy after injury has been to remove the right liver [2][3][4][5][6][7][8][9][10][11][12].…”

Major Liver Resection as Definitive Treatment in Post‐cholecystectomy Common Bile Duct Injuries

“…The course of hepatectomy and histopathological results is detailed in Table 4. The mean length of stay was 9.2 days after surgery (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

“…Management includes endoscopic and percutaneous procedures, surgery and also liver transplant [8,9]. Regarding surgical options, although CBDI can commonly be managed successfully with a biliary reconstruction, 5.6-15 % of cases in different published series require liver resection [10][11][12][13][14][15].…”