Laparoscopic Repair of Post-cholecystectomy Bile Duct Injury: an Advance in Surgical Management
- 510 Downloads
Despite widespread advances in laparoscopic surgery, laparoscopic repair of post-cholecystectomy bile duct injury (BDI) has rarely been reported related mainly to technical difficulty. We describe three cases of BDI treated laparoscopically with one illustrated by a video. With our gained experience in hepatic pedicle dissection during laparoscopic pancreaticoduodenectomy, we decided to perform laparoscopic repair of BDI in patients with an intact biliary confluence without vascular injury. Three patients were operated including two women: one was re-operated by subcostal incision for peritonitis and two had undergone cholecystectomy without conversion. Surgical technique is detailed in the manuscript and the video. Laparoscopic repair was performed between 45 and 300 days after cholecystectomy. Surgery lasted between 250 and 270 min with no conversion and no transfusion. The postoperative course was uneventful with a hospital stay ranging from 7 to 9 days. After a mean follow-up of 9–33 months, patients were symptom free with normal liver function tests. The laparoscopic approach can be safely and effectively proposed to a subgroup of patients with BDI. This approach has the advantages of the laparoscopic approach and represents the main new surgical advancement in the management of this complication.
KeywordsCholecystectomy Bile duct injury Laparoscopic repair Traumatism
Bile duct injury
Compliance with Ethical Standards
The authors state that informed consent was obtained from all patients, and that the study protocol has been approved by the institute’s committee on human research.
Conflict of Interest
The authors declare that they have no conflict of interest.
(MP4 84,585 kb)
- 1.Schwaitzberg SD, Scott DJ, Jones DB, McKinley SK, Castrillion J, Hunter TD, Michael Brunt L. Threefold increased bile duct injury rate is associated with less surgeon experience in an insurance claims database: More rigorous training in biliary surgery may be needed. Surg Endosc 2014; 11: 3068–73.CrossRefGoogle Scholar
- 2.Grbas H, Kunisek L, Zelić M, Petrosić N, Cepić I, Pirjavec A, Lovasić F, Uravić M. Outcome evaluation of 10,317 laparoscopic cholecystectomies: a 17-year experience at a single center. Hepatogastroenterology 2013; 128:1873–6.Google Scholar
- 8.Fatima J, Barton JG, Grotz TE, Geng Z, Harmsen WS, Huebner M, Baron TH, Kendrick ML, Donohue JH, Que FG, Nagorney DM, Farnell MB. Is there a role for endoscopic therapy as a definitive treatment for post-laparoscopic bile duct injuries? J Am Coll Surg 2010;211(4):495–502.CrossRefPubMedGoogle Scholar
- 12.Sicklick JK, Camp MS, Lillemoe KD, Melton GB, Yeo CJ, Campbell KA, Talamini MA, Pitt HA, Coleman J, Sauter PA, Cameron JL. Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients. Ann Surg 2005;241(5):786–92.CrossRefPubMedPubMedCentralGoogle Scholar