Abstract
Background
Bile duct injury is a major complication of laparoscopic cholecystectomy. The purpose of this study was to evaluate our management strategy and outcomes for the treatment of such injuries.
Methods
We studied 54 consecutive patients who had de novo bile duct injury (n = 20) or prior biliary injury repair (n = 34) associated with laparoscopic cholecystectomy. All patients were managed using a multidisciplinary approach.
Results
Definitive operation, almost always Roux-en-Y hepaticojejunostomy, was required in 85% of patients. We inserted external percutaneous biliary catheters in 98% of cases prior to surgery. There were no operative deaths, and the 30-day complication rate was 20%. Eight patients (15%) were managed nonoperatively. Overall, 96% of patients had no long-term, objectively definable biliary sequelae.
Conclusions
Treatment of bile duct injury associated with laparoscopic cholecystectomy is optimally done using a multidisciplinary approach. Surgical reconstruction is required in most cases and can be safely accomplished with minimal morbidity and excellent long-term outcomes.
Similar content being viewed by others
References
Adamsen S, Hansen OH, Funch-Jensen P, Schulze S, Stage JG, Wara P (1997) Bile duct injury during laparoscopic cholecystectomy: a prospective nationwide series. J Am Coll Surg 184: 571–578
Blumgart LH (1994) Hilar and intrahepatic biliary enteric anastomosis. Surg Clin North Am 74: 845–863
Doctor N, Dooley JS, Dick R, Watkinson A, Rolles K, Davidson BR (1998) Multidisciplinary approach to biliary complications of laparoscopic cholecystectomy. Br J Surg 85: 627–632
Hart R, Passi R, Hall W (2000) Long-term outcome after repair of major bile duct injury created during laparoscopic cholecystectomy. J Hepat Pancreat Biliary Surg 2: 325–332
Johnson SR, Koehler A, Pennington LK, Hanto DW (2000) Long-term results of surgical repair of bile duct injuries following laparoscopic cholecystectomy. Surgery 128: 668–677
Lillemoe KD, Melton GB, Cameron JL, Pitt HA, Campell KA, Talamini MA, Sauter PA, Coleman J, Yeo CJ (2000) Postoperative bile duct strictures: management and outcome in the 1990s. Ann Surg 232: 430–441
Lillemoe KD, Martin SA, Cameron JL, Yeo CJ, Talamini MA, Kaushal S, Coleman J, Venbrux AC, Savader SJ (1997) Major bile duct injuries during laparoscopic cholecystectomy: follow-up after combined surgical and radiologic management. Ann Surg 225: 459–471
MacFadyen BV, Vecchio R, Ricardo AE, Mathis CR (1998) Bile duct injury after laparoscopic cholecystectomy: the United States experience. Surg Endosc 12: 315–321
Pitt HA, Kaufman SL, Coleman J, White RI, Cameron JL (1989) Benign postoperative biliary strictures: operate or dilate? Ann Surg 210: 417–427
Rossi RL, Tsao JI (1994) Biliary reconstruction. Surg Clin North Am 74: 825–841 discussion 843-844
Savader SJ, Lillemoe KD, Prescott CA, Winick AB, Venbrux AC, Lund GB, Mitchell SE, Cameron JL, Osterman FA (1997) Laparoscopic cholecystectomy-related bile duct injuries: a health and financial disaster. Ann Surg 225: 268–273
Soper NJ, Flye MW, Brunt LM, Stockman PT, Sicard GA, Picus D, Edmundowicz SA, Aliperti G (1993) Diagnosis and management of biliary complications of laparoscopic cholecystectomy. Am J Surg 165: 663–669
Stewart L, Way LW (1995) Bile duct injuries during laparoscopic cholecystectomy: factors that influence the results of treatment. Arch Surg 130: 1123–1129
Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180: 101–125
Sutherland F, Launois B, Stanescu M, Campion JP, Spiliopoulos Y, Stasik C (1999) A refined approach to the repair of postcholecystectomy bile duct strictures. Arch Surg 134: 299–302
Vitale GC, Stephens G, Wieman TJ, Larson GM (1993) Use of endoscopic retrograde cholangiopancreatography in the management of biliary complications after laparoscopic cholecystectomy. Surgery 114: 806–814
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Robinson, T.N., Stiegmann, G.V., Durham, J.D. et al. Management of major bile duct injury associated with laparoscopic cholecystectomy. Surg Endosc 15, 1381–1385 (2001). https://doi.org/10.1007/s00464-001-8156-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-001-8156-0