Abstract
Cholecystectomy is one of the common surgical procedure performed across the world and bile duct injury is a dreaded complication. The present review addresses the classification of injuries, preoperative preparation and evaluation of these patients and appropriate timing of surgery. A detailed preoperative evaluation combined with a meticulous wide anastomosis by experienced surgeons is the key in achieving long term success. Vascular injuries and its consequences on repair and outcome is also reviewed. Long term results of surgical repair and quality of life in these patients are excellent
Similar content being viewed by others
References
Gilliland TM, Traverso LW (1990) Modern standards for comparison of cholecystectomy with alternative treatments for symptomatic cholelithiasis with emphasis on long-term relief of symptoms. Surg Gynecol Obstet 170:39–44
Mcsherry CK (1989) Cholecystectomy: the gold standard. Am J Surg 158:174–178
Andren-Sandberg A, Allinder G, Bengmark S (1985) Accidental lesions of the common bile duct at cholecystectomy. Ann Surg 201:328–332
Perrisat J (1993) Laparoscopic cholecystectomy: the European experience. Am J Surg 165:444–449
Lee VS, Chari RS, Cucchiaro G, Meyers WC (1993) Complications of laparoscopic cholecystectomy. Am J Surg 165:527–532
Davidoff AM, Pappas TN, Murray EA, Hilleren DJ, Johnson RD, Baker ME et al (1992) Mechanisms of major biliary injury during laparoscopic cholecystectomy. Ann Surg 215:196–202
Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC (1993) Complications of laparoscopic cholecystectomy: a national survey of 4292 hospitals and an analysis of 77,604 cases. Am J Surg 165:9–14
Woods MS, Traverso LW, Kozarek RA, Tsao J, Rossi RL, Gough D, Donohue JH (1994) Characteristics of biliary tract complications during laparoscopic cholecystectomy: a multi-institutional study. Am J Surg 167:27–34
The Southern Surgeons club (1991) A prospective analysis of 1518 cholecystectomies. N Engl J Med 324:1073–1078
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
Sikora SS, Kumar A, Das NR, Sarkari A, Saxena R, Kapoor VK (2001) Laparoscopic bile duct injuries: spectrum at a tertiary-care center. J Laproendosc Adv Surg Tech A11:63–68
Chaudhary A, Manisegran M, Chandra A, Agarwal AK, Sachdev AK (2001) How do bile duct injuries sustained during laparoscopic cholecystectomy differ from those during open cholecystectomy? J Laparoendosc Adv Surg Tech A 11(4):187–191
Bismuth H, Majno PE (2001) Biliary strictures: classification based on the principles of surgical treatment. World J Surg 25:1241–1244
Sikora SS, Srikanth G, Sarkari A, Kumar A, Saxena R, Kapoor VK (2003) Hilar benign biliary strictures: need for subclassification. ANZ J Surg 73(7):484–488
Bektas H, Schrem H, Winny M, Klempnauer J (2007) Surgical treatment and outcome of iatrogenic bile duct lesions after cholecystectomy and the impact of different clinical classification systems. Br J Surg 94(9):1119–1127
Lau WY, Lai EC (2007) Classification of iatrogenic bile duct injury. Hepatobiliary Pancreat Dis Int 6(5):459–463
Hintze RE, Adler A, Veltzke W, Abou-Rebyeh H, Hammerstingl R, Vogl T et al (1997) Clinical significance of magnetic resonance cholangiopancreatography (MRCP) compared to endoscopic retrograde cholangiopancreatography (ERCP). Endoscopy 29:182–187
Mendler MH, Bouillet P, SautereauD CP, Cessot F, Le Sidaner A et al (1998) Value of MR cholangiography in the diagnosis of obstructive diseases of the biliary tree: a study of 58 cases. Am J Gastroenterol 93:2482–2490
Coakley FV, Schwartz LH, Blumgart LH, Fong Y, Jarnagin WR, Panicek DM et al (1998) Complex postcholecystectomy biliary disorders: preliminary experience with evaluation by means of breath-hold MR cholangiography. Radiology 209:141–146
Chaudhary A, Negi SS, Puri SK, Narang P (2002) Comparison of magnetic resonance cholangiography and percutaneous transhepatic cholangiography in the evaluation of bile duct strictures after cholecystectomy. Br J Surg 89(4):433–436
deReuver PR, Grossmann I, Busch OR, Obertop H, van Gulik TM, Gouma DJ (2007) Referral pattern and timing of repair are risk factors for complications after reconstructive surgery for bile duct injury. Ann Surg 245(5):763–770
Goykhman Y, Kory I, Small R, Kessler A, Klausner JM, Nakache R, Ben-Haim M (2008) Long-term outcome and risk factors of failure after bile duct injury repair. J Gastrointest Surg 12(8):1412–1417
Schol FP, Go PMNYH, Gouma DJ (1995) Outcome of 49 repairs of bile duct injuries after laparoscopic cholecystectomy. World J Surg 19:753–756
Hepp J (1985) Hepaticojejunostomy using the left biliary trunk for iatrogenic biliary lesions. World J Surg 9:507–511
Blumgart LH, Kelly CJ (1984) Hepaticojejunostomy in benign and malignant high bile duct stricture: approaches to the left ducts. Br J Surg 71:257–261
Winslow ER, Fialkowski EA, Linehan DC, Hawkins WG, Picus DD, Strasberg SM (2009) “Sideways”: results of repair of biliary injuries using a policy of side-to-side hepatico-jejunostomy. Ann Surg 249(3):426–434
Bachellier P, Nakano H, Weber JC, Lemarque P, Oussoultzoglou E, Candau C, Wolf P, Jaeck D (2001) Surgical repair after bile duct and vascular injuries during laparoscopic cholecystectomy: when and how? World J Surg 25(10):13351345
Longmire WP, Sanford MC (1948) Intrahepatic cholangiojejunostomy with partial hepatectomy for biliary obstruction. Surgery 128:330–347
Smith R (1981) Injuries of the bile ducts. In: Smith LR, Sherlock DS (eds) Surgery of the gallbladder and bile ducts. Butterworths, London, pp 361–381
Mercado MA, Chan C, Orozco H, Villalta JM, Barajas-Olivas A, Eraña J, Domínguez I (2006) Long-term evaluation of biliary reconstruction after partial resection of segments IV and V in iatrogenic injuries. J Gastrointest Surg 10(1):77–82
Mercado MA, Chan C, Salgado-Nesme N, López-Rosales F (2008) Intrahepatic repair of bile duct injuries. A comparative study. J Gastrointest Surg 12(2):364–368
Lillemoe KD, Melton GB, Cameron JL, Pitt HA, Campbell KA, Talamini MA et al (2000) Post operative bile duct strictures: management and outcome in the 1990s. Ann Surg 232:430–441
Chapman WC, Halvey A, Blumgart LH, Benjamin IS (1995) Postcholecystectomy bile duct strictures. Arch Surg 130:597–604
Stewart L, Way LW (1995) Bile duct injuries during laparoscopic cholecystectomy: factors that influence the results of treatment. Arch Surg 130:1123–1129
Tocchi A, Costa G, Lepre L, Liotta G, Mazzoni G, Sita A (1996) The long-term outcome of hepaticojejunostomy in the treatment of benign bile duct strictures. Ann Surg 224:162–167
Sikora SS, Pottakkat B, Srikanth G, Kumar A, Saxena R, Kapoor VK (2006) Postcholecystectomy benign biliary strictures—long-term results. Dig Surg 23(5–6):304–312
Schmidt SC, Langrehr JM, Raakow R, Klupp J, Steinmüller T, Neuhaus P (2002) Right hepatic lobectomy for recurrent cholangitis after combined bile duct and right hepatic artery injury during laparoscopic cholecystectomy: a report of two cases. Langenbecks Arch Surg 387:183–187
Heinrich S, Seifert H, Krähenbühl L, Fellbaum C, Lorenz M (2003) Right hemihepatectomy for bile duct injury following laparoscopic cholecystectomy. Surg Endosc 17:1494–1495
Lichtenstein S, Moorman DW, Malatesta JQ, Martin MF (2000) The role of hepatic resection in the management of bile duct injuries following laparoscopic cholecystectomy. Am Surg 66(4):372–376
Laurent A, Sauvanet A, Farges O, Watrin T, Rivkine E, Belghiti J (2008) Major hepatectomy for the treatment of complex bile duct injury. Ann Surg 248(1):77–83
Thomson BN, Parks RW, Madhavan KK, Garden OJ (2007) Liver resection andtransplantation in the management of iatrogenic biliary injury. World J Surg 31:2363–2369
deSantibañes E, Ardiles V, Gadano A, Palavecino M, Pekolj J, Ciardullo M (2008) Liver transplantation: the last measure in the treatment of bile duct injuries. World J Surg 32(8):1714–1721
Ozden I, Bilge O, Tekant Y, Alper A, Emre A, Arioğul O (2008) Liver transplantation in the management of iatrogenic biliary tract injury. World J Surg 32(6):1230
Fernandez JA, Robles R, Marin C, Sanchez-Bueno F, Ramirez P, Parrilla P (2004) Laparoscopic iatrogeny of the hepatic hilum as an indication for liver transplantation. Liver Transpl 10:147–152
Halasz NA (1991) Cholecystectomy and hepatic artery injury. Arch Surg 126:137–138
Wudel LJ, Wright JK, Pinson CW et al (2001) Bile duct injury following laparoscopic cholecystectomy: a cause for continued concern. Am Surg 67:557–563
Bismuth H (1981) How to treat a postoperative stenosis? In: Bismuth H, Lazorthes F (eds) Operative injury of the common bile duct. Masson, Paris, pp 47–107
Alves A, Farges O, Nicolet J, Watrin T, Sauvanet A, Belghiti J (2003) Incidence and consequence of an hepatic artery injury in patients with postcholecystectomy bile duct strictures. Ann Surg 238(1):93–96
Holbert BL, Baron RL, Dodd GD 3rd (1996) Hepatic infarction caused by arterial insufficiency: spectrum and evolution of CT findings. Am J Roentgenol 166:815–820
Smith GS, Birnbaum BA, Jacobs JE (1998) Hepatic infarction secondary to arterial insufficiency in native livers: CT findings in 10 patients. Radiology 208:223–229
Gupta N, Soloman H, Fairchild R, Kaminski DL (1998) Management and outcome of patients with combined bile duct and hepatic artery injuries. Arch Surg 133:176–181
Madariaga JR, Dodson SF, Selby R, Todo S, Iwatsuki S, Starzl TE (1994) Corrective treatment and anatomic considerations for laparoscopic cholecystectomy injuries. J Am Coll Surg 179:321–325
Stewart L, Robinson TN, Lee CM, Liu K, Whang K, Way LW (2004) Right hepatic artery injury associated with laparoscopic bile duct injury: incidence, mechanism, and consequences. J Gastrointest Surg 8(5):523–530
Li J, Frilling A, Nadalin S, Paul A, Malagò M, Broelsch CE (2008) Management of concomitant hepatic artery injury in patients with iatrogenic major bile duct injury after laparoscopic cholecystectomy. Br J Surg 95(4):460–465
Schmidt SC, Settmacher U, Langrehr JM, Neuhaus P (2004) Management and outcome of patients with combined bile duct and hepatic arterial injuries after laparoscopic cholecystectomy. Surgery 135(6):613–618
Koffron A, Ferrario M, Parsons W, Nemcek A, Saker M, Abecassis M (2001) Failed primary management of iatrogenic biliary injury: incidence and significance of concomitant hepatic arterial disruption. Surgery 130:722–728
Buell JF, Cronin DC, Funaki B, Koffron A, Yoshida A, Lo A, Leef J, Millis JM (2002) Devastating and fatal complications associated with combined vascular and bile duct injuries during cholecystectomy. Arch Surg 137(6):703–708
Agarwal AK, Gupta V, Singh S, Agarwal S, Sakhuja P (2008) Management of patients of postcholecystectomy benign biliary stricture complicated by portal hypertension. Am J Surg 195(4):421–426
Perakath B, Sitaram V, Mathew G, Khanduri P (2003) Post-cholecystectomy benign biliary stricture with portal hypertension: is a portosystemic shunt before hepaticojejunostomy necessary? Ann R Coll Surg Engl 85(5):317–320
Blumgart LH, Kelley CJ, Benjamin IS (1984) Benign bile duct stricture following cholecystectomy: critical factors in management. Br J Surg 71:836–843
Sikora SS, Srikanth G, Agrawal V, Gupta RK, Kumar A, Saxena R, Kapoor VK (2008) Liver histology in benign biliary stricture: fibrosis to cirrhosis. .. and reversal? J Gastroenterol Hepatol 23(12):1879–1884
Way LW, Dunphy JE (1972) Biliary stricture. Am J Surg 124:287–295
Jarnagin WR, Blumgart LH (2000) Benign biliary strictures. In: Blumgart LH, Fong Y (eds) Surgery of the liver and biliary tracts, 3rd edn. WB Saunders Company Ltd, London, England, pp 895–933
Mercado MA, Domínguez I (2011) Classification and management of bile duct injuries. World J Gastrointest Surg 3(4):43–48
Connor S, Garden OJ (2006) Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg 93:158–168
Raute M, Podlech P, Jaschke W, Manegold BC, Trede M, Chir B (1993) Management of bile duct injuries and strictures following cholecystectomy. World J Surg 17:553–562
McDonald MI, Farnell MB, Nagorney DM, Ilstrup DM, Kutch JM (1995) Benign biliary strictures: repair and outcome with a contemporary approach. Surgery 118:582–591
Pitt HA, Miyamato T, Parapatis SK, Thompkins RK, Longmire WP (1982) Factors influencing outcome in patients with postoperative biliary strictures. Am J Surg 144:14–21
Schweizer WP, Matthews JB, Baer HU, Nudelmann LI, Triller J, Halter F et al (1991) Combined surgical and interventional radiological approach for complex benign biliary tract obstruction. Br J Surg 78:559–563
Bottger T, Junginger T (1991) Long-term results after surgical treatment of iatrogenic injury of the bile ducts. Eur J Surg 157:477–480
Moossa AR, Mayer AD, Stabile B (1990) Iatrogenic injury to the bile duct. Who, how, where? Arch Surg 125:1028–1031
Boerma D, Rauws EA, Keulemans YC, Bergman JJ, Obertop H, Huibregtse K et al (2001) Impaired quality of life 5 years after bile duct injury during laparoscopic cholecystectomy: a prospective analysis. Ann Surg 234:750–757
Melton GB, Lillemoe KD, Cameron JL, Sauter PA, Coleman J, Yeo CJ (2002) Major bile duct injuries associated with laparoscopic cholecystectomy: effect of surgical repair on quality of life. Ann Surg 235:888–895
Sarmiento JM, Farnell MB, Nagorney DM, Hodge DO, Harrington JR (2004) Quality-of-life assessment of surgical reconstruction after laparoscopic cholecystectomy-induced bile duct injuries: what happens at 5 years and beyond? Arch Surg 139:483–489
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sikora, S.S. Management of Post-Cholecystectomy Benign Bile Duct Strictures: Review. Indian J Surg 74, 22–28 (2012). https://doi.org/10.1007/s12262-011-0375-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-011-0375-6