Skip to main content
SpringerLink
Log in

Management of Post-Cholecystectomy Benign Bile Duct Strictures: Review

  • Review Article
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. 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

    PubMed  CAS  Google Scholar 

  2. Mcsherry CK (1989) Cholecystectomy: the gold standard. Am J Surg 158:174–178

    Article  PubMed  CAS  Google Scholar 

  3. Andren-Sandberg A, Allinder G, Bengmark S (1985) Accidental lesions of the common bile duct at cholecystectomy. Ann Surg 201:328–332

    Article  PubMed  CAS  Google Scholar 

  4. Perrisat J (1993) Laparoscopic cholecystectomy: the European experience. Am J Surg 165:444–449

    Article  Google Scholar 

  5. Lee VS, Chari RS, Cucchiaro G, Meyers WC (1993) Complications of laparoscopic cholecystectomy. Am J Surg 165:527–532

    Article  PubMed  CAS  Google Scholar 

  6. 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

    Article  PubMed  CAS  Google Scholar 

  7. 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

    Article  PubMed  CAS  Google Scholar 

  8. 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

    Article  PubMed  CAS  Google Scholar 

  9. The Southern Surgeons club (1991) A prospective analysis of 1518 cholecystectomies. N Engl J Med 324:1073–1078

    Article  Google Scholar 

  10. 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

    PubMed  CAS  Google Scholar 

  11. 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

    Article  Google Scholar 

  12. 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

    Article  PubMed  CAS  Google Scholar 

  13. Bismuth H, Majno PE (2001) Biliary strictures: classification based on the principles of surgical treatment. World J Surg 25:1241–1244

    Article  PubMed  CAS  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. 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

    Article  PubMed  CAS  Google Scholar 

  16. Lau WY, Lai EC (2007) Classification of iatrogenic bile duct injury. Hepatobiliary Pancreat Dis Int 6(5):459–463

    PubMed  Google Scholar 

  17. 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

    Article  PubMed  CAS  Google Scholar 

  18. 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

    Article  PubMed  CAS  Google Scholar 

  19. 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

    PubMed  CAS  Google Scholar 

  20. 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

    Article  PubMed  CAS  Google Scholar 

  21. 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

    Article  Google Scholar 

  22. 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

    Article  PubMed  Google Scholar 

  23. Schol FP, Go PMNYH, Gouma DJ (1995) Outcome of 49 repairs of bile duct injuries after laparoscopic cholecystectomy. World J Surg 19:753–756

    Article  PubMed  CAS  Google Scholar 

  24. Hepp J (1985) Hepaticojejunostomy using the left biliary trunk for iatrogenic biliary lesions. World J Surg 9:507–511

    Article  PubMed  CAS  Google Scholar 

  25. 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

    Article  PubMed  CAS  Google Scholar 

  26. 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

    Article  PubMed  Google Scholar 

  27. 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

    Article  Google Scholar 

  28. Longmire WP, Sanford MC (1948) Intrahepatic cholangiojejunostomy with partial hepatectomy for biliary obstruction. Surgery 128:330–347

    Google Scholar 

  29. 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

    Google Scholar 

  30. 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

    Article  PubMed  Google Scholar 

  31. 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

    Article  PubMed  Google Scholar 

  32. 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

    Article  PubMed  CAS  Google Scholar 

  33. Chapman WC, Halvey A, Blumgart LH, Benjamin IS (1995) Postcholecystectomy bile duct strictures. Arch Surg 130:597–604

    Article  PubMed  CAS  Google Scholar 

  34. Stewart L, Way LW (1995) Bile duct injuries during laparoscopic cholecystectomy: factors that influence the results of treatment. Arch Surg 130:1123–1129

    Article  PubMed  CAS  Google Scholar 

  35. 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

    Article  PubMed  CAS  Google Scholar 

  36. 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

    Article  PubMed  CAS  Google Scholar 

  37. 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

    Article  PubMed  CAS  Google Scholar 

  38. 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

    PubMed  CAS  Google Scholar 

  39. 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

    PubMed  CAS  Google Scholar 

  40. 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

    Article  PubMed  Google Scholar 

  41. 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

    Article  PubMed  CAS  Google Scholar 

  42. 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

    Article  Google Scholar 

  43. 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

    Article  PubMed  Google Scholar 

  44. 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

    Article  PubMed  Google Scholar 

  45. Halasz NA (1991) Cholecystectomy and hepatic artery injury. Arch Surg 126:137–138

    Article  PubMed  CAS  Google Scholar 

  46. 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

    PubMed  Google Scholar 

  47. 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

    Google Scholar 

  48. 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

    PubMed  Google Scholar 

  49. 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

    CAS  Google Scholar 

  50. 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

    PubMed  CAS  Google Scholar 

  51. 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

    Article  PubMed  CAS  Google Scholar 

  52. 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

    PubMed  CAS  Google Scholar 

  53. 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

    Article  PubMed  Google Scholar 

  54. 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

    Article  PubMed  CAS  Google Scholar 

  55. 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

    Article  PubMed  Google Scholar 

  56. 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

    Article  PubMed  CAS  Google Scholar 

  57. 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

    Article  PubMed  Google Scholar 

  58. 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

    Article  PubMed  Google Scholar 

  59. 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

    Article  PubMed  CAS  Google Scholar 

  60. Blumgart LH, Kelley CJ, Benjamin IS (1984) Benign bile duct stricture following cholecystectomy: critical factors in management. Br J Surg 71:836–843

    Article  PubMed  CAS  Google Scholar 

  61. 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

    Article  PubMed  Google Scholar 

  62. Way LW, Dunphy JE (1972) Biliary stricture. Am J Surg 124:287–295

    Article  PubMed  CAS  Google Scholar 

  63. 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

    Google Scholar 

  64. Mercado MA, Domínguez I (2011) Classification and management of bile duct injuries. World J Gastrointest Surg 3(4):43–48

    Article  PubMed  Google Scholar 

  65. Connor S, Garden OJ (2006) Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg 93:158–168

    Article  PubMed  CAS  Google Scholar 

  66. 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

    Article  PubMed  CAS  Google Scholar 

  67. 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

    Article  PubMed  CAS  Google Scholar 

  68. 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

    Article  PubMed  CAS  Google Scholar 

  69. 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

    Article  PubMed  CAS  Google Scholar 

  70. Bottger T, Junginger T (1991) Long-term results after surgical treatment of iatrogenic injury of the bile ducts. Eur J Surg 157:477–480

    PubMed  CAS  Google Scholar 

  71. Moossa AR, Mayer AD, Stabile B (1990) Iatrogenic injury to the bile duct. Who, how, where? Arch Surg 125:1028–1031

    Article  PubMed  CAS  Google Scholar 

  72. 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

    Article  PubMed  CAS  Google Scholar 

  73. 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

    Article  PubMed  Google Scholar 

  74. 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

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Gastroenterology, Manipal Institute of Liver and Digestive Diseases, Manipal Hospital, Bangalore, India

    Sadiq S. Sikora

Authors
  1. Sadiq S. Sikora
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sadiq S. Sikora.

Rights and permissions

Reprints 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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-011-0375-6

Keywords

Search

Navigation