J Korean Surg Soc.  2009 Nov;77(5):326-332. 10.4174/jkss.2009.77.5.326.

Clinical Experiences of Management of Bile Duct Injuries during Laparoscopic Cholecystectomy

• Kim JY
• Kim KJ
• Moon HG
• Jeong SH
• Jeong CY
• Ju YT
• Jung EJ
• Lee YJ
• Choi SK
• Ha WS
• Park ST
• Hong SC

• KMID: 1750701
• DOI: http://doi.org/10.4174/jkss.2009.77.5.326

Abstract

PURPOSE
Laparoscopic cholecystectomy (LC) has become the gold standard of management of gallstone disease. LC is associated with a two-to-four times higher incidence of bile duct injury, which is a rare but more serious complication than open cholecystectomy. We reviewed our experiences with the management of bile duct injury during laparoscopic cholecystectomy.
METHODS
From January 1999 to April 2009, 13 patients with bile duct injuries following LC were managed in our hospital. Patients' charts were retrospectively reviewed to analyze perioperative management.
RESULTS
Among the 13 patients, 7 patients sustained their bile duct injuries at our hospital. Six patients were referred to our hospital to manage their bile duct injuries. Five patients' injuries were identified during LC. According to the Strasberg classification, there are 5 cases of type A, 2 cases of type C, 1 case of type D and 5 cases of type E injuries. Four type A bile duct injuries were treated by direct ductal ligation during LC and 1 type A bile duct injury and 1 type C bile duct injury were managed by non-surgical treatment. Type D and type E injuries were managed by Roux-en-Y hepaticojejunostomy.
CONCLUSION
Bile duct injuries are a rare but serious complications that occur during laparoscopic cholecystectomy. Most minor bile duct injuries are well treatable with non-surgical management, whereas major bile duct injuries require surgical management. The combination of non-surgical management and surgical treatment results in successful outcomes in bile duct injuries.

Keyword

Laparoscopic cholecystectomy; Bile duct injury

MeSH Terms

Bile
Bile Ducts
Cholecystectomy
Cholecystectomy, Laparoscopic
Gallstones
Humans
Incidence
Ligation
Retrospective Studies

Figure

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  Fig. 1 Type A injury. (A) contrast leakage from the small duct of liver bed is demonstrated (white arrow). (B) 10 days after PTBD, there is no sign of contrast leakage (case 11).

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  Fig. 2 Type C injury. (A) percutaneous transhepatic cholangiogram shows contrast leakage of right hepatic duct (white arrow, case 4). (B) percutaneous transhepatic cholangiogram performed 3 months later shows no contrast leakage (case 4). (C) contrast leakage from aberrant right hepatic duct is demonstrated (white arrow, case 8). (D) 2 months after, there is no contrast leakage (case 8).

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  Fig. 3 Percutaneous transhepatic cholangiogram shows type E4 bile duct injury having no communication between right and left hepatic duct (case 12).

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