Bile duct injury during laparoscopic cholecystectomy.

OBJECTIVE

To determine the nature of bile duct injuries during laparoscopic cholecystectomy, the treatment of these injuries and patient outcome.

DESIGN

Case series review.

SETTING

Two tertiary care hospitals.

PATIENTS

Twenty-one patients (average age 37 years) who sustained bile duct injuries during laparoscopic cholecystectomy over a 2-year period. Two groups were analysed: patients whose injury was recognized intraoperatively (9 patients) and patients in whom it was diagnosed postoperatively (12 patients).

INTERVENTIONS

Laparoscopic cholecystectomy, duct-to-duct repair over a T tube, Roux-en-Y hepaticojejunostomy, endoscopic cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC).

RESULTS

Misidentification of the common duct during laparoscopic cholecystectomy, resulting in accidental division or resection of a portion of the duct, and obstruction of the duct by hemoclips were the most common types of injury. Pain, jaundice and bile collections were the typical presenting features of injuries that became evident after laparoscopic cholecystectomy. ERCP and PTC accurately defined the injuries. Immediate duct-to-duct repair over a T tube was associated with a high failure rate. Twenty of the 21 patients required Roux-en-Y hepaticojejunostomy for definitive treatment. There were no deaths.

CONCLUSIONS

Proper identification of the pertinent anatomy will prevent the majority of these injuries. Prompt radiographic visualization of the biliary tract is indicated in patients who have pain, jaundice and bile collections postoperatively. A hepaticojejunostomy is the procedure of choice for repair of these bile duct injuries.