Bile duct injuries during laparoscopic cholecystectomy. Long term results. a monoinstitutional experience

Abstract

Introduction: Bile duct injury(BDI) is perhaps the most feared complication of laparoscopic cholecystectomy(LC).Proper management of BDI is mandatory to avoid immediate or later life -threatening sequelae. Methods: We analyzed our prospectively established bile duct injury(BDI) after laparoscopic cholecystectomy(LC) database. From 1996 to 2017 we treated 47 patients with BDI after LC. The BDIs were graded according to the classification of Strasberg. After treatment the follow-up evaluation was focused on clinical outcome and biochemical analysis. Results: Ten patients had minor BDIs(6 patients had Type A injury and 4 patients had Type D injury). In all of these cases the BDI was recognized postoperatively. Three patients were managed with stents, six patients required laparotomy and bile duct ligation, and one patient underwent laparoscopy and ligation of a duct of Luschka. Thirty seven patients had major bile duct injuries. Three had E1, 9 had E2, 12 had E3, 12 had E4, and 1 patient had type E5 injury. Seven patients had biliary peritonitis lasting from 1 to 6 days, one of them died 20 days postoperatively because of sepsis. Among the patients with a major BDI, a Roux -en-Y hepaticojejunostomy was performed. No postoperative complications have been observed in 43 patients. One patient had four episodes of small bowel obstruction due to adhesions. The final outcome has been graded as excellent in 43 patients and good in 3. Conclusion: Laparoscopic BDI has a significant morbidity and considerable mortality rate. Early recognition and proper management of the patients diminishes the consequences.