Abstract
The quality of immediate repair of common bile duct injuries with or without tissue loss occurring during elective cholecystectomy is crucial and maybe the sole factor behind future stricture formation with its considerable morbidity and mortality. Successful repair of iatrogenic common bile duct injuries has been achieved by immediate saphenous vein grafts in two patients with cystic duct avulsion, in one patient whose duct was split by a balloon catheter, and in one patient where a segment of the duct was resected. Follow-up for 5 years demonstrated that the grafting remained sound and produced no complications. Consequently, the immediate repair of iatrogenic bile duct injuries using vein grafts deserves consideration.
Highlights
Despite recent developments and advances in gallstone dissolution, cholecystectomy remains one of the most frequently performed abdominal operations1’2
Factors implicated in causing iatrogenic bile duct injuries during cholecystectomy are variations in normal anatomy, cholecystectomy more than 5 days following an attack of acute cholecystitis, and haemorrhage in the region of the porta hepatis[1]
Despite knowledge of the circumstances under which iatrogenic bile duct injuries occur during elective cholecystectomy1’3, it seems that such injuries will continue to appear even in the hands of the most experienced surgeons[8]
Summary
Despite recent developments and advances in gallstone dissolution, cholecystectomy remains one of the most frequently performed abdominal operations1’2. Ellis and Hoile[1] reported two cases of successful vein patch repair of postcholecystectomy common bile duct strictures with follow-up periods of 9 years and one year respectively. They suggested that progressive growth takes place in the duct wall in a circumferential manner with slow shrinkage and eventual absorption of the vein patch. Despite these findings the use of veins for the immediate repair of iatrogenic bile duct injuries has been ignored. This vein, which was not varicose in any patient, was obtained through a verticle 10 cm incision situated below the inguinal ligament over its terminal part after carefully ligating all its tributaries with 5/0 Polydioxanone (PDS, Ethicon, Edinburgh, UK) taking care not to compromise its lumen
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