Diagnosis and treatment of patients with bile duct injury after laparoscopic cholecystectomy

Abstract

Objective To study the role of endoscopic retrograde cholangiopancreatography (ERCP) in diagnosing and treating iatrogenic bile duct injury after laparoscopic cholecystectomy (LC). Methods A retrospective study was conducted on 45 patients with iatrogenic bile duct injury after LC who were investigated and treated by ERCP from December 2002 to August 2015. Results Using the Strasberg-Bismuth classification, there were 14 patients with type A and 4 with type C who were managed successfully using endoscopic nasobiliary drainage (ENBD) and interventional ultrasound abdominal localized puncture and drainage; 7 patients with type D were managed successfully using endoscopic sphincterotomy (EST) and endoscopic retrograde biliary drainage (ERBD). For the 5 patients with type EⅠand 3 patients with type EⅡ who were treated by EST and ERBD, one patient who had common bile duct transection required cholangioenteric Roux-en-Y anastomosis. For the 6 patients with type EⅢ and 6 patients with type EⅣ who were treated by EST and ERBD, a patient required a cholangioenteric Roux-en-Y anastomosis to achieve good results. Conclusions When iatrogenic bile duct injury is suspected after LC, correct assessment with ERCP should be taken immediately. ERCP when combined with ENBD and (or) ERBD could reduce bile duct pressure and dilate stenotic bile ducts to avoid further operation. Key words: Laparoscopic cholecystectomy; Bile duct injury; Endoscopic retrograde cholangio-pancreatography; Stasberg-Bismuth classification