Iatrogenic Bile Duct Injury during Cholecystectomy: Characteristics, Consequences, Surgical Treatment

Abstract

Introduction: Intraoperative bile duct injury is the most severe complication of cholecystectomy. Purpose of work was to study the nature, consequences and surgical treatment of iatrogenic injures of the bile duct obtained by cholecystectomy. Methods: A retrospective analysis of the nature of the injury and surgical techniques for the treatment of 16 patients with iatrogenic injures of the bile ducts during cholecystectomy from 2002 to 2020 which was 0,97% from all operated patients in a count of 1653. The Bektas H. et al., 2007 classification was used. Results: Type A1 - bile leakage while maintaining the main bile flow was observed in 2 (12.5%) cases after laparoscopic cholecystectomy. Type B2 injury – stenosis (clipping) of the main bile duct without damage was observed in 1 (6.25%) patient after LHE. Combined injures of types B and C in the form of bile duct clipping and linear damage of the bile duct wall were observed in 2 (12.5%) cases after LHE. Type C (C2C4) injury was observed in 1 (6.25%) case during open cholecystectomy. Type D injury - complete crossing of the bile duct was diagnosed in 10 (62, 5%) patients - in 4 owing to open cholecystectomy and in 6 - to laparoscopic. This was the most severe and heterogeneous group of patients. All patients hepaticojejunostomy according to Ru was performed. Conclusions: Iatrogenic injures of the bile ducts are more common in laparoscopic cholecystectomy. The most optimal method of correction of iatrogenic damage of bile ducts is a hepaticojejunostomy according to Ru.