Laparoscopic Cholecystectomy-induced Bile Duct Injuries – Surgical Repair Experience at a Referral Center

Abstract

Purpose: Bile duct injuries (BDI) are amongst the most feared iatrogenic injuries associated with laparoscopic cholecystectomy (LC) and entail high morbidity. Early diagnosis is crucial to improve surgical repair success which should be performed at high volume specialized centers. The authors review the surgical repair of laparoscopic cholecystectomy-induced BDI (LC-BDI) performed at their institution. Method: A retrospective analysis of the surgical repair of LC-BDI from January 2005 to May 2017 was performed. The following parameters were evaluated: type of injury; time from LC to BDI diagnosis and to surgical repair; surgical repair procedure; and postoperative morbidity and mortality. Results: During the study a group of 35 patients was identified, from which 57.1% were referred from other hospitals. Mean age was 56.1±14.4 and 60% of the patients were female. Intra-operative BDI diagnosis was made in 9 patients (25.7%); early after the surgery (<6 days) in 15 patients (42.9%) and late after the surgery (> 6 days) in 11 patients (31.4%). Classification of the BDI according to the Bismuth classification: type I, 15%; type II, 50%; type III, 19%; type IV, 12%; and type V, 4%. Median time to surgical repair was 20 days. The following surgical repair procedures were performed: hepaticojejunostomy, 16 (45.7%); hepaticoduodenostomy, 6 (17.1%); hepaticocholedocostomy, 3 (8.6%); choledocojejunostomy, 3 (8.6%); drainage, 3 (8.6%); choledocoduodenostomy, 2 (17.2%); choledoco-choledocostomy, 1 (8.6%); and choledocal suture, 1 (8.6%). The initial surgical repair was curative in 77.1% patients, with the remaining patients needing additional procedures (endoscopic, percutaneous, or surgical). There were 2 deaths (5.7%). Conclusion: Despite the decrease in LC-BDI rate they remain a significant complication and many times recognized at a late time and carrying higher morbidity. Prevention should be the main focus, but in case of an injury early diagnosis and treatment in a specialized center are fundamental.