Long-term outcome after repair of major bile duct injury created during laparoscopic cholecystectomy

Abstract

Background Major injury of the extrahepatic biliary tree is the most serious technical complication associated with laparoscopic cholecystectomy (LC). The aim was to determine the long-term outcome of repair of these injuries. Method Twenty-four patients (20 women, four men; mean age 36.1 [range 20–83] years) with major bile duct injury were referred between 1991 and 1997. Charts were retrospectively reviewed, and patient follow-up was documented in each case. Eleven injuries were identified at LC, and 13 later. Results End-to-end bile duct repair or choledochocholedochostomy (CC) was performed in nine patients, seven during LC and two when the injury was recognised later. Eight CC repairs failed and required revision to a hepaticojejunostomy (HJ) at a mean of 6.4 months (range 8 days to 15 months). HJ was performed as the primary method of repair in 15 patients (four injuries that were recognised during LC and I I subsequently). When injury was diagnosed after LC, the mean time to diagnosis was I I (range 3–21) days, and the mean time to repair was 45 (range 10–159) days. Of 23 HJ repairs, one required revision. Mean symptom-free duration after HJ is 4.5 years with a 96% patency rate. Discuss HJ is the preferred repair of major bile duct injury, providing excellent long-term results.