Management of sectoral bile duct injury during laparoscopic cholecystectomy – experience from a tertiary centre

Abstract

Introduction: Sectoral bile duct injury is a rare complication of laparoscopic cholecystectomy but contributes to significant morbidity to the patient with multiple subsequent interventions and procedures. Our aim was to identify the prevalence of sectoral bile duct injury as a complication of laparoscopic cholecystectomy at our tertiary centre. Additionally, we wanted to identify the risk factors, methods of diagnosis and preventative strategies in management of this rare yet challenging problem. Methods: A retrospective analysis of patient records was performed between 2008 and 2015, which revealed 4 cases of sectoral bile duct injury during laparoscopic cholecystectomy. Case notes, imaging, post operative management and follow up data was retrieved. Imaging included intraoperative cholangiogram (IOC), computed tomography intravenous cholangiography (CT IVC), and magnetic resonance cholangiopancreatography (MRCP). Results: 3 patients were suspected to have biliary injury secondary to acute post operative bile leak, while 1 patient represented with fevers and abdominal pain. Post operative diagnosis was achieved through CT IVC and endoscopic retrograde cholangiopancreatography (ERCP). 3 Patients proceeded to biliary reconstruction, while 1 was treated with biliary stenting (required multiple ERCP procedures). Conclusion: Anomalous biliary tree anatomy and misidentification of the anatomy by the operating surgeons are the main risk factors for sectoral duct injury. Strategies to prevent sectoral bile duct injury include careful dissection of the hepatocystic triangle, awareness of variable biliary anatomy, and thorough evaluation of biliary tract imaging. One should maintain high suspicion of sectoral duct injury in a patient with post operative bile leak and an intact common bile duct.