Prevention and treatment for aberrant bile duct injury in right posterior lobe by laparoscopic cholecystectomy

Abstract

Objective To investigate the prevention and treatment for aberrant bile duct injury in right posterior lobe by laparoscopic cholecystectomy (LC). Methods Clinical data of 4 patients with aberrant bile duct injury in right posterior lobe caused by LC who were admitted to the Sir Run Run Shaw Hospital Affiliated to Zhejiang University between January 2010 and December 2014 were analyzed retrospectively. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 1 case was male and 3 were female, aged 27-48 years old with a median age of 39 years old. According to Strasberg classification, the types of aberrant bile duct injury in right posterior lobe were all type C. Aberrant bile duct injury in right posterior lobe was found in case 1 and 2 during LC, case 1 was converted to receive right posterior lobe cholangiojejunostomy by laparotomy, and case 2 received end-to-end biliary anastomosis with T tube drainage. It was found in case 3 3 d after LC, and case 3 received right posterior bile duct drainage. It was found in case 4 1 d after LC, and case 4 received endoscopic retrograde cholangiography naso-biliary drainage. Results Case 1 recovered well after operation. Case 2 was observed with distal bile duct dilatation by MRCP at postoperative 8 months, and received right posterior lobe cholangiojejunostomy again. No biliary leakage, abnormal liver function, bile duct stenosis and cholangitis was observed during the follow-up after the second operation. For case 3, abdominal drainage tube was removed at postoperative 6 months. For case 4, naso-biliary tube and abdominal drainage tube were removed at postoperative 4 months. No bile leakage, abnormal liver function and bile duct stenosis was observed in 4 cases till the submission date. Conclusions It is difficult to treat the aberrant bile duct injury in right posterior lobe due to small bile duct and high position of injury. Early detection and early repair are the keys to good prognosis, and a variety of treatment methods can be used according to the types of injury and time of definite diagnosis. Key words: Bile ducts; Wounds and injuries; Cholecystectomy, laparoscopic