Bile Duct Injury Repairs after Laparoscopic Cholecystectomy: A Five-Year Experience in a Highly Specialized Community Hospital

Am Surg. 2019 Oct 1;85(10):1150-1154.

Abstract

Bile duct injury represents a complication after laparoscopic cholecystectomy, impairing quality of life and resulting in subsequent litigations. A five-year experience of bile duct injury repairs in 52 patients at a community hospital was reviewed. Twenty-nine were female, and the median age was 51 years (range, 20-83 years). Strasberg classification identified injuries as Type A (23), B (1), C (1), D (5), E1 (5), E2 (6), E3 (4), E4 (6), and E5 (1). Resolution of the bile duct injury and clinical improvement represent main postoperative outcome measures in our study. The referral time for treatment was within 4 to 14 days of the injury. Type A injury was treated with endobiliary stent placement. The remaining patients required T-tube placement (5), hepaticojejunostomy (20), and primary anastomosis (4). Two patients experienced bile leak after hepaticojejunostomy and were treated and resolved with percutaneous transhepatic drainage. At a median follow-up of 36 months, two patients (Class E4) required percutaneous balloon dilation and endobiliary stent placement for anastomotic stricture. The success of biliary reconstruction after complicated laparoscopic cholecystectomy can be achieved by experienced biliary surgeons with a team approach in a community hospital setting.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anastomosis, Surgical / statistics & numerical data
  • Bile Ducts / diagnostic imaging
  • Bile Ducts / injuries*
  • Bile Ducts, Extrahepatic / injuries
  • California
  • Cholecystectomy, Laparoscopic / adverse effects*
  • Cholecystectomy, Laparoscopic / statistics & numerical data
  • Female
  • Hospitals, Community
  • Humans
  • Jejunostomy / methods
  • Jejunostomy / statistics & numerical data
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Postoperative Complications / classification
  • Postoperative Complications / surgery*
  • Retrospective Studies
  • Stents / statistics & numerical data
  • Time Factors
  • Time-to-Treatment
  • Wounds and Injuries / classification
  • Young Adult