Extrahepatic bile duct injury during laparoscopic cholecystectomy -- own material

Despite recognised advantages of laparoscopy, the damage of extrahepatic bile ducts during cholecystectomy is a subject of ongoing discussions, as such injuries are more frequent comparing with open surgery.

The analysis included 6873 patients who underwent laparoscopic cholecystectomy. The study group comprised both the patients after elective surgery due to symptomatic cholelithiasis and patients after emergency procedures necessitated by acute cholecystitis.

Common bile duct was damaged in 9 patients. Five people had their main bile duct transected, in 2 people it was partial excision, and in the other 2 subjects - puncture damage with electrocoagulation took place. In seven cases, the damage was diagnosed still during laparoscopy and conversion to open surgery was performed. In two subjects the damage was diagnosed in postoperative period and it was subsequently confirmed by ERCP. Reconstructive surgery included: CBD suturing with interrupted stitches, end-to-end anastomosis over T-tube and Roux-en-Y bilioenteric anastomosis. Good postoperative outcome was obtained in 6 patients. One subject required repeated endoscopic dilatation and placement due to recurrent cholangitis. Two patients died due to upper gastrointestinal bleeding and multiple organ failure.

Extrahepatic bile duct injury remains a dangerous complication following cholecystectomy. It is more likely to occur in case of anomalous anatomy of bile ducts, inflammatory or malignant infiltration and technical errors of an operating surgeon. It is very important to diagnose the damage early enough, preferably still during laparoscopy. Imaging investigations (ultrasound, ERCP, MRCP, cholangiography) may be helpful in establishing the diagnosis during the postoperative period.