[Bile duct injuries in laparoscopic cholecystectomy]
1Hirurska klinika, Odjeljenje za laparoskopsku hirurgiju Univerzitetski Klinicki Centar Tuzla.
Unlabelled:
The aim this study was to analyse our management bile duct injuries following laparoscopic cholecystectomy.
Patients And Methods:
This prospective-retrospective study presents six cases of major bile duct injuries that occurred in our first 1000 laparoscopic cholecystectomies. Neuhaus et al. classification was used in this study.
Results:
Bile duct injuries following laparoscopic cholecystectomy were identified at 6 patients, on 2 patients the lesions were identified during laparoscopic cholecystectomy. Four types of lesions were identified: 2 patients with peripheral bile leak from the cystic duct (A2), 1 patient with the complete occlusionn of the common bile duct (B2), 1 patient with lateral injury of the common bile duct(C2) and one with the right hepatic duct injury (C1), 1 patient with transection of the common bile duct (D1). A total of 6 patients with biliary injuries following laparoscopic cholecystectomy were treated at our institution: a hepaticojejunostomy was performed in 2 patients, the sutures with the use of a T-tube was performed in 2 patients, occlusion the cystic duct was performed in 2 patients. One patient after primary hepaticojejunostomy required secondary hepaticojejunostomy because of the late stricture of the anastomosis. At this writing, all the patients are well and without problems after 1 to 4 years of follow-up evaluation.
Conclusion:
The small lateral injuries of the common bile duct and peripheral leakages can be treated endoscopically, the extended lateral injuries and complete bile duct transection require surgical repair. The treatment plan must be individualized for every patient, depending on the injury type and condition of the patient.
