Iatrogenic extrahepatic bile duct injury in 182 patients: causes and management

To describe the causes and treatment of iatrogenic bile duct injury caused by cholecystectomy.

182 patients with iatrogenic extrahepatic bile duct injury from 4 university hospitals of China were reviewed. Details of primary cholecystectomy, biliary reconstruction as well as postoperative management were recorded. All patients were followed up for at least 6 months (6 months to 9 years, median 3.5 years). The adequacy of repair was assessed by regular evaluation of the patients' clinical status and liver function variables. Hepatobiliary B-ultrasonography was used routinely in the follow up of patients, and magnetic resonance cholangiopancreatography was applied in the patients suggestive of abnormality.

In 152 patients, bile duct injury happened during open cholecystectomy, and in 30 patients during laparoscopic cholecystectomy. All the injuries developed during anterograde cholecystectomy (at the Calot's triangle). All the patients with these injuries underwent choledochocholedochostomy or Roux-en-Y choledochojejunostomy with good results (161 patients), recurrent stricture (11), and death (10).

During cholecystectomy, the Calot's triangle should be identified anatomically, but retrograde cholecystectomy is the optimal choice. Bile duct injury should be discovered as soon as possible and be managed timely. Different operative methods are optional according to the degree of injury and the postoperative period.