Surgical strategy for the management of biliary injury in laparoscopic cholecystectomy

The incidence of biliary injury during laparoscopic cholecystectomy remains high and several complications resulting from injuries have recently been reported. The aim of this study is to elucidate the surgical strategy for the management of biliary injury during laparoscopic cholecystectomy.

Ten patients with biliary injury during laparoscopic cholecystectomy are retrospectively reviewed.

Second operations as initial repair were performed in five patients in our institute. Duct-to-duct anastomosis for one and duct-enterostomies for two were performed in three common bile duct transections. Simple closures were performed for the other two biliary injuries. Another five cases underwent both laparoscopic cholecystectomies and second operations for initial repair when they were referred to our service. Four were treated by a third operation in our institution including hilar bile duct resections and duct-enterostomies in two, and right hepatic lobectomies in the other two cases. The last patient could not be treated because of his poor condition and he died of hepatic failure soon after the consultation.

Complications resulting from biliary injury have recently been reported, necessitating liver transplantation. Laparoscopic surgeons should avoid biliary injury and must not perform inadequate biliary reconstruction, which leads to secondary biliary cirrhosis, cholangitis, liver failure, and finally patient death.