Bile duct injuries associated with laparoscopic and open cholecystectomy: sixteen-year experience
Jin-Shu Wu1, Chuang Peng, Xian-Hai Mao
1Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, Changsha 410005, Hunan Province, China.
Aim:
To summarize the experience in diagnosis, management and prevention of iatrogenic bile duct injury (IBDI).
Methods:
A total of 210 patients with bile duct injury occurred during cholecystectomy admitted to Hunan Provincial People's Hospital from March 1990 to March 2006 were included in this study for retrospective analysis.
Results:
There were 59.5% (103/173) of patients with IBDI resulting from the wrong identification of the anatomy of the Calot's triangle during cholecystectomy. The diagnosis of IBDI was made on the basis of clinical features, diagnostic abdominocentesis and imaging findings. Abdominal B ultrasonography (BUS) was the most popular way for IBDI with a diagnostic rate of 84.6% (126/149). Magnetic resonance cholangiography (MRC) could reveal the site of injury, the length of injured bile duct and variation of bile duct tree with a diagnostic rate 100% (45/45). According to the site of injury, IBDI could be divided into six types. The most common type (type 3) occurred in 76.7% (161/210) of the patients and was treated with partial resection of the common hepatic duct and common bile duct. One hundred and seventy-six patients were followed up. The mean follow-up time was 3.7 (range 0.25-10) years. Good results were achieved in 87.5% (154/176) of the patients.
Conclusion:
The key to prevention of IBDI is to follow the "identifying-cutting-identifying" principle during cholecystectomy. Re-operation time and surgical procedure are decided according to the type of IBDI.
