Damage to the bile ducts at cholecystectomy

Six patients who incurred iatrogenic injury to the extrahepatic bile duct following elective cholecystectomy are described. All cases were diagnosed three weeks to one year after operation. In none of the patients was an operative cholangiogram performed during the original cholecystectomy to detect congenital biliary tree anomalies or obstruction. Possible risk factors contributing to such injuries were intraoperative bleeding, common bile duct exploration in patients with obstructive jaundice, and poor surgical assistance. Obesity was not found to be of significance since all six patients were thin. Iatrogenic bile duct injuries are best managed at the time of injury during the primary operation. When recognized later in the postoperative period, choledocho/hepaticojejunostomy gives the best result.