[Treatment of biliary injuries after laparoscopic cholecystectomy: retrospective study of 27 patients]
1Service Médico-Chirurgical des Maladies de l'Appareil Digestif et de Transplantation Hépatique, Hôpital Saint Eloi - Montpellier, France. p-puche@chu-montpellier.fr
Unlabelled:
Biliary injuries after laparoscopic cholecystectomy are rare but serious. Their mortality rate can reach 9%.
Aim Of The Study:
Describe the management of biliary injuries after laparoscopic cholecystectomy in our center.
Patients:
Between January 1995 and June 2005, 27 patients (13 women, 14 men) were treated. The mean age was 53 years old (range, 18-92 years). The biliary injuries were common bile duct sections (n=16, 60%), common bile duct stenoses (n=5, 18.5%), biliary fistulas from the cystic duct (n=4, 15%), and biliary fistulas from an aberrant biliary duct (n=2, 7.5%).
Results:
Acute cholecystis was present in 40% of cases (n=11). An intraoperative cholangiography was done in 12 patients (44%). The mortality rate was 0%. Of the common bile duct sections, 43% were diagnosed during the cholecystectomy (n=7) or after the cholecystectomy within a mean of 11.2 days (n=9). Common bile duct injuries were treated in 16 cases with hepatojejunostomy and in five cases with an external biliary drain. Fistulas from the cystic duct were diagnosed within a mean 14.8 days. A fistula from an aberrant biliary duct was diagnosed during the cholecystectomy (n=1) or in the second postoperative day (n=1). Fistulas were treated with a clip on the cystic duct (n=2), an external biliary drain (n=1), a biliary endoprosthesis (n=1), and the biliary aberrant duct suture (n=2).
Conclusion:
Common bile duct injuries are a serious complication because their treatment is a hepaticojejunostomy in 75% of cases.
