[Bile duct injuries during laparoscopic cholecystectomy : Classification, recognition and repair]

Bile duct injuries during laparoscopic cholecystectomy are rare but serious complications.

Bile duct injuries can be classified based on their location, injury pattern and possible concomitant vascular injury. Several classifications exist with the Neuhaus classification, which is widely used in Germany, allowing a clinically oriented classification of bile duct injuries. The diagnostic algorithm is based on whether the injury is diagnosed due to bile leakage or bile duct occlusion and whether there is also a circulatory disturbance of the liver. The differentiated use of laboratory, image-based, endoscopic and interventional methods enables not only classification but also treatment planning.

About half of all bile duct lesions can be treated by an endoscopic intervention; however, with increasing size of the defect, with complete occlusion of the bile duct or with relevant circulatory disturbances of the liver, the probability for the need of a surgical procedure increases. Intraoperatively, a distinction must be made between repair by suturing and splinting and reconstruction of the bile duct by patch plasty or hepaticojejunostomy. Partial liver resection or liver transplantation may be necessary, especially in cases of circulatory disorders. In addition to appropriate experience, good communication and interdisciplinary cooperation between endoscopy, interventional radiology and surgery are crucial for the success of the treatment. In this respect, contacting a specialized center for liver and transplantation surgery as soon as possible is advised.