Management and outcome of major bile duct injuries after laparoscopic cholecystectomy: From therapeutic endoscopy to liver transplantation
- 1 November 2002
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Liver Transplantation
- Vol. 8 (11), 1036-1043
- https://doi.org/10.1053/jlts.2002.35557
Abstract
Laparoscopic cholecystectomy is associated with a higher rate of bile duct injuries than an open cholecystectomy. The annual incidence of bile duct injuries has remained almost constant and these injuries tend to be more serious, making demands on the method of repair. We wanted to report the management and outcome of major bile duct injuries after laparoscopic cholecystectomy in patients referred to a hepatobiliary and liver transplantation unit. Eighteen patients (14 women), with a median age of 53.5 years were referred to the liver surgery unit with a major bile duct injury after laparoscopic cholecystectomy. The injury was identified after a median of 3 days (range, 0 to 25 days) after operation and the median time interval to referral was 79 days (0 to 2270 days). Fourteen patients had undergone surgery before referral. By the time of referral, four patients had developed end‐stage cirrhosis, necessitating liver transplantation. Three of them had undergone bilioenteric drainage operations at the referring institute. Of the remaining 14 patients, three were managed by therapeutic endoscopic procedures. Ten patients were managed with Roux‐en‐Y hepaticojejunostomy. One died of septic complications before the repair. A median time for hospitalization in our unit was 33 days (range, 10 to 164 days). At present, 16 patients are alive. One patient died of Kaposi's sarcoma 7 months after liver transplantation. A long interval between bile duct injury and referral was associated with the development of end‐stage liver disease. Surgery of biliary lesions is demanding, and surgical experience with multidisciplinary approach, including therapeutic endoscopy and liver transplantation, is necessary for successful outcome.Keywords
This publication has 28 references indexed in Scilit:
- Postoperative Bile Duct Strictures: Management and Outcome in the 1990sAnnals of Surgery, 2000
- Changing referral pattern of biliary injuries sustained during laparoscopic cholecystectomyBritish Journal of Surgery, 2000
- Complications of Cholecystectomy: Risks of the Laparoscopic Approach and Protective Effects of Operative CholangiographyAnnals of Surgery, 1999
- Complications of laparoscopic cholecystectomy in SwitzerlandSurgical Endoscopy, 1998
- Common bile duct injuries during laparoscopic cholecystectomy that result in litigationSurgical Endoscopy, 1998
- Bile duct injury after laparoscopic cholecystectomySurgical Endoscopy, 1998
- Laparoscopic Cholecystectomy-Related Bile Duct InjuriesAnnals of Surgery, 1997
- An External Audit of Laparoscopic Cholecystectomy in the Steady State Performed in Medical Treatment Facilities of the Department of DefenseAnnals of Surgery, 1996
- A Prospective Analysis of 1518 Laparoscopic CholecystectomiesNew England Journal of Medicine, 1991
- The european experience with laparoscopic cholecystectomyThe American Journal of Surgery, 1991