Treatment of bile duct injuries at our department

Introduction: The conversion rate during laparoscopic cholecystectomy is between 3 and 5% according to the data in the literature. The incidence of bile duct injury during LC is around 0.5%. This data is still much higher than that of after open cholecystectomy (0.1%).

Patients: We performed 281 laparoscopic cholecystectomies in 2008 and converted 11 cases (3.8%). We did not have any bile duct injuries during laparoscopic procedures. In one of the converted cases we realized that the gall bladder penetrated to the common bile duct. We had to resect the affected part of the duct to restore the continuity of the biliary tree with Roux-Y hepatico-jejunostomy. Histological examination of the gall bladder and the resected duct proved adenocarcinoma arising in the gall bladder. One other patient was referred to our department for bile duct reconstruction after having laparoscopic cholecystectomy and diagnostic ERCP done in a different institution. We also used Roux-Y hepatico-jejunostomy with Voelker drainage to reconstruct the biliary tree. Both patients had uneventful recovery. They did not develop anastomotic stricture nor cholangitis since the operation.

Conclusion: The conversion rate during laparoscopic cholecystectomy is in concordance with the data in the literature. We did not have bile duct injury during the laparoscopic operations, but had to resect 1 bile duct due to oncological reason (0.3%). Roux-Y hepatico-jejunostomy with Voelker drainage is suitable procedure for biliary reconstruction, but requires experienced operating team.