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DOI: 10.1055/s-0039-1697633
Early Surgical Repair of Bile Duct Injuries following Laparoscopic Cholecystectomy: The Sooner the Better
Publication History
08 April 2018
26 July 2019
Publication Date:
18 October 2019 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00028781/201904/lookinside/thumbnails/10-1055-s-0039-1697633_1800038oa-1.jpg)
Abstract
Background We aimed to investigate the outcomes of the immediate surgical repair of bile duct injuries (BDIs) following laparoscopic cholecystectomy.
Materials and Methods Between January 2012 and May 2017, patients, who underwent immediate surgical repair (within 72 hours) for postcholecystectomy BDI, by the same surgical team expert in hepatobiliary surgery, were enrolled into the study. Data collection included demographics, type of BDI according to the Strasberg classification, time to diagnosis, surgical procedures, and outcome.
Results There were 13 patients with a mean age of 43 ± 12 years. Classification of BDIs were as follows: type E in six patients (46%), type D in three patients (23%), type C in two (15%), and types B and A in one patient each (7.6%). Mean time to diagnosis was 22 ± 15 hours. Surgical procedures included Roux-en-Y hepaticojejunostomy for all six patients with type-E injury, primary repair of common bile duct for three patients with type-D injury, and primary suturing of the fistula orifice was performed in two cases with type-C injury. Other two patients with type-B and -A injury underwent removal of clips which were placed on common bile duct during index operation and replacing of clips on cystic duct where stump bile leakage was observed probably due to dislodging of clips, respectively. Mean hospital stay was 6.6 ± 3 days. Morbidity with a rate of 30% (n = 4) was observed during a median follow-up period of 35 months (range: 6–56 months). Mortality was nil.
Conclusion Immediate surgical repair of postcholecystectomy BDIs in selected patients leads to promising outcome.
Keywords
cholelithiasis - laparoscopic cholecystectomy - hepato-pancreato-biliary surgery - postoperative complication - bile duct injury - emergency surgery - surgical repairInstitutional Review Board Statement
The study was reviewed and approved by the Institutional Review Board of Sisli Hamidiye Etfal Training and Research Hospital.
Author Contributions
M.B. and O.B. contributed to the conception and design, acquisition of data, or analysis and interpretation of data; O.B. and P.Y. drafted the article or revising it critically for important intellectual content; O.K. and M.B. made the final approval of the version to be published.
Informed Consent Statement
All study participants provided informed written consent prior to study enrollment.
Disclosure
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. M.B., P.Y., O.B., and O.K. have no financial or commercial relationship to disclose.
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References
- 1 Lau WY, Lai EC, Lau SH. Management of bile duct injury after laparoscopic cholecystectomy: a review. ANZ J Surg 2010; 80 (1,2): 75-81
- 2 Buddingh KT, Weersma RK, Savenije RA, van Dam GM, Nieuwenhuijs VB. Lower rate of major bile duct injury and increased intraoperative management of common bile duct stones after implementation of routine intraoperative cholangiography. J Am Coll Surg 2011; 213 (02) 267-274
- 3 Pekolj J, Alvarez FA, Palavecino M, Sánchez Clariá R, Mazza O, de Santibañes E. Intraoperative management and repair of bile duct injuries sustained during 10,123 laparoscopic cholecystectomies in a high-volume referral center. J Am Coll Surg 2013; 216 (05) 894-901
- 4 Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995; 180 (01) 101-125
- 5 Eikermann M, Siegel R, Broeders I. , et al; European Association for Endoscopic Surgery. Prevention and treatment of bile duct injuries during laparoscopic cholecystectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 2012; 26 (11) 3003-3039
- 6 Pawa S, Al-Kawas FH. ERCP in the management of biliary complications after cholecystectomy. Curr Gastroenterol Rep 2009; 11 (02) 160-166
- 7 Nuzzo G, Giuliante F, Giovannini I. , et al. Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56 591 cholecystectomies. Arch Surg 2005; 140 (10) 986-992
- 8 Meyers WC, Peterseim DS, Pappas TN. , et al. Low insertion of hepatic segmental duct VII-VIII is an important cause of major biliary injury or misdiagnosis. Am J Surg 1996; 171 (01) 187-191
- 9 Butte JM, Hameed M, Ball CG. Hepato-pancreato-biliary emergencies for the acute care surgeon: etiology, diagnosis and treatment. World J Emerg Surg 2015; 10: 13
- 10 Nordin A, Halme L, Mäkisalo H, Isoniemi H, Höckerstedt K. Management and outcome of major bile duct injuries after laparoscopic cholecystectomy: from therapeutic endoscopy to liver transplantation. Liver Transpl 2002; 8 (11) 1036-1043
- 11 Rogers EA, Tang SJ, Porter J, Ahmed N. Suspected bile duct injuries and appropriate early referral can reduce chances of litigation. J Miss State Med Assoc 2011; 52 (09) 275-277
- 12 Sicklick JK, Camp MS, Lillemoe KD. , et al. Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients. Ann Surg 2005; 241 (05) 786-792 , discussion 793–795
- 13 Carroll BJ, Birth M, Phillips EH. Common bile duct injuries during laparoscopic cholecystectomy that result in litigation. Surg Endosc 1998; 12 (04) 310-313 , discussion 314
- 14 Chandrasekar TS, Hussain H, Murugesh M. Endoscopic management of biliary injuries and leaks. J Dig Endosc 2012; 3 (Suppl S1): 27-32
- 15 Holte K, Bardram L, Wettergren A, Rasmussen A. Reconstruction of major bile duct injuries after laparoscopic cholecystectomy. Dan Med Bull 2010; 57 (02) A4135
- 16 Pioche M, Ponchon T. Management of bile duct leaks. J Visc Surg 2013; 150 (3, Suppl): S33-S38
- 17 Llach J, Bordas JM, Elizalde JI. , et al. Sphincterotomy in the treatment of biliary leakage. Hepatogastroenterology 2002; 49 (48) 1496-1498
- 18 Kaffes AJ, Hourigan L, De Luca N, Byth K, Williams SJ, Bourke MJ. Impact of endoscopic intervention in 100 patients with suspected postcholecystectomy bile leak. Gastrointest Endosc 2005; 61 (02) 269-275
- 19 Weber A, Feussner H, Winkelmann F, Siewert JR, Schmid RM, Prinz C. Long-term outcome of endoscopic therapy in patients with bile duct injury after cholecystectomy. J Gastroenterol Hepatol 2009; 24 (05) 762-769
- 20 Chow S, Bosco JJ, Heiss FW, Shea JA, Qaseem T, Howell D. Successful treatment of post-cholecystectomy bile leaks using nasobiliary tube drainage and sphincterotomy. Am J Gastroenterol 1997; 92 (10) 1839-1843
- 21 Sahajpal AK, Chow SC, Dixon E, Greig PD, Gallinger S, Wei AC. Bile duct injuries associated with laparoscopic cholecystectomy: timing of repair and long-term outcomes. Arch Surg 2010; 145 (08) 757-763
- 22 Hajjar NA, Tomuş C, Mocan L. , et al. Management of bile duct injuries following laparoscopic cholecystectomy: long-term outcome and risk factors infuencing biliary reconstruction. Chirurgia (Bucur) 2014; 109 (04) 493-499
- 23 Walsh RM, Henderson JM, Vogt DP, Brown N. Long-term outcome of biliary reconstruction for bile duct injuries from laparoscopic cholecystectomies. Surgery 2007; 142 (04) 450-456 , discussion 456–457
- 24 Thomson BN, Parks RW, Madhavan KK, Wigmore SJ, Garden OJ. Early specialist repair of biliary injury. Br J Surg 2006; 93 (02) 216-220
- 25 Lillemoe KD, Martin SA, Cameron JL. , et al. Major bile duct injuries during laparoscopic cholecystectomy. Follow-up after combined surgical and radiologic management. Ann Surg 1997; 225 (05) 459-468 , discussion 468–471
- 26 Felekouras E, Petrou A, Neofytou K. , et al. Early or delayed intervention for bile duct injuries following laparoscopic cholecystectomy? A dilemma looking for an answer. Gastroenterol Res Pract 2015; 2015: 104235
- 27 Fischer CP, Fahy BN, Aloia TA, Bass BL, Gaber AO, Ghobrial RM. Timing of referral impacts surgical outcomes in patients undergoing repair of bile duct injuries. HPB (Oxford) 2009; 11 (01) 32-37
- 28 Dageforde LA, Landman MP, Feurer ID, Poulose B, Pinson CW, Moore DE. A cost-effectiveness analysis of early vs late reconstruction of iatrogenic bile duct injuries. J Am Coll Surg 2012; 214 (06) 919-927
- 29 Perera MT, Silva MA, Hegab B. , et al. Specialist early and immediate repair of post-laparoscopic cholecystectomy bile duct injuries is associated with an improved long-term outcome. Ann Surg 2011; 253 (03) 553-560
- 30 Kapoor VK. Bile duct injury repair—earlier is not better. Front Med 2015; 9 (04) 508-511