Management of post laparoscopic cholecystectomy major bile duct injury: comparison of MRCP with conventional methods

ABSTRACT

Postlaparoscopic cholecystectomy bile duct injury remains one of the devastating complications seen in current surgical practice. Aim of study This study describes the diagnostic role of magnetic resonance cholangiopancreatography [MRCP] in such injuries compared with conventional methods. Patients and Eighteen patients referred to the Division of Hepatobiliary Surgery, King Khalid University Hospital from July 1998 to September 2000 were retrospectively studied. The technique of the repair was by utilizing Roux- en- Y hepaticojejunostomy with establishment of mucosa- to- mucosa anastomosis. The study included presentation, age and gender. The presentation of patients were variable and frequently included pain, Jaundice with or without cholangitis in 13 patients, bile leakage with development of biliary peritonitis in three, and development of external biliary fistula in two patients. Beside lower incidence of complication, MRCP was more diagnostic and informative in planning surgery by mapping both ducts proximal and distal to site of injury or stricture in 14 out of 18 patients. The Bismuth level of bile duct injuries were type I in one, type II in five, type III in 11 and type IV in one patient. All patients are alive, well and no complications occurred in the immediate postoperative period. Only two patients developed stricture within four months after surgery, one of them treated conservatively with repeated dilatation and stenting was done for the other. Hepaticojeunostomy is the procedure of choice for repair of bile duct injuries and provides adequate bilairy drainage. MRCP is an ideal diagnostic test when bile duct injury is suspeted following laparoscopic cholecystectomy