Treatment of Biliary Tract Injury in Patients with Acute Cholecystitis Receiving Laparoscopic Cholecystectomy / 中国微创外科杂志

ABSTRACT

Objective To explore the prevention and management of biliary tract injury during laparoscopic cholecystectomy(LC) in patients with acute cholecystitis.Methods Between October 1999 and October 2008,368 patients with acute cholecystitis received LC in our hospital,7 of them developed biliary tract injury during the operation,and therefore underwent the biliary repair or Roux-en-Y anastomosis between the common bile duct and jejunum as well as T-tube drainage.Results Among these 7 cases,5 cases was converted to open abdominal operation during the procedure of LC,of which 2 cases(1 with total bile duct transection and 1 with electric burn of bile duct) showed stenosis of the bile duct in 12 and 3 months respectively after the T tube was removed,and then was cured by a second Roux-en-Y anastomosis.Two of the 7 patients received biliary repair because of electric burn;cholangiography showed no stenosis after 3-month T-tube drainage.In one patient who had severe injury to the common bile duct,Roux-en-Y anastomosis was performed,and then the patient was discharged from the hospital in 2 weeks with the T tube;one month later,re-examination by cholangiography showed that the case was cured.In the 7 patients,jaundice was observed in 2 cases in 3 to 5 days after the surgery;ERCP showed biliary stenosis in one of them,and complete biliary atresia in another.Subsequent abdominal exploration on the two cases revealed complete common bile duct occlusion in one and partially occluded common hepatic duct in the other.Roux-en-Y anastomosis between the bile duct and jejunum combined with T-tube drainage was therefore made on the patients.The 7 cases were followed up for 0.5 to 6 years,during the period,none of them showed biliary stenosis,residual stones or other complications.No patient died during the follow-up.Conclusion Biliary tract injury during LC in patients with acute cholecystitis can be avoided as long as we choose the right time for LC as well as for conversion to an open surgery.