Bile Duct Injury during Laparoscopic Cholecystectomy

ABSTRACT

PURPOSE: Laparoscopic cholecystectomy has replaced open surgery as the standard treatment for symptomatic cholelithiais. The combined use of ERCP and endoscopic sphincterotomy makes it possible for the diagnosis and management of common bile duct stones also. The authors reviewed cases for complications and clinical results in order to elucidate the efficacy of laparoscopic cholecystectomy in our hospital. METHODS: Of the 996 subjects who underwent laparoscopic cholecystectomy in our hospital between 1994 to 2000, only subjects of bile duct injury during or after the surgery were chosen for study. The clinical signs, symptoms, laboratory data, treatment method and complications were reviewed retrospectively. RESULTS: 8 patients developed bile peritonitis (0.81%), and 2 of these died of complications. Abdominal pain was noted in all patients. Intraabdominal bile collection was detected with ultrasonography (6 cases), endoscopic retrograde cholangiopancreatography (6 cases), percutaneous transhepatic cholangiography (3 cases) and computerized tomography (1 case). Management of bile peritonitis was done with Roux-en-Y hepaticojejunostomy (3 cases), naso-biliary tube drainage (2 case), sono-guided bile drainage (1 case) and primary closure of the common bile duct (2 case). CONCLUSION: This study demonstrated that laparoscopic cholecystectomy is a relatively safe and effective approach for the management of gallstones. And though vague and nonspecific, there were clinical signs and symptoms revealing bile leakage such as abdominal pain, tenderness, fever, jaundice and so on. Therefore, prompt and proper management for bile leakage should be accomplished to prevent lethal outcome.