Management of Bile Duct Injuries During Laparoscopic Cholecystectomy / 中国微创外科杂志

ABSTRACT

Objective To discuss the management of bile duct injuries during laparoscopic cholecystectomy(LC).Methods From March 1992 to October 2006,totally 8876 cases of LC were performed in our hospital.Bile duct injury occurred in 16 of them,among which,the common bile duct was mistakenly cut in 4 cases,partly torn in 5,and wrongly clipped in 5,and electrical burn injury happened in 3.The patients received bile duct repair and T-tube drainage(6),bile duct anastomosis plus T-tube drainage(3),or Roux-en-Y bowel biliary anastomosis(5) after the accidents.In 2 patients,the titanium clips were removed.Results In one of the patients with the bile duct been cut,bile duct anastomosis was performed,and T-tube drainage was continued for 3 months;however,3 to 5 months after the T tube being removed,the patient had to underwent Roux-en-Y bowel biliary anastomosis because of biliary stenosis.No obstructive jaundice occurred in this patient after the Roux-en-Y.Two patients received a second t Roux-en-Y bowel biliary anastomosis owing to anastomotic stenosis.The second operation was carried out 9 or 10 month after the first surgery,and the patients were then followed up for 2 to 4 years.None of them developed cholangitis or calculi during the follow-up.One patient,who suffered a clipped bile duct,underwent Roux-en-Y bowel biliary anastomosis after the LC,but developed recurrent infection of the bile duct after the second operation.Among the 16 patients,12 were cured,10 of them were followed up for 3 to 4 years,during which no one showed biliary symptoms.Conclusions Bile duct injury is one of the major complications after LC.Early prevention and intervention are very important to avoid repeated operations.