Surgical treatment of iatrogenic lesions of the upper biliary tract

ABSTRACT

To study the outcome of biliary reconstruction in cases of Iatrogenic Bile duct Injury and Structures. Retrospective study conducted from Oct. 1989 to Dec. 2002. Dept. of Hepatobiliary Surgery, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, People Republic of China. Ninety four patients who underwent biliary reconstruction. Amongst the 94 patients, 74 injuries resulted from Laparoscopic procedure and 28 from Open Cholecystectomy, while one was the result of Mini Cholecystecomy The patients underwent repair based on Bismuth classification. The outcome was graded as excellent, good and poor. There was no pre-operative death in this series. During the follow-up of 13-15 years, 75 [79.8%] patients had excellent results, 13 [13.8%] good results and 6 [6.4%] poor results. Four patients amongst the poor group died. To reduce the incidence of bile duct injuries it is important to recognize the cystic duct, the common hepatic and the common bile duct junction, and to be familiar with the anatomical variations and the congenital anomalies. The classification of iatrogenic bile duct injuries and strictures, and the timing and technique of biliary reconstruction influence the outcome in these cases