title: Outcome of 49 repairs of bile duct injuries after laparoscopic cholecystectomy.
abstract: Treatment of bile duct injuries after laparoscopic cholecystectomy is still under discussion. The aim of this study was to evaluate the results of end-to-end or biliodigestive anastomosis for various types of bile duct injury. Patient charts of 49 (0.81%) classified bile duct injuries from a national survey of 6076 laparoscopic cholecystectomies in The Netherlands were analyzed. The median follow-up after repair was 183 days (range 14-570 days). Statistical analysis showed that an end-to-end anastomosis was preferred by the surgeons for less severe bile duct injuries and a biliodigestive repair for more severe injuries. Three patients died owing to a delayed detected bile duct injury. Twelve bile duct strictures occurred after repair, leading to a stricture rate of 25%. The time elapsed between repair and occurrence of a stricture was 134 days (range 13-270 days). The type of repair or the severity of the bile duct injury did not determine the outcome of the repair. Histologically proved cholecystitis predisposed a stricture at the repair site. It was concluded that treatment of bile duct injuries is associated with a high stricture rate at the repair site of the anastomosis. End-to-end anastomosis is mostly successful for the less severe injury detected during laparoscopic cholecystectomy. For all other cases this repair can at least be considered a temporary internal drainage procedure. The biliodigestive anastomosis can best be considered a delayed repair after a drainage procedure has resolved the local inflammatory status.
authors.affiliation: Department of Surgery, University Hospital Maastricht, The Netherlands.
authors.forename: F P
authors.initials: FP
authors.lastname: Schol
authors.forename: P M
authors.initials: PM
authors.lastname: Go
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D017081:Cholecystectomy, Laparoscopic; D001651:Cholestasis, Extrahepatic / Q000209:etiology; D003135:Common Bile Duct / Q000293:injuries* / Q000601:surgery; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006500:Hepatic Duct, Common / Q000293:injuries* / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D016896:Treatment Outcome