Late results of primary repair and follow-up in 53 patients with injuries to the common bile duct occurring during cholecystectomy (distal perforation, tears, ligation or suture).
The late results of primary repair of accidental injuries to the common bile duct occurring during cholecystectomy were evaluated in 53 cases. These lesions occurred in 20 patients who had distal perforation produced by the Bakes dilator, in 17 cases with accidental tearing of the anterior or posterior wall of the common bile duct, and in 16 cases in whom the common bile duct was accidentally ligated or sutured. In cases of perforation, choledochostomy plus suturing of the perforation had a high operative mortality and 4 out of 6 cases developed benign stricture soon after surgery. When sphincteroplasty or choledochoduodenostomy was added, a stricture developed in only 1 out of 7 cases. In cases with accidental tears, suturing of the lesion plus choledochostomy produced very good late results. In patients with accidental ligation or suturing of the common bile duct, two different postoperative complications were seen: seven cases had biliary fistula and all developed benign stricture 2 years after surgery. In nine cases jaundice appeared 6 months after surgery, and a benign stricture developed in 7 of them. The most important "treatment" of these lesions is to prevent them from occurring during cholecystectomy by employing a meticulous surgical technique.
Csendes
A
A
Department of Surgery, University Hospital Santiago, Chile.
Díaz
J C
JC
Burdiles
P
P
Maluenda
F
F
Korn
O
O
D002763:Cholecystectomy / Q000009:adverse effects*; D002768:Choledochostomy / Q000009:adverse effects; D003135:Common Bile Duct / Q000293:injuries* / Q000601:surgery; D003137:Common Bile Duct Diseases / Q000209:etiology; D003251:Constriction, Pathologic / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008026:Ligation / Q000009:adverse effects; D008297:Male; D012189:Retrospective Studies; D012421:Rupture; D013537:Sutures / Q000009:adverse effects