title: Management of major biliary complications after laparoscopic cholecystectomy.
abstract: OBJECTIVE
  A total of 50 major bile duct injuries after laparoscopic cholecystectomy were managed by the Duke University Hepatobiliary Service from 1990-1992. The management of these complex cases is reviewed.
  
  
  BACKGROUND
  Laparoscopic cholecystectomy is the preferred method for removing the gallbladder. Bile duct injury is the most feared complication of the new procedure.
  
  
  METHODS
  Review of videotapes, pathology, and management of the original operations were reviewed retrospectively, and the injuries categorized. Major biliary injury was defined as a recognized disruption of any part of the major extrahepatic biliary system. Biliary leakage was defined as a clinically significant biliary fistula in the absence of major biliary injury, i.e., with an intact extrahepatic biliary system.
  
  
  RESULTS
  Thirty-eight injuries were major biliary ductal injuries and 12 patients had simple biliary leakage. Twenty-four patients had the classic type injury or some variant of the classic injury. A standard treatment approach was developed which consisted of ERCP for diagnosis, preoperative PTC with the placement of stents, CT drainage immediately after the PTC for drainage of biliary ascites, and usually Roux-en-Y hepaticojejunostomy with placement of O-rings for future biliary access if necessary. Major ductal injuries were high in the biliary system involving multiple ducts in 31 of the 38 patients. Re-operation was required in 5 of the 38 patients with particularly complex problems.
  
  
  CONCLUSIONS
  Successful management of bile duct injury after laparoscopic cholecystectomy requires careful understanding of the mechanisms, considerable preoperative assessment by experts, and a multidisciplinary approach.
authors: Department of Surgery, Duke University Hepatobiliary Service, Durham, North Carolina.
authors: G
authors: G
authors: Branum
authors: C
authors: C
authors: Schmitt
authors: J
authors: J
authors: Baillie
authors: P
authors: P
authors: Suhocki
authors: M
authors: M
authors: Baker
authors: A
authors: A
authors: Davidoff
authors: S
authors: S
authors: Branch
authors: R
authors: R
authors: Chari
authors: G
authors: G
authors: Cucchiaro
authors: E
authors: E
authors: Murray
mesh_terms: D000713:Anastomosis, Roux-en-Y; D001652:Bile Ducts / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D001658:Biliary Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000209:etiology; D006801:Humans; D007582:Jejunostomy; D008099:Liver / Q000000981:diagnostic imaging / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed