Management of major bile duct injury associated with laparoscopic cholecystectomy.
BACKGROUND
Bile duct injury is a major complication of laparoscopic cholecystectomy. The purpose of this study was to evaluate our management strategy and outcomes for the treatment of such injuries.


METHODS
We studied 54 consecutive patients who had de novo bile duct injury (n = 20) or prior biliary injury repair (n = 34) associated with laparoscopic cholecystectomy. All patients were managed using a multidisciplinary approach.


RESULTS
Definitive operation, almost always Roux-en-Y hepaticojejunostomy, was required in 85% of patients. We inserted external percutaneous biliary catheters in 98% of cases prior to surgery. There were no operative deaths, and the 30-day complication rate was 20%. Eight patients (15%) were managed nonoperatively. Overall, 96% of patients had no long-term, objectively definable biliary sequelae.


CONCLUSIONS
Treatment of bile duct injury associated with laparoscopic cholecystectomy is optimally done using a multidisciplinary approach. Surgical reconstruction is required in most cases and can be safely accomplished with minimal morbidity and excellent long-term outcomes.
Robinson
T N
TN
Department of Surgery, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Denver, CO 80262, USA.
Stiegmann
G V
GV
Durham
J D
JD
Johnson
S I
SI
Wachs
M E
ME
Serra
A D
AD
Kumpe
D A
DA
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003135:Common Bile Duct / Q000293:injuries* / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged