Right hepatic lobectomy for recurrent cholangitis after combined bile duct and right hepatic artery injury during laparoscopic cholecystectomy: a report of two cases.
BACKGROUND
Bile duct injuries in combination with major vascular injuries may cause serious morbidity and may even require liver resection in some cases. We present two case studies of patients requiring right hepatic lobectomy after bile duct and right hepatic artery injury during laparoscopic cholecystectomy.


METHODS
Two patients sustained combined major bile duct and hepatic artery injury during laparoscopic cholecystectomy. Surgical management consisted of immediate hepaticojejunostomy with reconstruction of the artery in one patient and hepaticojejunostomy alone in the other patient. In both cases the initial postoperative course was uncomplicated.


RESULTS
After 4 and 6 months both patients suffered recurrent cholangitis due to anastomotic stricture. Both developed secondary biliary cirrhosis and required right hepatic lobectomy with left hepaticojejunostomy. The patients remain well 31 months and 4.5 years after surgery.


CONCLUSIONS
The outcome of bile duct reconstruction may be worse in the presence of combined biliary and vascular injuries than in patients with an intact blood supply of the bile ducts. We recommend arterial reconstruction when possible in early recognized injuries to prevent late strictures. Short-term follow-up is most important for early recognition of postoperative strictures and to avoid further complications such as secondary biliary cirrhosis.
Schmidt
S C
SC
Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow Clinics, Humboldt University of Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. sven.schmidt@charite.de
Langrehr
J M
JM
Raakow
R
R
Klupp
J
J
Steinmüller
T
T
Neuhaus
P
P
D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries*; D002761:Cholangitis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods; D002764:Cholecystitis / Q000601:surgery; D002769:Cholelithiasis / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006499:Hepatic Artery / Q000293:injuries*; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D008105:Liver Cirrhosis, Biliary / Q000209:etiology / Q000517:prevention & control; D009017:Morbidity; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome