title: Surgical management of bile duct injuries following laparoscopic cholecystectomy: analysis and follow-up of 28 cases.
abstract: BACKGROUND
  Biliary tract lesions pose a dreaded complication of laparoscopic cholecystectomy. In a retrospective study we analyzed the clinical presentation, diagnostic and therapeutic management and outcome of 28 patients presenting with iatrogenic bile duct injuries.
  
  
  METHODS
  Between 1994 and 2001 we treated 28 patients with bile duct lesions following laparoscopic cholecystectomy at our center. Operation notes and charts of all patients were reviewed systematically. A follow-up examination of each patient was performed after a median of 12 months (range 1-90).
  
  
  RESULTS
  Twenty-two patients presented with major circumferential bile duct defect lesions. Less severe injuries (n=6) were two minor bile leaks, one bile duct stricture and three tangential lesions. Twenty-six patients were referred to our institution within 16 days (range 0-226 days). Six patients were treated by nonsurgical procedures: endoscopic stenting in four and percutaneous intervention in two. In one of the remaining patients a cystic duct leak was closed via laparotomy, and in 21 a hepaticojejunostomy was performed. Reconstruction of a hepaticojenunostomy was performed in two of these patients. Patients were dismissed from the hospital after a median of 13 days (range 4-156). Four patients presenting with generalized biliary peritonitis required prolonged intensive care. One or more episodes of cholangitis were seen in five patients during follow-up examinations.
  
  
  CONCLUSIONS
  Major iatrogenic bile duct injuries are associated with high morbidity and prolonged hospitalization. Interdisciplinary cooperation and early referral to an experienced center is crucial in the management of patients suffering from this affliction. Cholangitis is a marked problem in the follow-up.
authors.affiliation: Klinik und Poliklinik für Chirurgie, Klinikum der Universität Regensburg, Germany. hendrik.seeliger@klinik.uni-regensburg.de
authors.forename: Hendrik
authors.initials: H
authors.lastname: Seeliger
authors.forename: Alois
authors.initials: A
authors.lastname: Fürst
authors.forename: Carl
authors.initials: C
authors.lastname: Zülke
authors.forename: Karl-Walter
authors.initials: KW
authors.lastname: Jauch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D015599:Trauma Severity Indices