title: Major bile duct injuries after laparoscopic cholecystectomy: a tertiary center experience.
abstract: Bile duct injury is a severe and potentially life-threatening complication of laparoscopic cholecystectomy. Several series have described a 0.5% to 1.4% incidence of bile duct injuries during laparoscopic cholecystectomy. The aim of this study was to report on an institutional experience with the management of complex bile duct injuries and outcome after surgical repair. Data were collected prospectively from 40 patients with bile duct injuries referred for surgical treatment to our center between April 1998 and December 2003. Prior to referral, 35 patients (87.5%) underwent attempts at surgical reconstruction at the primary hospital. In 77.5% of the patients, complex type E1 or type E2 BDI was found. Concomitant with bile duct injury, seven patients had vascular injuries. Roux-en-Y hepaticojejunostomy was carried out in 33 patients. In two patients, Roux-en-Y hepaticojejunostomy and vascular reconstruction were necessary. Five patients, one with primary nondiagnosed Klatskin tumor, required right hepatectomy. Two patients, both with bile duct injuries and vascular damage, died postoperatively. Because of progressive liver insufficiency, one of them was listed for high-urgency liver transplantation but died prior to intervention. At the median follow-up of 589 days, 82.5% of the patients are in excellent general condition. Seven patients have signs of chronic cholangitis. Major bile duct injuries remain a significant cause of morbidity and even death after laparoscopic cholecystectomy. Because they present a considerable surgical challenge, early referral to an experienced hepatobiliary center is recommended.
authors.affiliation: Department of General Surgery and Transplantation,University Hospital Essen, Essen, Germany. frilling@uni-essen.de
authors.forename: Andrea
authors.initials: A
authors.lastname: Frilling
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.forename: Frank
authors.initials: F
authors.lastname: Weber
authors.forename: Nils Roman
authors.initials: NR
authors.lastname: Frühauf
authors.forename: Jennifer
authors.initials: J
authors.lastname: Engel
authors.forename: Susanne
authors.initials: S
authors.lastname: Beckebaum
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Thomas
authors.initials: T
authors.lastname: Zöpf
authors.forename: Massimo
authors.initials: M
authors.lastname: Malago
authors.forename: Christoph Erich
authors.initials: CE
authors.lastname: Broelsch
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000209:etiology* / Q000601:surgery*