title: Isolated right segmental hepatic duct injury following laparoscopic cholecystectomy.
abstract: OBJECTIVE
  Laparoscopic cholecystectomy (LC) is the treatment of choice for gallstones. There is an increased incidence of bile duct injuries in LC compared with the open technique. Isolated right segmental hepatic duct injury (IRSHDI) represents a challenge not only for management but also for diagnosis. We present our experience in the management of IRSHDI, with long-term follow-up after treatment by a multidisciplinary approach.
  
  
  METHODS
  Twelve consecutive patients (9 women, mean age 48 years) were identified as having IRSHDI. Patients' demographics, clinical presentation, management and outcome were collected for analysis. The mean follow-up was 44 months (range 2-90 months).
  
  
  RESULTS
  Three patients had the LC immediately converted to open surgery without repair of the biliary injury before referral. Treatments before referral included endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage and surgery, isolated or in combination. The median interval from LC to referral was 32 days. Eleven patients presented with biliary leak and biloma, one with obstruction of an isolated right hepatic segment. Post-referral management of the biliary lesion used a combination of ERCP stenting, percutaneous drainage and stent placement and surgery. In 6 of 12 patients ERCP was the first procedure, and in only one case was IRSHDI identified. In 6 patients, percutaneous transhepatic cholangiography (PTC) was performed first and an isolated right hepatic segment was demonstrated in all. The final treatment modality was endoscopic management and/or percutaneous drainage and stenting in 6 patients, and surgery in 6. The mean follow-up was 44 months. No mortality or significant morbidity was observed.
  
  
  CONCLUSIONS
  Successful management of IRSHDI after LC requires adequate identification of the lesion, and multidisciplinary treatment is necessary. Half of the patients can be treated successfully by nonsurgical procedures.
authors.affiliation: Division of Gastroenterology, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29464, USA.
authors.forename: Rafael F
authors.initials: RF
authors.lastname: Perini
authors.forename: Renan
authors.initials: R
authors.lastname: Uflacker
authors.forename: John T
authors.initials: JT
authors.lastname: Cunningham
authors.forename: J Bayne
authors.initials: JB
authors.lastname: Selby
authors.forename: David
authors.initials: D
authors.lastname: Adams
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D001646:Bile; D017734:Bile Ducts, Extrahepatic / Q000293:injuries* / Q000601:surgery; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D001651:Cholestasis, Extrahepatic / Q000209:etiology; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012017:Referral and Consultation; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome