[Surgical treatment of iatrogenic bile duct injuries following laparoscopic cholecystectomy: analysis of long-term results. Retrospective clinical study in 51 patients operated in the Campania region from 1991 to 2003].
An higher incidence rate of iatrogenic bile duct injuries is reported in cholecystectomy performed with the laparoscopy than with the laparotomy approach. The aim of this study was to provide a multicentre report on surgical treatment and the outcome of biliary complications during and following laparoscopic cholecystectomy. A questionnaire was mailed to all surgeons with experience in laparoscopic cholecystectomy in the Campania region. Data were collected from January 1991 to December 2003. Each patient was requested to indicate age, gender, associated diseases, site and type of lesion, surgical experience, diagnosis, treatment and complications. Twenty-six surgeons answered the questionnaire. Fifty-one patients (36 F/15 M; mean age: 42.5 +/- 11.9, range 13-91 years) with bile duct injuries following laparoscopic cholecystectomy were reported. The most frequent lesions were main bile duct partial or total transection. The intraoperative mortality rate was 1/51 (1.9%) due to a complex biliary and vascular injury. The postoperative mortality rate of revision surgery was 5/50 (10%). T-tube positioning (n = 20) and Roux-en-Y hepato-jejunostomy (n = 20) were the procedures most frequently performed. The complication rate in patients treated with the T-tube was significantly higher than in those treated with hepatico-jejunostomy. Surgical treatment of biliary injuries following laparoscopic cholecystectomy was characterized by unusually high mortality and morbidity for a non-neoplastic disease. Roux-en-Y hepato-jejunostomy remains the procedure of choice for these injuries.
Conzo
Giovanni
G
LAP Club, Gruppo collaborativo per lo studio della chirurgia videolaparoscopica, Città della Scienza, Napoli.
Amato
Giuseppe
G
Angrisani
Luigi
L
Bardi
Ugo
U
Barone
Giovanni
G
Belli
Giulio
G
Brancaccio
Umberto
U
Calise
Fulvio
F
Caliendo
Angelo
A
Celsi
Salvatore
S
Corcione
Francesco
F
Cuccurullo
Diego
D
De Falco
Giuseppe
G
Delrio
Paolo
P
De Werra
Carlo
C
De Sena
Guido
G
Docimo
Giovanni
G
Esposito
Maria Grazia
MG
Fantini
Corrado
C
Giardiello
Cristiano
C
Musella
Mario
M
Molino
Carlo
C
Muto
Crescenzo
C
Pennetti
Lucio
L
Puziello
Alessandro
A
Porcelli
Alberto
A
Rea
Roberto
R
Rendano
Franco
F
Palazzo
Antonietta
A
Santangelo
Michele
M
Santaniello
Walter
W
Santini
Luigi
L
Sperlongano
Pasquale
P
Stanzione
Francesco
F
Tartaglia
Alberto
A
Tricarico
Annunziato
A
Vincenti
Rodolfo
R
Lorenzo
Michele
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000401:mortality; D004322:Drainage; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016019:Survival Analysis