title: [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].
abstract: 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.
authors.affiliation: LAP Club, Gruppo collaborativo per lo studio della chirurgia videolaparoscopica, Città della Scienza, Napoli.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Conzo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Amato
authors.forename: Luigi
authors.initials: L
authors.lastname: Angrisani
authors.forename: Ugo
authors.initials: U
authors.lastname: Bardi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Barone
authors.forename: Giulio
authors.initials: G
authors.lastname: Belli
authors.forename: Umberto
authors.initials: U
authors.lastname: Brancaccio
authors.forename: Fulvio
authors.initials: F
authors.lastname: Calise
authors.forename: Angelo
authors.initials: A
authors.lastname: Caliendo
authors.forename: Salvatore
authors.initials: S
authors.lastname: Celsi
authors.forename: Francesco
authors.initials: F
authors.lastname: Corcione
authors.forename: Diego
authors.initials: D
authors.lastname: Cuccurullo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Falco
authors.forename: Paolo
authors.initials: P
authors.lastname: Delrio
authors.forename: Carlo
authors.initials: C
authors.lastname: De Werra
authors.forename: Guido
authors.initials: G
authors.lastname: De Sena
authors.forename: Giovanni
authors.initials: G
authors.lastname: Docimo
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Esposito
authors.forename: Corrado
authors.initials: C
authors.lastname: Fantini
authors.forename: Cristiano
authors.initials: C
authors.lastname: Giardiello
authors.forename: Mario
authors.initials: M
authors.lastname: Musella
authors.forename: Carlo
authors.initials: C
authors.lastname: Molino
authors.forename: Crescenzo
authors.initials: C
authors.lastname: Muto
authors.forename: Lucio
authors.initials: L
authors.lastname: Pennetti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Puziello
authors.forename: Alberto
authors.initials: A
authors.lastname: Porcelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Rea
authors.forename: Franco
authors.initials: F
authors.lastname: Rendano
authors.forename: Antonietta
authors.initials: A
authors.lastname: Palazzo
authors.forename: Michele
authors.initials: M
authors.lastname: Santangelo
authors.forename: Walter
authors.initials: W
authors.lastname: Santaniello
authors.forename: Luigi
authors.initials: L
authors.lastname: Santini
authors.forename: Pasquale
authors.initials: P
authors.lastname: Sperlongano
authors.forename: Francesco
authors.initials: F
authors.lastname: Stanzione
authors.forename: Alberto
authors.initials: A
authors.lastname: Tartaglia
authors.forename: Annunziato
authors.initials: A
authors.lastname: Tricarico
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Vincenti
authors.forename: Michele
authors.initials: M
authors.lastname: Lorenzo
mesh_terms: 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