[Treatment of biliary injuries after laparoscopic cholecystectomy: retrospective study of 27 patients].
Biliary injuries after laparoscopic cholecystectomy are rare but serious. Their mortality rate can reach 9%.


OBJECTIVE
Describe the management of biliary injuries after laparoscopic cholecystectomy in our center.


METHODS
Between January 1995 and June 2005, 27 patients (13 women, 14 men) were treated. The mean age was 53 years old (range, 18-92 years). The biliary injuries were common bile duct sections (n=16, 60%), common bile duct stenoses (n=5, 18.5%), biliary fistulas from the cystic duct (n=4, 15%), and biliary fistulas from an aberrant biliary duct (n=2, 7.5%).


RESULTS
Acute cholecystis was present in 40% of cases (n=11). An intraoperative cholangiography was done in 12 patients (44%). The mortality rate was 0%. Of the common bile duct sections, 43% were diagnosed during the cholecystectomy (n=7) or after the cholecystectomy within a mean of 11.2 days (n=9). Common bile duct injuries were treated in 16 cases with hepatojejunostomy and in five cases with an external biliary drain. Fistulas from the cystic duct were diagnosed within a mean 14.8 days. A fistula from an aberrant biliary duct was diagnosed during the cholecystectomy (n=1) or in the second postoperative day (n=1). Fistulas were treated with a clip on the cystic duct (n=2), an external biliary drain (n=1), a biliary endoprosthesis (n=1), and the biliary aberrant duct suture (n=2).


CONCLUSIONS
Common bile duct injuries are a serious complication because their treatment is a hepaticojejunostomy in 75% of cases.
Service Médico-Chirurgical des Maladies de l'Appareil Digestif et de Transplantation Hépatique, Hôpital Saint Eloi - Montpellier, France. p-puche@chu-montpellier.fr
P
P
Puche
E
E
Jacquet
F
F
Borie
P E
PE
Colombo
H
H
Bouyabrine
A
A
Herrero
F
F
Guillon
J P
JP
Carabalona
J M
JM
Fabre
B
B
Millat
J
J
Domergue
F
F
Navarro
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001658:Biliary Fistula / Q000209:etiology / Q000628:therapy; D002758:Cholangiography / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003135:Common Bile Duct / Q000293:injuries*; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies