Hepaticojejunostomy in the treatment of iatrogenic biliary lesions following laparoscopic cholecystectomy. A retrospective study on 51 cases.
OBJECTIVE
Laparoscopic cholecystectomy is characterized by a higher incidence of iatrogenic biliary lesions. The Authors evaluate the role of hepaticojejunostomy in the treatment of iatrogenic biliary lesions following laparoscopic cholecystectomy in 51 patients observed in the Campania region, Italy from 1991 to 2003.


METHODS
The Authors report the data of a retrospective multicentric study of 51 patients -39 women (76.47%), 12 men (13.53%)-reoperated on for major biliary lesions following laparoscopic cholecystectomy. Hepaticojejunostomy in 20 cases (39.21%) and T-Tube plasty in 20 cases (39.21%) were performed.


RESULTS
The mean follow-up was 25.01 months. The mean hospital stay was 25.7 days. 1/51 patients (1.9%) died from intraoperative incontrollable hemorrhage while cumulative postoperative mortality was 9.8% (5/51 patients). Therapeutic success rate of hepaticojejunostomy was 70% with a T-Tube plasty success rate of 65%. 9/51 patients (17.64%) were reoperated while in 4/51 (7.84%) a biliary stent was positioned. In 1/51 patients (1.9%) a biliary cirrhosis and in 3/51 (5.7%) a bioumoral cholestasis was observed.


CONCLUSIONS
Laparoscopic cholecystectomy causes a higher incidence of iatrogenic biliary lesions. Hepaticojejunostomy gives better long-term results and lower morbidity compared to T-Tube plasty. Management of septic complications in patients with iatrogenic biliary lesions represents the first therapeutic step.
Conzo
Giovanni
G
LAP Club, Gruppo Collaborativo per lo Studio Della Chirurgia Videolaparoscopica Città della Scienza, Napoli, Italy. giovanni.conzo@unina2.it
Amato
Giuseppe
G
Angrisani
Luigi
L
Bardi
Ugo
U
Belli
Giulio
G
Brancaccio
Umberto
U
Calise
Fulvio
F
Celsi
Salvatore
S
Corcione
Francesco
F
Cuccurullo
Diego
D
De Falco
Giuseppe
G
De Werra
Carlo
C
De Sena
Guido
G
Docimo
Giovanni
G
Esposito
Maria Grazia
MG
Fantini
Corrado
C
Giardiello
Cristiano
C
Livrea
Antonio
A
Lorenzo
Michele
M
Molino
Carlo
C
Musella
Mario
M
Muto
Crescenzo
C
Palazzo
Antonietta
A
Porcelli
Alberto
A
Rea
Roberto
R
Rendano
Franco
F
Santangelo
Michele
M
Santaniello
Walter
W
Santini
Luigi
L
Sperlongano
Pasquale
P
Stanzione
Francesco
F
Tartaglia
Alberto
A
Tricarico
Annunziato
A
Vincenti
Rodolfo
R
Delrio
Paolo
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies