Management of postlaparoscopic cholecystectomy major bile duct injury: comparison of MRCP with conventional methods.
BACKGROUND
Postlaparoscopic cholecystectomy bile duct injury remains one of the devastating complications seen in current surgical practice.


OBJECTIVE
This study describes the diagnostic role of magnetic resonance cholangiopancreatography (MRCP) in such injuries compared with conventional methods.


METHODS
Eighteen patients referred to the Division of Hepatobiliary Surgery, King Khalid University Hospital from July 1998 to September 2000 were retrospectively studied. The technique of the repair was by utilizing Roux-en-Y hepaticojejunostomy with establishment of mucosa-to-mucosa anastomosis.The study included presentation, age and gender.


RESULTS
The presentation of patients were variable and frequently included pain, jaundice with or without cholangitis in 13 patients, bile leakage with development of biliary peritonitis in three, and development of external biliary fistula in two patients. Besides lower incidence of complication, MRCP was more diagnostic and informative in planning surgery by mapping both ducts proximal and distal to site of injury or stricture in 14 out of 18 patients. The Bismuth level of bile duct injuries were type I in one, type 11 in five, type III in 11 and type IV in one patient. All patients are alive, well and no complications occurred in the immediate postoperative period. Only two patients developed stricture within four months after surgery, one of them treated conservatively with repeated dilatation and stenting was done for the other.


CONCLUSIONS
Hepaticojejunostomy is the procedure of choice for repair of bile duct injuries and provides adequate bilairy drainage. MRCP is an ideal diagnostic test when bile duct injury is suspected following laparoscopic cholecystectomy.
Department of Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia.
Khalid Mohammad
KM
Abou El-Ella
Osama Nafea
ON
Mohamed
Mohamed Ibrahim
MI
El-Sebayel
Saleh Ali
SA
Al-Semayer
Ibrahim Abdulkarim
IA
Al Mofleh