Surgical management of segmental and sectoral bile duct injury after laparoscopic cholecystectomy: a challenging situation.
BACKGROUND
Injury to a segmental or sectoral bile duct is a rare event in laparoscopic cholecystectomy; its diagnosis and management may be difficult.


METHODS
Between April 1998 and December 2006, 73 patients referred to the author's tertiary center for management of postcholecystectomy biliary complications were studied. The patients with segmental/sectoral bile duct injury were divided into two groups: injury to a duct which drains at least one Couinaud segment (type 1) or injury to a minor biliary radical in the gallbladder fossa (type 2). Beside the management of concomitant vascular or other biliary injury, type 1 segmental/sectoral duct injury was repaired by biliary-enteric anastomosis and type 2 by oversewing.


RESULTS
Ten out of 73 referred patients had segmental/sectoral duct injuries (eight type 1, two type 2). Despite multiple radiological imaging and endoscopic procedures, in seven patients, the lesion was identified only by precise surgical dissection. The median length of hospital treatment was 26 (range 9-47) days. One patient died due to sepsis before any definitive treatment. During the mean follow-up of 43 (range 27-111) months, seven patients remained asymptomatic while two patients developed biliary anastomotic strictures requiring intervention.


CONCLUSIONS
Segmental/sectoral duct injury is difficult to be assessed by conventional radiological diagnostics and should be taken into consideration in every case of bile leakage. Surgical treatment, adapted to the type of lesion, generally results in a favorable outcome.
Li
Jun
J
Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany.
Frilling
Andrea
A
Nadalin
Silvio
S
Radunz
Sonia
S
Treckmann
Juergen
J
Lang
Hauke
H
Malago
Massimo
M
Broelsch
Christoph Erich
CE
D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D006801:Humans; D011183:Postoperative Complications / Q000175:diagnosis