title: Intraoperative management and repair of bile duct injuries sustained during 10,123 laparoscopic cholecystectomies in a high-volume referral center.
abstract: BACKGROUND
  Bile duct injury (BDI) remains the most serious complication of laparoscopic cholecystectomy (LC). The best strategy in terms of timing of repair is still controversial. The purpose of the current study is to review the experience in the intraoperative repair of bile duct injuries sustained during LC at a high-volume referral center.
  
  
  METHODS
  Single-institution retrospective analysis of a prospectively collected database. Patients with diagnosis of BDI sustained during LC between October 1991 and November 2010 were extracted.
  
  
  RESULTS
  Among 10,123 LC performed during the study period, 19 patients had a BDI sustained during the procedure. Intraoperative cholangiography was routinely used. Bile duct injury was diagnosed intraoperatively in 17 patients (89.4%). Mean age was 56.4 years (range 18 to 81 years) and 15 patients were women (88%). According to the Strasberg classification of BDI, there were 3 type C lesions, 12 type D lesions, and 2 type E2 lesions. There were no associated vascular injuries. Twelve cases (71%) were converted to open surgery. The repairs included 10 primary biliary closures, 4 Roux-en-Y hepaticojejunostomies, 2 end to end anastomosis, and 1 laparoscopic transpapillary drainage. Postoperative complications occurred in 5 patients (29.4%). During the follow-up period, early biliary strictures developed in 2 patients (11.7%) and were treated by percutaneous dilation and a Roux-en-Y hepaticojejunostomy with satisfactory long-term results.
  
  
  CONCLUSIONS
  The current series represents one of the largest single-center experiences in terms of intraoperative repair of BDI sustained during LC. The results suggest that a high level of intraoperative diagnosis is possible, where intraoperative cholangiography is a useful tool. The intraoperative repair of BDI sustained during LC by experienced hepatobiliary surgeons either by open or laparoscopic approach appears of paramount importance to assure optimal results.
authors.affiliation: Hepato-Pancreato-Biliary and Liver Transplant Sections, General Surgery Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. juan.pekolj@hospitalitaliano.org.ar
authors.forename: Juan
authors.initials: J
authors.lastname: Pekolj
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Alvarez
authors.forename: Martin
authors.initials: M
authors.lastname: Palavecino
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Sánchez Clariá
authors.forename: Oscar
authors.initials: O
authors.lastname: Mazza
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Santibañes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y; D001118:Argentina; D001652:Bile Ducts / Q000293:injuries* / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D061887:Conversion to Open Surgery; D016208:Databases, Factual; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D007583:Jejunum / Q000601:surgery; D007902:Length of Stay; D008099:Liver / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome