title: Bile duct injuries following laparoscopic cholecystectomy.
abstract: BACKGROUND
  Bile duct injuries occur rarely but are among the most dreadful complications following cholecystectomies.
  
  
  METHODS
  Prospective registration of bile duct injuries occurring in the period 1992-2013 at a tertiary referral hospital.
  
  
  RESULTS
  In total, 67 patients (47 women and 20 men) with a median age of 55 (range 14-86) years had a leak or a lesion of the bile ducts during the study period. Total incidence of postoperative bile leaks or bile duct injuries was 0.9% and for bile duct injuries separately, 0.4%. Median delay from injury to repair was 5 days (range 0-68 days). In 12 patients (18%), the injury was discovered intraoperatively. Bile leak was the major symptom in 59%, and 52% had a leak from the cystic duct or from assumed aberrant ducts in the liver bed of the gall bladder. Following the Clavien-Dindo classification, 39% and 45% were classified as IIIa and IIIb, respectively, 10% as IV, and 6% as V. In all, 31 patients had injuries to the common bile duct or hepatic ducts, and in these patients, 71% were treated with a hepaticojejunostomy. Of patients treated with a hepaticojejunostomy, 56% had an uncomplicated event, whereas 14% later on developed a stricture. Out of 36 patients with injuries to the cystic duct/aberrant ducts, 30 could be treated with stents or sphincterotomies and percutaneous drainage.
  
  
  CONCLUSIONS
  Half of injuries following cholecystectomies are related to the cystic duct, and most of these can be treated with endoscopic or percutaneous procedures. A considerable number of patients following hepaticojejunostomy will later on develop a stricture.
authors.affiliation: Department of Acute and Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway Department of Clinical Medicine K1, University of Bergen, Bergen, Norway asgaut.viste@helse-bergen.no.
authors.forename: A
authors.initials: A
authors.lastname: Viste
authors.affiliation: Department of Acute and Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway.
authors.forename: A
authors.initials: A
authors.lastname: Horn
authors.affiliation: Department of Acute and Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway.
authors.forename: K
authors.initials: K
authors.lastname: Øvrebø
authors.affiliation: Department of Acute and Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway.
authors.forename: B
authors.initials: B
authors.lastname: Christensen
authors.affiliation: Department of Acute and Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway.
authors.forename: J-H
authors.initials: JH
authors.lastname: Angelsen
authors.affiliation: Department of Acute and Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway.
authors.forename: D
authors.initials: D
authors.lastname: Hoem
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000293:injuries*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D012086:Reoperation; D015607:Stents; D015996:Survival Rate / Q000639:trends; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013997:Time Factors; D055815:Young Adult
keywords: Laparoscopic cholecystectomy; bile duct injuries; complications; mortality