Management of Bile Duct Injuries Following Laparoscopic Cholecystectomy: Long-term Outcome and Risk Factors Infuencing Biliary Reconstruction
N. Al Hajjar, C. Tomuş, L. Mocan, T. Mocan, F. Graur, C. Iancu, F. ZaharieOriginal article, no. 4, 2014
Background: Bile duct injury following cholecystectomyremains a severe complication with major implications forthe patient outcome.Aim: To assess the outcome of surgical treatment and study therisk factor infuencing biliary reconstruction in patients withbile duct injuries following laparoscopic cholecystectomy. Methods: Between January 2005 and December 2010, 43patients with bile duct injuries following laparoscopiccholecystectomy were treated to our center. According toStrasberg classification, the types of injuries were as follows:type A in 7 patients (16.28%), type D in 4 (9.3%), type E1 in9 (20.93%), type E2 in 11 (25.58%), type E3 in 10 (23.25%),and type E4 in 2 (4.65%) patients respectively. Managementafter referral included endoscopic sphincterotomy in patientswith minor lesions (Strasberg type A) and Roux-en-Yhepaticojejunostomy in 36 patients with major duct injuries(Strasberg type D and E). 55.55% of patients with major bileduct injuries have endoscopic or surgical attempts of repairsprior to referral. In case of biliary peritonitis or acutecholangitis, the reconstruction was preceded by prolongedexternal biliary drainage.Results: All minor lesions were successfully treated endoscopically,with outstanding long term results. For patients withmajor duct injuries, the postoperative mortality and morbidityrate were 5.55% and 25%, respectively. After a medianfollow-up period of 34.1 (range, 12-68) months, 30 patients(88.23%) remain in good general condition (using McDonaldclassification) and 4 patients (11.77%) developed a lateanastomotic stricture. Multivariate analyses have identifiedpostoperative biliary leak (p=0.012) as an independentpredictor factor for the occurrence of late anastomotic stricture.Conclusions: Minor bile duct injuries can be successfullytreated endoscopically if proper abdominal drainage ismaintained. Roux-en-Y hepaticojejunostomy is feasible andsafe with contained morbidity and durable results even whenprevious surgery has failed. Postoperative biliary leak is asignificant predictor for poor long term outcome.
