Johnson SR, Koehler A, Pennington LK, Hanto DW. Long-term results of surgical repair of bile duct injuries following laparoscopic cholecystectomy. Surgery 2000 Oct;128(4):668-77
Department of Surgery, Division of Transplantation and Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
BACKGROUND: Laparoscopic
cholecystectomy (LC) is associated with an increased incidence
of bile duct injuries when compared with the open surgical technique.
Long-term results of repaired injuries and hepatic damage associated
with chronic biliary obstruction are lacking. METHODS: From Aug
1, 1991 until Dec 1, 1999, there were 27 patients referred for
management of complex biliary injuries that occurred during LC.
Patients underwent percutaneous transhepatic cholangiography and
placement of transhepatic catheters with computed tomography-guided
biloma drainage when indicated. On the basis of the cholangiography
findings, patients underwent Roux-en-Y hepaticojejunostomy (HJ)
and liver biopsy or were treated with nonsurgical interventions.
RESULTS: Twenty-one of 27 patients (77. 8%) underwent HJ, and
16 of these 21 patients (76.2%) also underwent hepatic biopsy.
In 1 patient, a recurrent stricture developed at 20 months after
the initial repair; and, in a second patient, an episode of cholangitis
developed in the postoperative period with the transhepatic catheters
in place. Five of 16 patients (31.2%) demonstrated marked hepatic
fibrosis with 4 (25%) of these patients showing evidence of evolving
cirrhosis at the time of HJ. CONCLUSIONS: In this series with
55 months of follow-up, HJ repair of LC injuries was associated
with an initial 95.2% success rate and an ultimate success rate
of 100%. Despite this, delayed referral, averaging 12 months,
was associated with significant hepatic injury in 5 of 16 (31.3%)
patients who underwent biopsy.
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