Mechanisms of Major Biliary Injury During Laparoscopie Cholecystectomy

TLDR

Laparoscopic cholecystectomy is the preferred method for gallbladder removal, but bile duct injury remains its most significant complication. The authors reviewed 12 cases of bile duct injury that occurred during laparoscopic cholecystectomy. Among the injuries, eight were classic misidentifications, one involved clip ligation, three resulted from excessive cautery or laser, most patients presented with persistent abdominal pain, and 10 required Roux‑en‑Y hepaticojejunostomy while one had direct repair and another underwent endoscopic dilation.

Abstract

Laparoscopie cholecystectomy has become the procedure of choice for surgical removal of the gallbladder. The most significant complication of this new technique is injury to the bile duct. Twelve cases of bile duct injury during laparoscopie cholecystectomy were reviewed. Eight injuries were of a classic type: misidentification of the common duct for the cystic duct, resection of part of the common and hepatic ducts, and associated right hepatic arterial injury. Another injury was similar: clip ligation of the distal common duct with proximal ligation and division of the cystic duct, resulting in biliary obstruction and leakage. Three complications arose from excessive use of cautery or laser in the region of the common duct, resulting in biliary strictures. Evaluation of persistent diffuse abdominal pain led to the recognition of ductal injury in most patients. Ultimately, 10 patients required a Roux-en-Y hepaticojejunostomy to provide adequate biliary drainage. One patient had a successful direct common duct repair, and the remaining patient underwent endoscopie dilatation.