Bile Duct Injuries During Laparoscopic Cholecystectomy - Two Years Experience at Sheikh Zayed Hospital

Abstract

The introduction of laparoscopic cholecystectomy has been associated with an increased incidence of bile duct injury. Although several studies have shown a low incidence of bite duct injuries during laparoscopic cholecystectomy 37, concerns remain because of the sustained increase in the number of referral for biliary reconstruction after the laparoscopic procedure. Three (20%) of fifteen patients with iatrogenic bile duct injures were indigenous to this hospital while twelve patients have been referred to our institution because of major bile duct injuries after laparoscopic cholecystectomy. The injury was recognized during laparoscopic procedure in 100% of indigenous cases and in only four of the 12 (33.3%) referred patients. Fourteen patients underwent Hepaticojejunostomy at least once, one patient of indigenous group required choledochorrhaphy with T-tube drainage. Hepaticojejunostomy above the bifurcation was required in 7 patients (50%), at the bifurcation in 3, and below the bifurcation in 4 patients. Five of the 12 patients in whom the initial repair was performed at the local hospital presented with early stricture (median 7 months). The common denominator of the development of bile duct injuries during laparoscopic cholecystectomy is the failure to identify the structures in Calot’s triangle .Specific steps during laparoscopic cholecystectomy to avoid bile duct injuries are described. Expertise in
hepatobiliary surgery appears to optimize results of biliary reconstruction.