Accidental Lesions of the Common Bile Duct at Cholecystectomy

Abstract

Sixty-five cases of accidental lesion of the choledochus at cholecystectomy reported from 51 Swedish hospitals to the Patients' Insurance Syndicate in Stockholm 1975-1981 were studied. The results were evaluated as to the time of detection and the primary surgical repair done. Fifty-five of the 65 lesions were detected and repaired at the cholecystectomy and ten were detected and repaired the first 10 days after the primary operation. In 38 of 55 lesions detected before surgery, an end-to-end choledochostomy was performed. Good results without further surgical intervention were achieved in 22%. The 17 other preoperatively detected lesions were treated with choledocho/hepaticoenterostomy, and good results were achieved without further surgical intervention in 54%. Of the ten patients in whom the lesions were detected after surgery, three were reconstructed with an end-to-end choledochostomy; all of these developed obstruction that led into further reoperations. In the remaining seven patients the lesions were repaired within 10 days with a choledocho/hepaticoenterostomy; three of them did not require further surgical intervention and four had to be reoperated. There was no mortality at the first repair, but two cases of hospital mortality at reoperations. However, the morbidity have been substantial for patients with as well as without obvious further surgical complications. The results indicate that in this selected group choledocho/hepaticoenterostomy should be the procedure of choice. However, the accumulated rate of biliary strictures increased with time, which requires a considerably longer follow-up to know the end results of this of avoidable complication to "a straightforward cholecystectomy."

Damage to the Bile Ducts at Cholecystectomy

“…However, it is wrong to assume that operative cholangiography always affords protection against duct damage [9,10]. The injury can occur due to poor surgical technique after the study has shown a normal biliary tree, or because the operative cholangiogram was interpreted incorrectly [11]. Bengmark et al [11] reported 65 injuries of the choledochus at cholecystectomy in patients when peroperative cholangiography was performed in all except three.…”

“…The injury can occur due to poor surgical technique after the study has shown a normal biliary tree, or because the operative cholangiogram was interpreted incorrectly [11]. Bengmark et al [11] reported 65 injuries of the choledochus at cholecystectomy in patients when peroperative cholangiography was performed in all except three. Surgeons performing cholecystectomy should be aware of the many anatomical variations which occur, especially in the Calot's triangle, and thus the need to expose the area clearly before any structures are divided, clamped, or ligated.…”

“…Therefore surgeons should be skilled enough to recognize and promptly repair the injury over a T-tube by end-to-end anastomosis, because it achieves the best results [12]. However, the choledocho/ hepaticojejunostomy gives a better result when a segment of the bile duct is damaged, making tension-free end-to-end anastomosis technically difficult, or when the injury is diagnosed later in the postoperative period [13][14][15]. On inquiry it was also discovered that the surgeons who performed the six cholecystectomies were assisted by a very junior staff member or a nurse.…”

Management and prevention of iatrogenic bile duct injury

“…In more recent times, multi centre series, national surveys and single centre series have estimated that the overall prevalence of bile duct injury during the era of open cholecystectomy to be around 0.1-0.2% (10,11,12). This low incidence has occurred over a century of experience and could be considered as a reference for comparison for other techniques of cholecystectomy.…”

Management of Post-Cholecystectomy Benign Bile Duct Strictures: Review

“…The incidence of BDI during open cholecystectomy is reported to be approximately 0.1-0.2% [1][2][3]. The exact incidence of BDI following LC is not known, but is definitely higher than that following open cholecystectomy and reportedly varies between 0.4% and 0.6% [4][5][6][7][8][9][10].…”