Laparoscopic management of bile duct and bowel injury during laparoscopic cholecystectomy

Abstract

Accidental injuries to the bile duct and bowel are significant risks of laparoscopic surgery and sometimes require conversion to open surgery. Although some of the injuries related to laparoscopic cholecystectomy can be managed by endoscopic techniques, laparoscopic surgery is not yet sufficiently perfected. We investigated the efficacy of laparoscopic management combined with endoscopic tube or stent insertion in cases of bile duct and bowel injuries during laparoscopic cholecystectomy. Laparoscopic cholecystectomy was attempted on 1,190 consecutive patients between April 1992 and June 1999. The first 70 patients underwent only preoperative intravenous infusion cholangiography (IVC), and the remaining 1,120 patients were subjected to both preoperative IVC and intraoperative cholangiography. We experienced 16 cases of bile duct injury (1.4%). Five patients with circumferential injuries of the bile duct were converted to open surgery for biliary reconstruction. The other 11 patients with partial laceration injuries of the bile duct and biliary leakage from the cystic duct underwent a laparoscopic simple closure technique. In 10 of these patients, an endoscopic tube or stent was inserted on the day after surgery to facilitate biliary decompression and drainage. Bowel injuries occurred in seven patients (0.6%). Three intestinal injuries were due to careless technique, and two duodenal injuries and two intestinal injuries were related to dense adhesions. All of these injuries were successfully repaired using laparoscopic techniques, autosuturing devices, or extracorporeal suturing via the umbilical incision. No postoperative complications were identified. We concluded that the biliary injury site could be closed with a laparoscopic technique so long as the biliary injury was not circumferential. Bowel injuries also could be repaired laparoscopically.

Laparoscopic Cholecystectomy Requires Conversion in Few Patients Only: A Prospective Study of 370 Patients

“…The reported incidence of bile duct injuries in LC range from 0.59% to 2.9%. [20][21][22][23] In our study, there was only one (0.27%) case of bile duct injury which was detected intraoperatively and was repaired over t-tube after conversion. Such low incidence of this injury in our study is probably due to our selection of cases, experience and technique of LC.…”

Laparoscopic Cholecystectomy Results In Patients With Different Age Groups

“…The technique should help avoid CBDI due to identify aberrant bile duct and anatomic variation. However some studies don't support routine intraoperative cholangiography that increase operative time and cost and not decreases CBDI [25,30,31]. As a conclusion it's thought that biliary anomalies are more common in young patients.…”

Effectiveness of Laparoscopic Surgery for Gallstones and Common Bile Duct Lithiasis: a Systematic Overview

“…Low quality: it very likely that future studies change our confidence in the estimate of effect, therefore our confidence is low. Table. 2001; Elder, 1996;Finan, 2006;Zacks, 2002;Collet, 1997;Ibrahim, 2006;Weber, 2003;Feldman, 1994;Perez Lara, 2006;Sungler, 2000;Daradkeh, 1999;Ji, 2005;Fernandes, 2000;Palanivelu, 2006;da Silveira, 2006;Gurusamy, 2006;Chandler, 2000;Kiviluoto, 1998;Glavic, 2001;Eldar, 1998;Lujan, 1995;Tan, 2006;Perez-Morales, 2005;Bagia, 2001;Schafer, 2003;Kwon, 2001;Woods, 1996).…”

“…These lesions required a median of 9 days' hospital stay, and morbidity and mortality rates of 42.9% and 1.7% respectively were reported (Sicklick, 2005). One small case series that assessed laparoscopic repair of minor lesions reported that most of these only involved simple sutures associated with the endoscopic drainage (Kwon, 2001), (Treatment studies 4). One retrospective case series applied a quality-of-life questionnaire in 59 patients who had undergone surgical reconstruction after a bile duct lesion during LC and no differences between the patient and control groups were observed in any of the assessed domains (Sarmiento, 2004).…”

“…Cystic and hepatic duct lesions are among the most frequent complications of laparoscopic cholecystectomy (LC) (Kwon, 2001;Regoly-Merei, 1998;Targarona, 1998;Nuzzo, 2005), with values varying from 11.9% to 43% for morbidity and 1.7% to 12% for mortality (Regoly-Merei, 1998;Targarona, 1998;Sarmiento, 2004;Sicklick, 2005). Their incidence is approximately 0.31 to 1.34 per 1,000 cases.…”