During the last decade laparoscopic cholecystectomy has become established as the gold standard.
The drawbacks in the form of bile duct injuries have also come into focus.
Dr Claes Söderlund and colleagues from Sweden prospectively assessed the results of 1568 patients.
The research team evaluated the risks, management, and preventive measures of bile duct injuries.
The significant complications of all patients operated upon with laparoscopic cholecystectomy between 1999 and 2003 were recorded.
The team classified bile duct injuries according to Strasberg into types A to E.
|A type C injury was due to a small-caliber suture|
|World Journal of Surgery|
Transected major bile ducts, injuries of type E, were regarded as “major” injuries.
Types A, B, C, and D were considered “minor” injuries.
The researchers transected major bile ducts in 5 patients, 3 of whom had acute cholecystitis.
In the 2 patients operated on electively, the bile duct injuries were detected postoperatively.
However, the team detected the bile ducts intraoperatively when the operation was performed of necessity.
The bile ducts were all reconstructed with a Roux-en-Y hepaticojejunostomy.
The researchers noted that 2 patients had anastomotic strictures.
Minor bile duct injuries were encountered in 19 patients.
The researchers treated the 13 patients with leakage from the cystic duct or gallbladder bed, injury type A, with endoscopic stenting without sequelae.
The 5 patients that sustained a lateral bile duct injury, type D, were treated with a simple suture over a T-tube or endoscopically without further problems.
The researchers observed that a transected aberrant right hepatic bile duct, type C injury, was due to its small-caliber sutured.
Dr Söderlund commented, “Minor bile duct injuries could be managed at the primary hospital if the endoscopic expertise were at hand.”
“Acute cholecystitis seems to be a risk factor for bile ducts injuries.”