IATROGENIC BILE-DUCT INJURY AT CHOLECYSTECTOMY

Injury to the biliary tree at cholecystectomy is an uncommon, but seri ous complication of this procedure. Our experience in the management o f five patients with such injuries is reported. The injury presented a s jaundice in two patients, and as jaundice with cholangitis, intraope rative bile leak and ascites with peritonitis in each of the remaining three patients. The most useful diagnostic tools were percutaneous tr anshepatic cholangiography and endoscopic retrograde cholangio-pancrea tography. Repair of the injury was performed by a primary end-to-end a nastomosis of the common bile duct in one patient and by a Roux-en-Y c holedocho- or hepaticojejunostomy in four. The best results were achie ved when the patient was referred early following the initial operatio n or prior to the development of liver damage and irreversible cholest asis. The literature on the subject is reviewed.