LATE RESULTS OF PRIMARY REPAIR AND FOLLOW-UP IN 53 PATIENTS WITH INJURIES TO THE COMMON BILE-DUCT OCCURRING DURING CHOLECYSTECTOMY (DISTAL PERFORATION, TEARS, LIGATION OR SUTURE)

The late results of primary repair of accidental injuries to the commo n bile duct occurring during cholecystectomy were evaluated in 53 case s. These lesions occurred in 20 patients who had distal perforation pr oduced by the Bakes dilator, in 17 cases with accidental tearing of th e anterior or posterior wall of the common bile duct, and in 16 cases in whom the common bile duct was accidentally ligated or sutured. In c ases of perforation, choledochostomy plus suturing of the perforation had a high operative mortality and 4 out of 6 cases developed benign s tricture soon after surgery. When sphincteroplasty or choledochoduoden ostomy was added, a stricture developed in only 1 out of 7 cases. In c ases with accidental tears, suturing of the lesion plus choledochostom y produced very good late results. In patients with accidental ligatio n or suturing of the common bile duct, two different postoperative com plications were seen: seven cases had biliary fistula and all develope d benign stricture 2 years after surgery. In nine cases jaundice appea red 6 months after surgery, and a benign stricture developed in 7 of t hem. The most important ''treatment'' of these lesions is to prevent t hem from occurring during cholecystectomy by employing a meticulous su rgical technique.