CORRECTIVE TREATMENT AND ANATOMIC CONSIDERATIONS FOR LAPAROSCOPIC CHOLECYSTECTOMY INJURIES

BACKGROUND: Complete reports of biliary and vascular injuries after la paroscopic cholecystectomy are rare. STUDY DESIGN: Fifteen patients wi th complex laparoscopic cholecystectomy injuries underwent corrective operations. The injuries consisted of 14 bile duct injuries and one la rge laceration of a cirrhotic liver. Five of the bile duct injuries we re accompanied by inadvertent occlusion of the right hepatic artery, a nd one was further complicated by portal vein occlusion. One hepatic a rtery occlusion and one portal vein occlusion were successfully recons tructed. Two patients with arterial occlusion required right hepatic l obectomy. Corrective biliary operations consisted of common hepaticoje junostomy (seven cases), right and left hepaticojejunostomies (one cas e), right anterior and left hepaticojejunostomies (two cases), right h epaticojejunostomy (one case), right posterior hepaticojejunostomy (on e case), and left hepaticojejunostomy after right lobectomy (two cases ). RESULTS: Except for a patient with a severe laceration of a cirrhot ic liver who died as a result of hepatic failure, the remaining 14 pat ients are alive and well with normal hepatic function tests at six and 37 months after corrective operations. CONCLUSIONS: A knowledge of an atomy is critical to the prevention of injuries to the hepatobiliary t ree and related structures during laparoscopic cholecystectomy.