BILIARY COMPLICATIONS OF LAPAROSCOPIC CHOLECYSTECTOMY

Laparoscopic cholecystectomy has rapidly become the preferred treatmen t for symptomatic gallstones. Although this procedure has certain adva ntages over open cholecystectomy, concern has been expressed regarding the potential for bile duct injuries. In an effort to understand the scope of this problem, a retrospective review was performed of all pat ients referred to UCLA after having sustained biliary injuries during laparoscopic cholecystectomy. Over a 14-month period, 10 patients were referred to UCLA with 12 major bile duct injuries. One patient had a false positive cholangiogram leading to an unnecessary biliary-enteric bypass and subsequent dehiscence, resulting in a biliary fistula. Six patients were referred on an acute basis, whereas four patients under went attempted biliary reconstruction at outside facilities and were u ltimately referred with either a biliary stricture or a fistula. Revie w of cholangiograms suggested that bile duct anomalies were present in five patients. There did not appear to be a relationship between the use of either electrocautery or laser and bile duct injuries. To date eight patients have been successfully managed via Roux-en-Y hepaticoje junostomies, with a mortality rate of 0%. Although the exact frequency cannot be ascertained from the current study, our data demonstrate th at major biliary complications do occur during laparoscopic cholecyste ctomy. Most of these injuries, however, can be safely and successfully treated with surgical biliary reconstruction. Early diagnosis and tre atment with liberal use of intraoperative cholangiography and a low th reshold for conversion to open laparotomy appears to be associated wit h a more favorable outcome.