DIAGNOSIS AND MANAGEMENT OF BILIARY COMPLICATIONS OF LAPAROSCOPIC CHOLECYSTECTOMY

Laparoscopic cholecystectomy has become the operation of choice for sy mptomatic cholelithiasis. However, this operation may result in seriou s biliary complications. Our aims were to review our experience with b iliary complications of laparoscopic cholecystectomy and to document t he mechanisms of the injuries and the techniques of managing these com plications. We treated 20 patients with biliary complications of lapar oscopic cholecystectomy. Symptomatic collections of bile (bilomas) wer e present in five patients. One of there patients underwent operative ligation of an accessory bile duct in the gallbladder bed, whereas the others had percutaneous or endoscopic therapy. In the remaining 15 pa tients (of whom 13 were referred from other hospitals), injuries to th e major bile ducts were managed by combined radiologic, endoscopic, an d operative therapies. In 10 of these patients (67%), the mechanism of injury was the misidentification of the common bile duct as the cysti c duct. In 3 of 15 patients, a noncircumferential injury to the latera l aspect of the common bile duct occurred. The Bismuth levels of the r emaining bile duct injuries were type I in 3, type II in 4, type III i n 3, and type IV in 2. Early outcome of therapy for these bile duct in juries has been favorable. One patient was lost to follow-up, and 2 di ed of nonbiliary causes, whereas 12 patients are alive and well with n ormal serum liver enzyme levels at 4 to 19 months postoperatively (mea n: 14 months). The most common cause of major bile duct injury during laparoscopic cholecystectomy is mistaking the common bile duct for the cystic duct. Most bilomas can be managed successfully with noninvasiv e methods. Coordinated efforts by radiologists, endoscopists, and surg eons are necessary to optimize the management of patients with major b ile duct injury, suggesting that patients with biliary complications o f laparoscopic cholecystectomy should be referred to specialty centers for optimal care.