LAPAROSCOPIC CHOLECYSTECTOMY BILE-DUCT INJURIES - MORE THAN MEETS THEEYE

Laparoscopic cholecystectomy (LC) has rapidly become standard treatmen t of symptomatic cholelithiasis. Its advantages are well known, while its risks have not been well defined. The most common major complicati on of LC is bile duct injury. Over the past year, we have treated six patients for this problem. Injuries included: one partial laceration o f the common bile duct; one partial laceration of the common hepatic d uct; three complete common hepatic duct transections at the bifurcatio n, and one clip obstruction of the right hepatic duct. Intraoperative cholangiography was performed in two of six patients. Injury was recog nized in these two cases, which were converted to celiotomy for immedi ate repair. One was repaired primarily; the other required a hepaticoj ejunostomy. Injuries were not identified at LC in four. Three of the f our patients required biliary-enteric reconstruction procedures. With a mean follow-up period of 13 months, four of six patients remain symp tomatic. LC does carry a real risk of bile duct injury. Routine intrao perative cholangiography may decrease this risk or at least allow earl y recognition and repair when it has occurred. Conversion to an open p rocedure is not a complication of LC but rather a sign of good surgica l judgement. Patients not following the routine postoperative course m ust be evaluated for a possible bile duct injury to prevent the morbid ity of delayed diagnosis.