Introduction: Bile duct complications after laparoscopic cholecystectomy oc
cur twice to three times more frequently than after an open procedure. Four
different types of lesions may be differentiated by the Siewert classifica
tion: postoperative bile fistulas (type I), late strictures (type II), tang
ential injuries of the bile duct (type III) and defect lesions (type IV). T
he diagnostic and therapeutic management is demonstrated in relation to our
own experience and the literature. Methods: Eleven patients (median age 43
.8 +/- 17.2) with bile duct complications after laparoscopic cholecystectom
y were operatively treated between November 1993 and December 1998, Nine pa
tients (four type-II lesions, five type-IV lesions) were referred from anot
her hospital: 2 defect lesions out of 410 laparoscopic cholecystectomies (0
.5%) were documented in our own patient group. Results: Four patients with
late strictures were operatively treated with a hepaticocholedochostomy (n
= 2) or hepaticojejunostomy (n = 2) after 14.3 +/- 8.4 months and were disc
harged from hospital after 10.6 +/- 3.8 days. In both cases with type-IV le
sion and a short defect, an end-to-end anastomosis was successful (hospital
stay 11.6 +/- 1.0 days), However, a retrocolic Roux-Y end-to-side hepatico
jejunostomy was perfomed in all cases with a larger defect (n = 5; hospital
stay 14.8 +/- 2.0 days). The two defect lesions in our own group were dete
cted by intraoperative cholangiography and immediately treated after conver
sion either with hepaticocholedochostomy or hepaticojejunostomy (hospital s
tay 11.2 +/- 0.6 days). Conclusions: The incidence of bile duct complicatio
ns after laparoscopic cholecystectomy might be kept down by anatomic prepar
ation, selective intraoperative cholangiography and early consideration of
conversion to open procedure. The clinical course after biliary tract injur
y can be positively influenced only by a standard diagnostic and operative
procedure and by an early transfer to a specialized center.