MAJOR BILE-DUCT INJURIES DURING LAPAROSCOPIC CHOLECYSTECTOMY - FOLLOW-UP AFTER COMBINED SURGICAL AND RADIOLOGIC MANAGEMENT

Objective The authors provide the results of follow-up evaluation afte r combined surgical and radiologic management of 89 patients with majo r bile duct injuries during laparoscopic cholecystectomy. Summary Back ground Data The incidence and mechanism of injury of major bile duct i njuries during laparoscopic cholecystectomy has been clearly defined. Furthermore, a number of series have described the management of these injuries by surgical, endoscopic, and radiologic techniques with exce llent short-term results. Long-term follow-up data, however, are lacki ng in the management of these injuries. Methods Data were collected pr ospectively on 89 patients treated ata single institution with major b ile duct injuries after laparoscopic cholecystectomy managed between J uly 1, 1990, and July 1, 1996. Patients referred with injuries underwe nt early percutaneous transhepatic cholangiography and biliary drainag e. Based on the cholangiographic appearance and clinical situation, pa tients were managed by either percutaneous balloon dilatation or surgi cal reconstruction with a Roux-en-Y hepaticojejunostomy with transanas tomotic stenting. Follow-up was obtained by personal interview during October 1996. Results Two patients died without an attempt at definiti ve therapy. Both deaths were caused by sepsis and multisystem organ fa ilure present at the time of transfer to the authors' institution. The remaining 87 patients were managed initially by either balloon dilata tion (N = 28) or surgical reconstruction (N = 59). Ten patients have n ot completed treatment and still have biliary stents in place. Evaluat ion of 25 patients completing treatment after balloon dilatation (mean follow-up, 27.8 months) showed a success rate of 64%. Evaluation of 5 2 patients completing treatment after surgical reconstruction (mean fo llow-up, 33.4 months)showed a success rate of 92%. All failures were m anaged successfully by either surgical reconstruction or balloon dilat ation. Conclusions Major bile duct injuries can be managed successfull y by combined surgical and radiologic techniques. This series provides , for the first time, significant follow-up on a large number of patie nts with overall success rates of 64% after balloon dilatation and 92% after surgical reconstruction. The combination of surgery and balloon dilatation resulted in a successful outcome in 100% of patients treat ed.