Bile duct injury following laparoscopic cholecystectomy: A cause for continued concern

Previous reports suggest that bile duct injuries sustained during laparosco pic cholecystectomy (lap chole) are frequently severe and related to cauter y and high clip ligation. We performed a review of patients who sustained b ile duct injury from lap chole since 1990 and assessed time to injury recog nition, time to referral, Bismuth classification, initial and subsequent re pairs, rate of recurrence, and length of follow-up. Seventy-four patients [ median age 44 years, 58 of 74 female (7856)] were referred with a bile duct injury after lap chole. The level of injury was evenly divided between the bile duct bifurcation and the common hepatic duct: Bismuth III, IV, and V (40 of 74, 54%) versus Bismuth I and II (34 of 74, 46%). Concomitant hepati c arterial injury was identified in nine (12%) patients. Patients referred early after bile duct injury and requiring operative intervention underwent hepaticojejunostomy at a median of 2 days after referral. After surgical r econstruction at our center there has been an overall success rate of 89 pe r cent with no need for reintervention. Six (10%) of these patients have re quired one additional balloon dilatation at a mean follow-up of > 24 months . One (2%) patient underwent biliary-enteric revision in follow-up. In pati ents with bile duct injury, stricture repair without delay was successful i n the majority of patients treated in this series. Only one of 64 patients reconstructed at our center has required reoperation; six others have requi red a single balloon dilatation with subsequent good or excellent results. The majority of patients treated with operative repair at an experienced ce nter can expect good long-term results with rare need for reintervention.