Surgical treatment of latrogenic lesions of the proximal common bile duct

Between January 1979 and September 1999 a series of 96 patients were operat ed on at our institution for iatrogenic biliary injuries, and among them 62 involved the proximal biliary tract. Injuries, according to the Strasberg classification, were type E2 in 18 patients, type E3 in 29 patients, and ty pe E4 in 15 patients. The most frequent primary surgical procedures were la paroscopic cholecystectomy in 27 of the 62 patients (43.6%) and open cholec ystectomy in 30 patients (48.3%). Previous repair had been attempted in 25 patients (40.3%). A total of 58 cholangiojejunostomies were performed. Repa ir had been performed directly, and a T-tube had been left in the main bile duct in four patients with E2 Strasberg lesions. Postoperative death occur red in four patients (6.4%). Outcome was graded as excellent, good, or poor depending on clinical symptoms, liver function tests, and the need for rei ntervention due to anastomotic stricture. The final outcome was evaluated i n 54 patients. The mean follow-up was 5.9 +/- 0.3 years, with the longest f ollow-up 10.2 years. Following our first repair 49 of the 54 patients (90.7 %) had excellent results, 1 (1.9%) had good results, and 4 (7.4%) had poor results. None of the patients who underwent immediate or early repair had c omplications. Diagnostic and therapeutic courses are given on the basis of the type of lesion and the timing of repair. We emphasize the importance of timing (i.e., carrying out surgical repair as soon as possible) and of cho langiojejunostomy reconstruction in respect to defined technical principles . Moreover, we believe that repair treatment at a hepatobiliary center with multidisciplinary competence greatly influences the final long-term outcom e.