# 2071
BILE DUCT INJURY FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY.
William C. Chapman, Allen J. Herline, Jacob P. Debelak, Scott Seidel, Kevin Revis, Kelly Wright, Wright Pinson, Vanderbilt Univ Med Ctr, Nashville, TN
Introduction and Methods: Previous reports suggest that bile duct injuries sustained at laparoscopic cholecystectomy (lap chole) are severe, related to cautery and high clip ligation. We performed a review of patients having bile duct injury from lap chole since 1990 and assessed time to injury recognition, presenting symptoms, time to referral, Bismuth type of injury, initial and subsequent repairs, rate of recurrence and length of follow up. Results: Forty-five patients (average age 49y/o, females 35/45 (78%)) were referred with a bile duct injury after lap chole. Twenty (20/45, 44%) of the patients had injury recognized at the initial procedure and 16 had immediate repair (primary repair in 8, hepaticojejunostomy in 6, and choledochoduodenostomy in 2). In the 25 patients recognized later, evidence of bile leaks-44% and jaudice-28% were the most frequent presenting signs, followed by pain-24% and cholangitis-12%. The level of injury was evenly divided between those involving the bile duct bifurcation and the common hepatic duct, Bismuth III, IV, V(21/45, 47%) vs. Bismuth I, II (24/45, 53%). Concomitant hepatic arterial injury was identified in 5 (11%) patients. Patients requiring operative intervention after referral all underwent choledocho- or hepaticojejunostomy without delay. There was no mortality in the 45 patients. Twelve of 16 (75%) patients undergoing repair at the time of lap chole required operative revision at a mean of 12 months. Following definitive treatment at our center, 7(16%) patients have required balloon dilatation or temporary stent placement at a mean follow-up of >24 months. One (2%) patient underwent biliary-enteric revision in follow-up. Conclusions:
1.) Bile duct stricture repair without delay at our center was successful without the need for further intervention in 82% of patients. Only 2% have required reoperation. 2.) Patients repaired at the time of lap chole needed further intervention in 87% of patients (75% required reoperation). 3.) The majority of patients treated with operative repair at an experienced center can expect good long-term results with infrequent need for re-intervention.
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