Abstract
Background. Laparoscopic cholecystectomy (LC) is associated with an increased incidence of bile
duct injuries when compared with the open surgical technique. Long-term results of
repaired injuries and hepatic damage associated with chronic biliary obstruction are
lacking. Methods. From Aug 1, 1991 until Dec 1, 1999, there were 27 patients referred for management
of complex biliary injuries that occurred during LC. Patients underwent percutaneous
transhepatic cholangiography and placement of transhepatic catheters with computed
tomography-guided biloma drainage when indicated. On the basis of the cholangiography
findings, patients underwent Roux-en-Y hepaticojejunostomy (HJ) and liver biopsy or were treated with nonsurgical interventions.
Results. Twenty-one of 27 patients (77.8%) underwent HJ, and 16 of these 21 patients (76.2%)
also underwent hepatic biopsy. In 1 patient, a recurrent stricture developed at 20
months after the initial repair; and, in a second patient, an episode of cholangitis
developed in the postoperative period with the transhepatic catheters in place. Five
of 16 patients (31.2%) demonstrated marked hepatic fibrosis with 4 (25%) of these
patients showing evidence of evolving cirrhosis at the time of HJ. Conclusions. In this series with 55 months of follow-up, HJ repair of LC injuries was associated
with an initial 95.2% success rate and an ultimate success rate of 100%. Despite this,
delayed referral, averaging 12 months, was associated with significant hepatic injury
in 5 of 16 (31.3%) patients who underwent biopsy. (Surgery 2000;128:668-77.)
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Article info
Footnotes
*Reprint requests: Douglas W. Hanto, MD, PhD, University of Cincinnati College of Medicine, Department of Surgery, Division of Transplantation, 231 Bethesda Ave, Cincinnati, OH 45267-0558.
**Surgery 2000;128:668-77
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
