Major bile duct injuries after laparoscopic cholecystectomy: A tertiary center experience |
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Authors: | Email author" target="_blank">Andrea?FrillingEmail author Jun?Li Frank?Weber Nils?Roman?Frühauf Jennifer?Engel Susanne?Beckebaum Andreas?Paul Thomas?Z?pf Massimo?Malago Christoph?Erich?Broelsch |
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Institution: | (1) Department of General Surgery and Transplantation, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany;(2) Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany |
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Abstract: | Bile duct injury is a severe and potentially life-threatening complication of laparoscopic cholecystectomy. Several series
have described a 0.5% to 1.4% incidence of bile duct injuries during laparoscopic cholecystectomy. The aim of this study was
to report on an institutional experience with the management of complex bile duct injuries and outcome after surgical repair.
Data were collected prospectively from 40 patients with bile duct injuries referred for surgical treatment to our center between
April {dy1998} and December 2003. Prior to referral, 35 patients (87.5%) underwent attempts at surgical reconstruction at
the primary hospital. In77.5%of the patients, complex typeE1or typeE2BDIwas found. Concomitant with bile duct injury, seven
patients had vascular injuries. Roux-en-Y hepaticojejunostomy was carried out in 33 patients. In two patients, Roux-en-Y hepaticojejunostomy
and vascular reconstruction were necessary. Five patients, one with primary nondiagnosed Klatskin tumor, required right hepatectomy.
Two patients, both with bile duct injuries and vascular damage, died postoperatively. Because of progressive liver insufficiency,
one of them was listed for high-urgency liver transplantation but died prior to intervention. At the median follow-up of 589
days, 82.5% of the patients are in excellent general condition. Seven patients have signs of chronic cholangitis. Major bile
duct injuries remain a significant cause of morbidity and even death after laparoscopic cholecystectomy. Because they present
a considerable surgical challenge, early referral to an experienced hepatobiliary center is recommended. |
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Keywords: | Laparoscopic cholecystectomy major bile duct injuries |
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