Treatments of Proximal Bile Duct Necrosis and Stricture from Iatrogenic Bile Duct Injury of Laparoscopic Cholecystectomy

Lee, Hyo Jun; Hwang, Shin; Lee, Sung Gyu; Song, Gi Won; Lee, Young Joo; Kim, Ki Hun

Abstract

PURPOSE
Most bile duct injuries can be recognized intraoperatively, or within a few days after a laparoscopic cholecystectomy, with a favorable prognosis following proper management. However, a significant delay in the diagnosis, improper management, or other risk factors can lead to serious intractable biliary complications. Herein, the clinical courses of these serious biliary complications were analyzed to find their optimal treatment methods. METHODS: Between 1998 an 2003, 9 cases of serious biliary complications were encountered following a laparoscopic cholecystectomy. Patients detected early and with uneventful biliary reconstruction were excluded. Their mid- and long-term clinical courses were retrospectively analyzed. RESULTS: Their treatment methods undertaken to them were divided as follows: Primary hepaticojejunostiomy (HJ) to the necrotic proximal bile duct (n=3) : delayed stricture occurred in 1 patient among them; HJ to the delayed-onset proximal bile duct stricture (n=2) : There was no recurrence; Right lobectomy and HJ to the proximal bile duct stricture after right portal vein embolization (n=3) : There was no recurrence; And, induction of parenchymal atrophy applied to the isolated right posterior duct injury through portal vein embolization and sequential bile duct occlusion (n=1). CONCLUSION: Necrosis and stricture of the injured proximal bile duct should be managed by a case-by-case basis because every patient revealed different clinical features. Long- term surveillance over 5 years is recommended to detect late- onset biliary stricture.