Bile Duct Injury during Laparoscopic Cholecystectomy

Shim, Gyu Beom; Choi, In Seok; Ko, Dea Gyeung; Choi, Won Joon; Yoon, Dea Sung

Abstract

PURPOSE: Laparoscopic cholecystectomy (LC) has become the standard procedure for gallbladder disease. LC is associated with bile duct injury, which can cause serious complications. We evaluate the treatment, results and the relation with cholangiopancreatography for bile duct injury during LC.
METHODS
860 cases of LC were performed from April 2000 to August 2005. Among them, 7 cases of bile duct injury were reviewed for the diagnosis, management and operation findings.
RESULTS
According to the Strasberg classification, there were 5 cases of type E, 1 case of type C and 1 case of type D. All of them were identified at operation and they were immediately managed. Among the type E cases, the type E1 was managed by CBD end-to-end anastomosis with internal drainage, type the E2 and type E3 were managed by Roux-en-Y hepaticojejunostomy, the type C were managed by primary repair with T-tube drainage and the type D were managed by primary repair. Although all of cases were visible at the cystic duct on preoperative cholangiopancreatography, we could not identify the type E on the operation findings.
CONCLUSION
In this study, although the cystic duct was identified on cholangiopancreatography preoperatively, the possibility of bile duct injury increases if there was severe inflammation and adhesion. For the management of bile duct injury, we recommend CBD end-to-end anastomosis for type E1, Roux-en-Y hepaticojejunostomy for type E2 and E3, and primary repair and/or drainage for type C and D.