Bile duct injuries following laparoscopic cholecystectomy

Introduction: Bile duct injuries occur rarely but are among the most dreadful complications following cholecystectomies. Methods: prospective registration of bile duct injuries occurring in the period 1992–2013 at a tertiary referral hospital. Results: in total, 67 patients (47 women and 20 men) with a median age of 55 (range 14– 86) years had a leak or a lesion of the bile ducts during the study period. total incidence of postoperative bile leaks or bile duct injuries was 0.9% and for bile duct injuries separately, 0.4%. median delay from injury to repair was 5 days (range 0–68 days). in 12 patients (18%), the injury was discovered intraoperatively. Bile leak was the major symptom in 59%, and 52% had a leak from the cystic duct or from assumed aberrant ducts in the liver bed of the gall bladder. following the clavien–dindo classification, 39% and 45% were classified as iiia and iiib, respectively, 10% as iV, and 6% as V. in all, 31 patients had injuries to the common bile duct or hepatic ducts, and in these patients, 71% were treated with a hepaticojejunostomy. of patients treated with a hepaticojejunostomy, 56% had an uncomplicated event, whereas 14% later on developed a stricture. out of 36 patients with injuries to the cystic duct/aberrant ducts, 30 could be treated with stents or sphincterotomies and percutaneous drainage. Conclusion: half of injuries following cholecystectomies are related to the cystic duct, and most of these can be treated with endoscopic or percutaneous procedures. a considerable number of patients following hepaticojejunostomy will later on develop a stricture.