Bile duct injury during laparoscopic cholecystectomie

Vladimir Zivanovic, MD, MSc, Scepanovic Radisav, MD, Prof, PhD, Perunovic Radoslav, MD, PhD, Goran Vasic, MD

KBC Dr D.Misovic University hospital

Bile duct injury is night mare to every surgeon as a worst complication excluding uncontrolled bleeding during operation. With advances in diagnostic technologies we still do not have good visualization of biliary tree especially in cases with acutised chronic inflammatory process where we have mixed of chronic fibrosis of adjacent tissue and edematous fresh inflammation of important structures. All preoperative diagnostic and advanced visualization with proper resolution of operative picture did not guarantee 100% free of bile duct injuries.

In our institution we perform from 2010 till September 2012, 2.680 laparoscopic cholecystectomies as elective 24h surgical procedures. Those procedures perform 6 experienced surgeons and 4 young colleges. Operative finding was 78% chronic inflammation and 22% with some degree of acutization even Dou preoperative diagnostic suggest less than 7% of acute process.

We have 7 patients with bile ducts injury. 2 of them with mayor which need operative reconstruction –Roux Y by pass, one lateral injury of CBD reoperated and with T tube satisfactorily finished. Four cases with minor bile leak of which one with intraoperative use of sub hepatic drainage tube, spontaneously stopped leakage after 7 days. Second one with endoscopic nasobiliary drainage. Third one with relaparoscopy and endoscopic stent procedure and fourth one with relaparoscopy 32nd postoperative day and endoscopic sfinkterectomy with satisfactory result.

In conclusion we can say that even with advances in surgical technologies and diagnostic we still do bile duct injuries. In our series it is 2.6 per 1.000 patients of which two (0.7 per 1.000) were mayor injury’s with excision of part of CBD and need for reconstructive surgery. We hope that the future is lying in new diagnostic and biliary tree mapping technologies which will reduce number of injuries.

Session: Poster Presentation

Program Number: P622