Repair 0ptions Following Iatrogenic Bile Duct Injuries
Journal of Surgery
Volume 3, Issue 5, October 2015, Pages: 50-55
Received: Oct. 1, 2015; Accepted: Oct. 13, 2015; Published: Oct. 24, 2015
Views 4203      Downloads 92
Mohamed Salah Eldin Abdelhamid, Surgery Department, Bani-Suef Faculty of Medicine, Bani-Suef University, Bani-Suef, Egypt
Ahmed Mohamed Sadat, Surgery Department, Kasr Elaini Faculty of Medicine, Cairo University, Cairo, Egypt
Ayman Hamdi Abouleid, Surgery Department, October 6th Faculty of Medicine, October 6th University, Giza, Egypt
Amr Mohamed Aly Mohamed, Surgery Department, Bani-Suef Faculty of Medicine, Bani-Suef University, Bani-Suef, Egypt
Mahmoud Ahmed Negida, Surgery Department, Kasr Elaini Faculty of Medicine, Cairo University, Cairo, Egypt
Ahmed Zaki Gharib, Surgery Department, October 6th Faculty of Medicine, October 6th University, Giza, Egypt
Adel Morad Abdullah, Surgery Department, October 6th Faculty of Medicine, October 6th University, Giza, Egypt
Article Tools
Follow on us
In the era of laparoscopic cholecystectomy there was a dramatic increase in the incidence of the bile duct injuries. It was estimated that major bile duct injury occurred in approximately 0.2% to 0.4% during open cholecystectomy opposed to 0.6% to 0.8% of patients undergoing laparoscopic cholecystectomy. The aim was to highlight the repair options for the happened injury. Included in the study were 22 patients, 19 sustained injury at our hospital and 3 referral cases between Feb. 1999 to Nov2014. The treatment options were end to end anastomosis over T-tube or straight stent and Roux-en Y hepaticojejunostomy with or without stenting the anastomosis. Regarding the injuries, according to Strasberg there were 2 A, 4 D, 8 E1, and 5 E2. The three referral cases were choledochodoudonostomy. They were treated through simple ligation of cystic duct in two cases, end to end anastomosis in seven cases (three of them over T-tube and four over straight stent). The remaining fifteen cases were treated with Roux-en Y hepaticojejunostomy with or without stenting the anastomosis (22 patients with 24 interventions due to 2 redo). We concluded that proximal bile ducts are at greater risk with laparoscopic cholecystectomy even with expert surgeon. Satisfactory results were obtained with end to end anastomosis over either T-tube or straight stent, however these two options cannot be applied to all cases as it is difficult to be done with non dilated ducts, so Roux-en-Y hepaticojejunostomy is the most feasible among all types of repairs as it can be applied to most cases even those with non dilated common bile duct.
Cholecystectomy, Laparoscopic, Bile Duct, Injuries
To cite this article
Mohamed Salah Eldin Abdelhamid, Ahmed Mohamed Sadat, Ayman Hamdi Abouleid, Amr Mohamed Aly Mohamed, Mahmoud Ahmed Negida, Ahmed Zaki Gharib, Adel Morad Abdullah, Repair 0ptions Following Iatrogenic Bile Duct Injuries, Journal of Surgery. Vol. 3, No. 5, 2015, pp. 50-55. doi: 10.11648/j.js.20150305.12
Copyright © 2015 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License ( which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Głuszek S, Kot M, Bałchanowski N, et al. Iatrogenic bile duct injuries--clinical problems Pol Przegl Chir. 2014 Jan; 86(1): 17-25.
Walsh RM, Henderson JM, Vogt DF, et al. Trends in bile duct injuries from laparoscopic cholecys tectomy. J Gastrointest Surg. 1998: 2: 458-462.
Stewart L, Way LW. Bile duct injuries during laparoscopic cholecystectomy; Factors that influence the results of treatment. Arch Surg. 1995; 130: 1123-1130.
Branum G, Schmit C, Baillie J, et al.: management of major biliary complications after laparoscopic cholecystectomy. Ann surg. 1993; 217: 532-41.
West Cott CJ, Pappas TN. Benign biliary strictures. In Cameron JL (ed). Current surgical therapy.: st. Louis, Missouri, Mosby. 1998; pp 425-434, 6th ed.
Strasberg SM, Herti M, Soper Nj.: Analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll surg. 1995; 180: 101-125.
Solheim K, Buanes T.: Bile duct injury. Int Surg. 1995; 80 (4): 361-4.
Gouma DJ, Obertop H.: Operative bile duct injury. In Taylor I and Johnson CD (eds). Recent advances in surgery.: London, har court Publishers Limited. 2001; pp 139-150.
Mercado MA, Orozco H, Martinez LM, et al. Survival and quality of life after bile duct reconstruction. HPB surg. 2000; 2: 321-324.
Jarnagin WR, Blumgart LH. Operative repair of bile duct injuries involving the hepatic duct confluence. Arch surg. 1999; 134: 769-775.
Choi YS, Han YS, Lee TG, et al.: Laparoscopic end to end choledochocholedochostomy. Lap endo Surg. 2006; 16 (3): 264-6.
Ludwig K, Bernhardt J, steffen H et al. Contribution of I.O.C. to the incidence and outcome of common bile duct injury during LC. Surg Endosc, 2002; 16 (7): 1098-104.
Lillemoe KD, Melton GB, Cameron JL, et al. Postoperative bile duct strictures: management and outcome in the 1990. Annsurg. 2000; 232: 430-441.
De Ledinghen V, Person B, Legoux JL, et al. Prevention of biliary stent occlusion by ursodeoxycholic acid plus norfloxacin: a multicenter randomized trial. Dig dis sci. 2000; 45: 145-150.
Woods MS, Traverso WL, Kozarek RA, et al.: Characteristics of biliary tract complications during laparoscopic cholecystectomy. Am J Surg. 1994; 167: 27-34.
Flum DR, Koepsell T, Heagerty P, et al. Common bile duct injury during laparoscopic cholecystectomy and the use of intraoperative cholangiography. Arch surg. 2001; 136 (11): 1287-92.
Murr MM, Gigot JF, Nagorney DM et al. Long term results of biliary duct injuries. Arch Surg. 1999; 134 (6): 604-610.
Mercado MA, Chan C, Orozco H, et al. To stent or not to stent bilioenteric anastomosis after iatrogenic injury. Arch Surg. 2002; 137 (1): 60-63.
Fingerhut A, Dziri C, Garden OJ, et al. ATOM, the all-inclusive, nominal EAES classification of bile duct injuries during cholecystectomy Surg Endosc. 2013 Dec; 27 (12): 4608-19.
Prasad A, De S, Mishra P, Tiwari A. Robotic assisted Roux-en- Y hepaticojejunostomy in a post-cholecystectomy type E2 bile duct injury. World J Gastroenterol. 2015 Feb 14; 21(6): 1703-6.
Barbier L, Souche R, Slim K et al. Long-term consequences of bile duct injury after cholecystectomy. J Visc Surg. 2014 Sep; 151(4): 269-79.
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
Tel: (001)347-983-5186