Background: Bile duct injury (BDI) persists as the utmost problem of laparoscopic cholecystectomy (LC). LC is the standard of care for symptomatic cholelithiasis, but it is associated with a higher incidence of BDI than the open approach.
Objective: To know the risks, incidence, types, and causes of BDIs, their timing and clinical presentation, the various imaging modalities, and management by various methods.
Materials and Methods: The article summarizes the profile, nature, treatment, and prognosis of 200 patients of LC with BDIs seen in General Surgery and Gastrosurgical Department of Civil Hospital at Ahmedabad, Gujarat, India, from year 2006 to 2009.
Result: The conversion of LC to open surgery was done in 14 cases of difficult LC of 200 (7%) cases to avoid BDI. Of 14 cases of BDIs, six detected during surgery required laparotomy. Common bile duct transaction occurred in four (28.57%) cases. The most common symptom was right upper abdominal pain. Imaging modalities to diagnosis, detect level and follow up of cases of BDI and Bile leak (BL) were USG, CT scan, ERCP, MRCP, T-tube cholangiogram. Almost half the number of the patients was treated conservatively. No mortality was observed.
Conclusion: BDI remains the most serious complication of LC and causes significant morbidity and financial loss to the patient. Early recognition and adequate multidisciplinary approach are the cornerstones for the optimal final outcome.
Key words: Bile duct injury, bile duct leak, laparoscopic cholecystectomy, T-tube cholangiogram
|
