Acta clinica Croatica, Vol. 42 No. 3, 2003.
Professional paper
Bile Duct Injuries during Open and Laparoscopic Cholecystectomy at Sestre Milosrdnice University Hospital from 1995 till 2001
Zvonimir Puljiz
Tomislav Kuna
Bjorn Dario Franjić
Hrvoje Hochstädter
Aljoša Matejčić
Miroslav Bekavac Bešlin
Abstract
Bile duct injury is one of the most severe complications of cholecystectomy. Several multi-center studies have demonstrated these injuries to be more commonly associated with laparoscopic cholecystectomy than with open cholecystectomy. During a 7-year period, from January 1995 till December 2001, 4528 patients underwent cholecystectomy at the University Department of Surgery, Sestre milosrdnice University Hospital in Zagreb, Croatia. Laparoscopic cholecystectomy was performed in 2657 (58%) of these patients. Bile duct injury was recorded in 15 (0.33%) patients, three (0.16%) of them submitted to open cholecystectomy. Of the latter, partial transsection of the common bile duct occurred in two patients and complete transsection in one patient. In the series of patients with laparoscopic cholecystectomy, bile duct injury occurred in 12 (0.45%) patients, with complete transsection of the common bile duct observed in five, partial transsection in three, and bile duct injury with a metal clip in three patients. Common bile duct stricture without apparent intraoperative injury developed in one patient during the late postoperative period. All these 15 patients with iatrogenic bile duct injury that occurred during either open or laparoscopic cholecystectomy were surgically managed. Roux-en-Y choledochojejunostomy was performed in nine patients, whereas the remaining six patients underwent common bile duct reconstruction by creating a terminoterminal anastomosis and T-tube insertion. Stricture of the anastomosis in the late postoperative period developed in five of these patients, who underwent secondary reconstruction of biliary continuity by Roux-en-Y choledochojejunostomy.
Keywords
Common bile duct injuries, etiology; Common bile duct, surgery; Cholecystectomy laparoscopic, methods; Intraoperative complications, surgery
Hrčak ID:
14661
URI
Publication date:
1.9.2003.
Visits: 2.608 *