Profile of bile duct injuries following laparoscopic cholecystectomy

Laparoscopic cholecystectomy procedure was the gold standard for symptomatic cholelithiasis and cholecystitis, but it was associated with a higher incidence of bile duct injury than an open approach.

Retrospective study of bile duct injuries cases at Wahidin Sudirohusodo Hospital Makassar in 2017.

A total of 111 laparoscopic cholecystectomy patients, 71 women and 40 men, median age of 46 years. 13 patients conversion an opened cholecystectomy resulted in severe adhesion 76.9% (10 patients), bleeding 7.6% (1 patients) and bile duct injury 15.4% (2 patients). Of four patients, 3.6% had bile duct injuries which discovered during operation 2 patients (50%) had significant leak bile symptoms and discovered postoperative other two patients (50%) had biloma as the major symptom. Two patients had right hepatic duct injuries (Strasberg type C), then treated with biliary drainage; one patient had a lateral wall injury to the common hepatic duct (Strasberg type D, then treated with T-tube drainage; and 1 patient had transected to the common hepatic duct (Strasberg type E2), then reconstructed with Roux en Y hepaticojejunostomy. Regarding the Clavien-Dindo classification, of 4 bile duct injuries patients, 75% (3 patients) were classified as grade III b, respectively, 25% (1 patient) as grade III a.

Laparoscopic cholecystectomy had become the treatment of choice for symptomatic cholelithiasis, and it was associated with an increase bile duct injury incidence. Despite increasing awareness of this problem, yet more attention should be concerned both related to preventive care and early recognition of such injury care.