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BMMR. 2006; 9(3): 94-98

Biliary duct injuries in laparoscopic cholecystectomy: long term results of a single unit

Kurt Y, Demirbas S, Akin ML, Uluutku AH, Celenk T.

Biliary duct injuries remain one of the
most devastating and challenging complications in
laparoscopic cholecystectomy today. The aim of this
study is to report on the results of laparoscopic
cholecystectomies for the evaluation of biliary duct
injuries in a single unit and review the strategies to
prevent them. A retrospective analysis was conducted
on laparoscopic cholecystectomies performed
between 1993 and 2004. The data was collated from
medical records of the patients. Biliary tract injuries
were classified according to the Strasberg classification.
A total of 918 laparoscopic cholecystectomies
were performed for symptomatic cholelithiasis in
our unit between 1993 and 2004. There were 664
women (72%) and 254 men (28%), and mean age
was 55.2 years (16-88 years). Five percent of the
cases were acute cholecystitis. There were five
(0.54%) major (three Strasberg E1, two Strasberg E2)
and seven (0.76%) minor (five Strasberg A, two
unidentified) biliary duct injuries. Five patients with
major injuries were treated by Roux-en-Y biliaryenteric
bypass. Total transection of the common bile
duct was recognized during the operation in two
patients (40%) but injuries in three patients were
recognized postoperatively. Of the seven minor injuries,
five were from the cystic duct stump and from
the liver bed (Strasberg A) two were unidentified,
managed conservatively. Of the five patients treated,
four were managed successfully by endoscopic retrograde
cholangiography with sphincterotomy and
percutaneous biliary drainage procedure, and one
underwent laparatomy. Biliary duct injuries are still
a highly encountered clinical problem during laparoscopic
cholecystectomy. Minor injuries could be
managed successfully by conservative methods. In
the management of the major injuries, early recognition
and Roux-en-Y biliary-enteric repair are the
most important factors for success.

Key words: laparoscopic cholecystectomy, biliary duct injury, complications.

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American Journal of Physiology, Biochemistry and Pharmacology


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