Surgery, Gastroenterology and Oncology

Background: The iatrogenic injury of the bile ducts is a serious accident of laparoscopic cholecystectomy. Its management is multidisciplinary. The aim of our work was to elucidate the factors influencing the long-term results after biliary repair.

Methods: A retrospective, analytical and descriptive study was carried out on a series of 44 cases of biliary injuries repaired over a period of 14 years.

Results: The injury was discovered intraoperatively in 18 cases, in early postoperative period in 20 cases and in late postoperative period in 6 cases. In total, there were 24 lesions classified D, five lesions (E1), five lesions (E2), five lesions (E3), four lesions (E4) and a lesion (E5). Immediate repair was performed on 16 patients: 9 repairs over T-tube, 5 hepatico-jejunal anastomosis, 1 end-to-end biliary anastomosis and one patient had bilioduodenal anastomosis. Early repair was performed on 8 patients: 7 patients had a repair of the common bile duct over T-tube and only 1 patient had an hepatico-jejunal anastomosis.20 patients were repaired late by hepatico-jejunal anastomosis. Hepatic resection has been reported in 4 of our patients. The overall mortality of biliary repairs was 9% and the overall morbidity was 18%. 13 patients presented biliary stricture. The factors influencing long-term outcomes were: Age (p = 0.023), absence of cholangiogram at repair (p = 0.04) and immediate repairs (p = 0.048). Late repair was associated with good long-term results.

Conclusion: The iatrogenic wound of the bile ducts is a frightening accident of laparoscopic cholecystectomy. Its care is multidisciplinary but not yet consensual.

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