Repair of common bile duct injuries
- Keith D Lillemoe, MD, FACS
Keith D Lillemoe, MD, FACS
- W Gerald Austen Professor of Surgery
- Harvard Medical School
Common bile duct injuries represent a serious and challenging surgical complication. These complex injuries are most often a consequence of laparoscopic cholecystectomy (LC) . Proper management requires a skilled and experienced hepatobiliary surgical team.
This topic will focus on the surgical repair of common bile duct injuries. Details of LC techniques and endoscopic management of complications from LC are discussed elsewhere.
●(See "Laparoscopic cholecystectomy".)
- McPartland KJ, Pomposelli JJ. Iatrogenic biliary injuries: classification, identification, and management. Surg Clin North Am 2008; 88:1329.
- Dolan JP, Diggs BS, Sheppard BC, Hunter JG. Ten-year trend in the national volume of bile duct injuries requiring operative repair. Surg Endosc 2005; 19:967.
- Hall JG, Pappas TN. Current management of biliary strictures. J Gastrointest Surg 2004; 8:1098.
- Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995; 180:101.
- Pekolj J, Alvarez FA, Palavecino M, et al. Intraoperative management and repair of bile duct injuries sustained during 10,123 laparoscopic cholecystectomies in a high-volume referral center. J Am Coll Surg 2013; 216:894.
- Branum G, Schmitt C, Baillie J, et al. Management of major biliary complications after laparoscopic cholecystectomy. Ann Surg 1993; 217:532.
- Massarweh NN, Flum DR. Role of intraoperative cholangiography in avoiding bile duct injury. J Am Coll Surg 2007; 204:656.
- Ladocsi LT, Benitez LD, Filippone DR, Nance FC. Intraoperative cholangiography in laparoscopic cholecystectomy: a review of 734 consecutive cases. Am Surg 1997; 63:150.
- Massarweh NN, Devlin A, Elrod JA, et al. Surgeon knowledge, behavior, and opinions regarding intraoperative cholangiography. J Am Coll Surg 2008; 207:821.
- Ferguson CM, Rattner DW, Warshaw AL. Bile duct injury in laparoscopic cholecystectomy. Surg Laparosc Endosc 1992; 2:1.
- Woods MS, Traverso LW, Kozarek RA, et al. Biliary tract complications of laparoscopic cholecystectomy are detected more frequently with routine intraoperative cholangiography. Surg Endosc 1995; 9:1076.
- Fletcher DR, Hobbs MS, Tan P, et al. Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study. Ann Surg 1999; 229:449.
- Sheffield KM, Riall TS, Han Y, et al. Association between cholecystectomy with vs without intraoperative cholangiography and risk of common duct injury. JAMA 2013; 310:812.
- Amott D, Webb A, Tulloh B. Prospective comparison of routine and selective operative cholangiography. ANZ J Surg 2005; 75:378.
- Ludwig K, Bernhardt J, Lorenz D. Value and consequences of routine intraoperative cholangiography during cholecystectomy. Surg Laparosc Endosc Percutan Tech 2002; 12:154.
- Pitt HA, Sherman S, Johnson MS, et al. Improved outcomes of bile duct injuries in the 21st century. Ann Surg 2013; 258:490.
- Strasberg SM. Biliary injury in laparoscopic surgery: part 2. Changing the culture of cholecystectomy. J Am Coll Surg 2005; 201:604.
- Stewart L, Way LW. Bile duct injuries during laparoscopic cholecystectomy. Factors that influence the results of treatment. Arch Surg 1995; 130:1123.
- Lillemoe KD, Melton GB, Cameron JL, et al. Postoperative bile duct strictures: management and outcome in the 1990s. Ann Surg 2000; 232:430.
- Baker, MS, Lillemoe, KD. Benign biliary strictures. In: Current surgical therapy, 9th ed, Cameron, JL (Ed), Mosby, St. Louis 2008. p 420.
- Oddsdottir, M, Hunter, JG. Gallbladder and the extrahepatic biliary system. In: Schwartz's principles of surgery, 8th ed, Brunicardi, FC, et al (Eds), McGraw-Hill, New York 2005. p 1212.
- Jabłońska B, Lampe P, Olakowski M, et al. Hepaticojejunostomy vs. end-to-end biliary reconstructions in the treatment of iatrogenic bile duct injuries. J Gastrointest Surg 2009; 13:1084.
- Surgical Maneuvers. Arch Surg 1999; 134:823.
- Kaufman SL, Cameron JL, Adams PE, et al. The management of surgically placed silastic transhepatic biliary stents. AJR Am J Roentgenol 1984; 142:347.
- Sicklick JK, Camp MS, Lillemoe KD, et al. Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients. Ann Surg 2005; 241:786.
- Walsh RM, Henderson JM, Vogt DP, Brown N. Long-term outcome of biliary reconstruction for bile duct injuries from laparoscopic cholecystectomies. Surgery 2007; 142:450.
- Melton GB, Lillemoe KD, Cameron JL, et al. Major bile duct injuries associated with laparoscopic cholecystectomy: effect of surgical repair on quality of life. Ann Surg 2002; 235:888.
- MECHANISM OF INJURY
- Role of intraoperative cholangiography
- CLASSIFICATION OF BILIARY INJURIES
- RECOGNITION OF BILE DUCT INJURY
- Intraoperative diagnosis
- When to postpone bile duct repair
- Delayed presentation
- - Bile leak
- - Biliary obstruction
- GOAL OF OPERATIVE MANAGEMENT
- REPAIR OPTIONS
- Segmental or accessory duct injury
- Transection of common bile duct
- - Short injured segment or distal injury
- - Long injured segment or proximal injury
- - Type E1 (Bismuth I)
- - Type E2 and E3 (Bismuth II and III)
- - Type E4 (Bismuth IV)
- - Type E5 (Bismuth V)
- Operative technique
- Morbidity and mortality
- Quality of life
- SUMMARY AND RECOMMENDATIONS