Biliary complications during and after laparoscopic cholecystectomy.

BACKGROUND/AIMS: Bile duct injury and bile leak are the most serious complications of laparoscopic cholecystectomy. The purpose of this study to present our experience in the management of biliary complications during and after laparoscopic cholecystectomy.

MATERIAL AND METHODS: There were eight biliary complications (0.72%) in 1115 consecutive laparoscopic cholecystectomies during the period from January 1991 to December 1995.

RESULTS: The biliary complications included: bile duct injuries in 3 patients, bile leak in 4 patients and malapplication of the endoclips on the common bile duct in patient. Three biliary complications were corrected by immediate conversion to laparotomy with good outcomes. Two patients with immediate postoperative bile leakage required laparotomy for religation of the cystic duct and one patient with delayed bile leakage was successfully corrected with conservative treatment. One common hepatic duct and right hepatic duct developed necrosis due to electrocoagulation and required a laparotomy with T-tube stent and had repeated attacks of cholangitis during the 21 month follow-up period. Another patient with common hepatic duct stricture due to endoclip injury needed re-laparotomy with T-tube stent and remained stationary over the 9 month follow-up period.

CONCLUSION: Bile leak and bile duct injuries after laparoscopic cholecystectomy present a difficult surgical problem, surgical or endoscopic interventions are needed to correct the biliary problem after the diagnosis was established by the radiological image study.