Multidisciplinary approach to extra-hepatic bile ducts injuries after laparoscopic cholecystectomy

BACKGROUND: Bile duct injuries (BDI) remain an important problem in gastrointestinal surgery. They are mostly often caused by laparoscopic cholecystectomy, which is one of the most practiced surgical interventions in the world. The injury occurs as a result of technical errors or misidentification of anatomical structures. Operator inexperience, inflammation, and anatomic abnormalities are key risk factors. Aim of this study is to examine the cases of an iatrogenic damage to the bile ducts after laparoscopic cholecystectomy in the Clinic of General, Biliary-Hepatic and Pancreatic Surgery Alexandrovska Hospital Sofia retrospectively for a period of 10 years. The objective is to optimize the diagnostic algorithms of BDI, to classify the most common BDI, to optimize the therapeutic behavior.METHODS: A retrospective study was preformed that included 30 patient cases who underwent laparoscopic cholecystectomy and had clinical symptoms of a bile duct injury after cholecystectomy. All patients underwent through a highly specialized treatment methods that combined a diagnostic and therapeutic effect. Surgical intervention was applied to patients after failure of other minimally invasive techniques (endoscopy and interventional radiology).RESULTS: Zero mortality rate was reported in the studied group of patients with BDI after laparoscopic cholecystectomy. Different types of complications were reported for each treatment group of patient cases with BDI.CONCLUSIONS: In the present study, we analyzed the multidisciplinary approach in the treatment of iatrogenic damage to the bile ducts after cholecystectomy with an emphasis on improving the quality of life in the long term. The early and correct diagnosis of iatrogenic biliary tract injuries is very important for the outcome of the condition, as their timely failure of recognition leads to serious complications, such as biliary cirrhosis, liver failure and death.