Interdisciplinary management of major bile duct injuries following laparoscopic cholecystectomy

In this study we analysed 25 patients retrospectively with severe bile duct injuries following laparoscopic cholecystectomy (of whom 20 where referred from other hospitals). The biliary injuries included complete transsection of the common hepatic or common bile duct in 4 patients, major bile duct leak in 8, ductal strictures in 9 and cystic duct leaks in 4. All but one patient required primary or secundary reconstructive surgery. Reconstruction of the biliary tract in our institution was accomplished with hepatico-jejunostomy in 20 patients. In 2 patients a ligation of a cystic duct leak was performed, whereas one patient underwent end-to-end anastomosis of the common bile duct. Endoscopic treatment was possible in one patient. After a median follow-up of 28 months (3-65) 90% are without symptoms. However, one patient required liver transplantation because of secondary biliary cirrhosis and another patient could be treated with PTCD after stenosis of the hepatico-jejunostomie.