BILE DUCT INJURIES DURING LAPAROSCOPIC CHOLECYSTECTOMY

Introduction. Due to high incidence of bile duct injuries (BDI) during the laparoscopic cholecystectomy, there is a need to define types and mechanisms of BDI, methods and results of their treatment, to determine the role of miniinvasive procedures for the treatment of small and partial types of BDI.

Objectives. Analyzing the experience of treatment of BDI during LC and development of guidelines for their management.

Methods. For a period from 1993 to 2014 in O. O. Shalimov National Institute of Surgery and Transplantology 187 patients with BDI during LC were treated, 158 women and 29 men at the age 24–74. Intraoperatively the BDI were identified in 40 (21.4%) of patients, in 147 (78.6%) — in the postoperative period (from 3 days to 2 years).

Results. Major BDI were identified in 140 patients: 27 — partial, 113 — complete. In 11 patients combined BDI and vascular injuries were identified, predominantly of right hepatic artery. The analysis of complete BDI revealed the prevalence of high types III, IV, and V (Bismuth) — in 113 (75.8%) of patients.

In the cases of small or partial BDI, the miniinvasive procedures were preferred (PTBD, ERCP), if needed — relaparoscopy. The patients with major lateral or complete BDI, with extended stenosis required surgical correction. The method of choice in this category of patients is the high hepaticojejunostomy, in both cases — intraoperative detection of BDI or in late postoperative period.

Satisfactory results were obtained in 177 (94.9%) of patients. Two patients (1.1%) died.