Bile duct injuries after laparoscopic cholecystectomy: single tertiary care center experience

The objective of this study was to systematize our experience with bile duct injuries (BDI) after laparoscopic cholecystectomy. From 2014 to 2020 in total 33 patients with BDI were identified at the time of reference to our center. Data of injury type (Strasberg classification), intervention needed, and the results of treatment were recorded. Afterwards any subsequent times was recorded when patient was in hospital with complications of BDI. Average age at the time of cholecystectomy was 57.21 years (range 26 – 83). Based on type of injury we had type A – 7, type B – 1, type D – 5, type E1 – 6, type E2 – 3, type E3 – 4 and type E4 – 7 patients. Two patients had late complications in form of liver abscess and had percutaneous drainage, 1 of those was unsuccessful and was managed surgically. Seven patients were managed only by endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC). In total 24 patient underwent surgical treatment. Five patients with less extensive damage had suturing of the lesion. But 19 patients with type E1-E5 damage required biliodigestive anastomosis modo Roux-en-Y. One patient had major bleeding postoperatively, one patient – insufficiency of anastomosis that required surgical revision. Nine patients had stenosis of anastomosis on average 10 months after reconstruction (1-48 months), that required PTC. Six patients didn’t have any complications after surgery. One patient died on 10th postoperative day due to thromboembolism. Management of BDIs are complex based on diversity of injuries and the timing of diagnosis and require multidisciplinary approach. Although this is a rare complication, absolute count of these patients tends to accumulate over the years and have serious impact on long-term quality of life, based on repeated hospitalizations and need for invasive manipulations.