Biliary complications postlaparoscopic cholecystectomy: mechanism, preventive measures, and approach to management: a review

Abstract

Laparoscopic cholecystectomy has emerged as a gold standard therapeutic option for the management of symptomatic cholelithiasis. However, adaptation of LC is associated with increased risk of complications, particularly bile duct injury ranging from 0.3 to 0.6%. Occurrence of BDI results in difficult reconstruction, prolonged hospitalization, and high risk of long-term complications. Therefore, more emphasis is placed on preventing these complications. In addition to adequate training, several techniques have been proposed to prevent bile duct injury including use of 30° scope, adequate delineation of structures in Calot's triangle (critical view), avoidance of diathermy close to common hepatic duct, and intraoperative cholangiogram, and to maintain a low threshold to conversion to open approach when uncertain. Management of Bile duct injury depends on the nature of injury, time of detection, and the expertise available, and would range from simple subhepatic drainage to Roux-en-Y hepaticojejunostomy particularly performed at specialised centers. This article based on the literature review aims to review the biliary complications following laparoscopic cholecystectomy with reference to its mechanism , preventive measures to be taken, and the management approach.

Figure 1

ERCP showing small CBD leak managed effectively by sphincterotomy.

Figure 2

MRCP revealing subhepatic and significant intra-abdominal bile collection from cystic duct leak. The CBD is not dilated. The patient was managed effectively with ERCP sphincterotomy.

Figure 3

MRCP revealing a complete transection of CBD just below the hilum. Subhepatic and intraperitoneal collection can also be noted. Patient underwent a successful hepaticojejunostomy and continues to do well 4 years after surgery.