Biliary tract injuries following routine cholecystectomy

Abstract

This retrospective study was done to review the epidemiology, etiology, method of treatment, and results of repairs of biliary tract injuries following routine cholecystectomy. Fourteen patients have been treated at our hospital for biliary tract injuries during a 10-year period (January 1974-December 1983). One injury occurred at our institution. During this same time span, 941 cholecystectomies were performed at our hospital giving an incidence of 0.11 per cent for the injury. Trained surgeons were responsible for nine injuries, family practitioners for two injuries, and a surgery resident for one injury. Two injuries were caused by individuals whose level of training could not be determined. In only one case was massive hemorrhage associated with the injury. Four patients had their injuries diagnosed and treated at the time of their original surgery. Two had successful initial repairs. The other two required further reconstructive surgery with good results. Ten patients had a delay in diagnosis, and nine required biliary tract reconstruction. Four of these had good results. Combining both groups, 13 patients required 20 procedures. Stents were used in 14 procedures with good results in 43 per cent. Stents were left in place 6.9 months. Five procedures were done without stents and four resulted in failure. Biliary tract injuries are devastating problems caused by trained surgeons through lack of attention. Better results can be obtained if the injury is recognized early and treated. The overall success rate was 62 per cent. The use of stents improved the success rate.