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August 1990

Iatrogenic Injury to the Bile DuctWho, How, Where?

Author Affiliations

From the Department of Surgery, University of California San Diego Medical Center, and VA Medical Center, La Jolla, Calif.

Arch Surg. 1990;125(8):1028-1031. doi:10.1001/archsurg.1990.01410200092014

• We reviewed 81 patients with bile duct injuries that occurred at cholecystectomy and/or common bile duct exploration. Thirty-two of the strictures were recurrent. The median follow-up was 9 years. High injuries were inflicted during the performance of cholecystectomy while low injuries were related to common bile duct exploration. Mitigating circumstances appear to be as follows: (1) inadequate access, exposure, and assistance; (2) absence of operative cholangiogram; (3) patient's obesity; and (4) early dissection of Calot's triangle. Noncontributory factors include the following: (1) level of training of surgeon, and (2) type of institution where the operation was performed. Following repair, 15 patients eventually died and 8 suffered intermittent cholangitis and/or cirrhosis. Mortality and morbidity were related to the following: (1) level of stricture; (2) number of previous attempts at repair; and (3) adequacy of reconstruction. Mucosa-to-mucosa anastomosis without tension is essential for optimal results.

(Arch Surg. 1990;125:1028-1031)