Analysis of the safety and feasibility of laparoscopic surgery for repairing LC-related biliary injury
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1.The Third Clinical Medical College of Ningxia Medical University, Yinchuan 750002, China;2.Department of Hepatobiliary Surgery, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, China

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R657.4

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    Abstract:

    Background and Aims Once bile duct injury occurs during laparoscopic cholecystectomy (LC), it can cause both physical and psychological suffering for the patient, negating the actual benefits of minimally invasive surgery. However, it is an adverse event that biliary surgeons in clinical practice cannot altogether avoid. With the ongoing development of minimally invasive surgical techniques, cases of laparoscopic repair of bile duct injury during LC have increasingly been reported. However, some scholars have questioned the safety and efficacy of these procedures, making it a controversial topic. This study summarized the data of patients undergoing laparoscopic repair for LC-related bile duct injuries performed in recent years and explored their feasibility and safety.Methods The clinical and follow-up data of 11 cases of LC-related bile duct injuries repaired through laparoscopic surgery at the Department of Hepatobiliary Surgery, Ningxia Hui Autonomous Region People's Hospital, from March 2019 to March 2023, were retrospectively analyzed. Bile duct injury during LC was diagnosed based on suspected bile leakage and intraoperative cholangiography. Bile duct injury after LC was assessed and confirmed through clinical manifestations, enhanced abdominal CT, MRCP, and laparoscopic exploration.Results Among the 11 patients, 4 were males and 7 were females. The Strasberg-Bismuth classification was used to categorize bile duct injury of patients, which included 3 cases of type C, 1 case of type D, 1 case of type E1, 3 cases of type E2, 2 cases of type E3, and 1 case of type E4. All patients completed the repair surgery of bile duct injury, of whom 7 cases underwent immediate intraoperative repair surgery (6 cases underwent total laparoscopic bile duct end-to-end anastomosis or repair, 1 case underwent laparoscopic-assisted small incision hepaticojejunostomy), and 4 cases underwent early bile duct injury repair surgery following LC (1 underwent total laparoscopic biliary-enteric anastomosis and 3 underwent laparoscopic-assisted small incision hepaticojejunostomy). The average time for the repair surgery was (173.63±44.33) minutes, and the median intraoperative blood loss was 100 (90–140) mL. There were no perioperative deaths, and no complications such as bile leakage or bile duct bleeding at the anastomosis sites were observed. The average length of hospital stay was (14.27±2.93) d. The average follow-up time for all patients was (38.09±17.23) months except for one patient with Strasberg-Bismuth type C bile duct injury who developed right hepatic duct stricture three months after laparoscopic proper hepatic duct repair and was successfully treated with laparoscopic right hepaticojejunostomy, no other complications, such as bile duct strictures or reflux cholangitis were observed during the follow-up period.Conclusion In hepatobiliary centers with advanced laparoscopic techniques, performing laparoscopic surgery to repair LC-related bile duct injury is relatively safe and feasible. However, it is essential to accurately assess the indications for surgery based on the Strasberg-Bismuth classification of bile duct injury and to implement an appropriate repair strategy as early as possible.

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YANG Zhiqi, WU Lang, DING Yang, LIU Jing, YAN Wentao, LI Minghao. Analysis of the safety and feasibility of laparoscopic surgery for repairing LC-related biliary injury[J]. Chin J Gen Surg,2024,33(8):1230-1239.
DOI:10.7659/j. issn.1005-6947.2024.08.004

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History
  • Received:June 19,2024
  • Revised:August 01,2024
  • Adopted:
  • Online: September 05,2024
  • Published: