복강경 담낭절제술 중 발생한 담관 손상 치료의 임상적 경험

Abstract

Purpose: Laparoscopic cholecystectomy (LC) has become the gold standard of management of gallstone disease. LC is associated with a two-to-four times higher incidence of bile duct injury, which is a rare but more serious complication than open cholecystectomy. We reviewed Our experiences with the management of bile duct injury during laparoscopic cholecystectomy. Methods: From January 1999 to April 2009, 13 patients with bile duct injuries following LC were managed in Our hospital. Patients' charts were retrospectively reviewed to analyze perioperative management. Results: Among the 13 patients, 7 patients sustained their bile duct injuries at Our hospital. Six patients were referred to our hospital to manage their bile duct injuries. Five patients' injuries were identified during LC. According to the Strasberg classification, there are 5 cases of type A, 2 cases of type C, 1 case of type D and 5 cases of type E injuries. Four type A bile duct injuries were treated by direct ductal ligation during LC and 1 type A bile duct injury and 1 type C bile duct injury were managed by non-surgical treatment. Type D and type E injuries were managed by Roux-en-Y hepaticojejunostomy. Conclusion: Bile duct injuries are a rare but serious complications that occur during laparoscopic cholecystectomy. Most minor bile duct injuries are well treatable with non-surgical management, whereas major bile duct injuries require surgical management. The combination of non-surgical management and surgical treatment results in successful outcomes in bile duct injuries. (J Korean Surg Soc 2009;77:326-332)