Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. Apr-Jun 1998;2(2):147-51.

A Multidisciplinary Approach to Major Bile Duct Injury Following Laparoscopic Cholecystectomy

Free PMC article

A Multidisciplinary Approach to Major Bile Duct Injury Following Laparoscopic Cholecystectomy

T S Yeh et al. JSLS. .
Free PMC article


Background and objectives: Many series describing the management of major bile duct injuries after laparoscopic cholecystectomy have been reported with satisfactory short-term results. However, the information of their prognosis with sufficient time-period follow-up is sparse.

Methods: Sixteen consecutive patients with major bile duct injury following laparoscopic cholecystectomy were retrospectively reviewed, including six common bile duct transections, four bile duct perforations, and six hilar strictures but without perforation. With respect to the level of bile duct injuries, there were the following based on Bismuth's classification: type 1 in six patients, type 2 in five patients, type 3 in three patients, type 4 in one patient, and type 5 in one patient. All patients received surgical management, interventional radiology and endoscopic treatment. The time periods of follow-up ranged from 37 to 72 months (mean, 52 months). The final results were rated as being excellent, good, fair, or poor, based on the criteria of symptoms, biochemical data, and radiology.

Results: There was no procedure-related mortality. Ten of the 16 patients had either excellent or good results, two had fair results, and four had poor results. Of the latter four, the patients had been classified as Bismuth type 1, 3, 4, and 5, respectively, and all sustained a failed initial surgical repair.

Conclusions: Using a multidisciplinary approach, 12 (75%) of the 16 patients attained a promising result through a long-term follow-up, while those with the higher biliary stricture and with an unsuccessful initial surgical repair had a disappointing outcome.


Figure 1.
Figure 1.
Endoscopic retrograde cholangiopancreatography shows malposition of metal clips on the common bile duct resulting in hilar stricture, rated as Bismuth type 2 injury.
Figure 2.
Figure 2.
Percutaneous transhepatic cholangiography shows transection of the common bile duct, rated as Bismuth type 1 injury.
Figure 3.
Figure 3.
T-tube cholangiography shows extravasation of the dye indicating hepaticojejunostomy leak.

Similar articles

See all similar articles


    1. Strasberg SM, Herd M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg. 1995;180:101–125 - PubMed
    1. Rossi RL, Schirmer WJ, Braasch JW, Sanders LB, Munson JL. Arch Surg. 1992;127:596–602 - PubMed
    1. Branum G, Schmitt C, Bailie J, et al. Management of major biliary complications after laparoscopic cholecystectomy. Ann Surg. 1993;217:532–541 - PMC - PubMed
    1. Lillemoe KD, Martin S, Cameron JL, et al. Major bile duct injuries during laparoscopic cholecystectomy: follow-up after combined surgical and radiologic management. Ann Surg. 1997;225:459–471 - PMC - PubMed
    1. Pitt HA, Miyamoto T, Parapatis SK, et al. Factors influencing outcomes in patients with postoperative biliary strictures. Am J Surg. 1932;144:14–21 - PubMed

MeSH terms

LinkOut - more resources