How Do Common Bile Duct Injuries Occur?
Common bile duct injuries occur most frequently during performance of a laparoscopic cholecystectomy. The injury typically occurs when the surgeon misidentifys the common bile duct for the cystic duct during the dissection phase of the operation.
The injury occurs in less than one percent of cholecystectomies. Excessive tension on the hartman’s pouch of the gallbladder by the surgeon’s first assistant may be contribute to this injury. Other factors, such as severe inflammation, the presence of visceral fat, bleeding from the dissection, or the mirizzi syndrome can make the dissection of the cystic duct treacherous to dissect off of the common bile duct.
Surgeons who perform laparoscopic cholecystectomy by exposing the “critical view” using a 360 degree dissection of calot’s triangle may have a lower incidence of biliary injuries.
What Happens After a Bile Duct Injury Occurs?
Injuries that are recognized at the time of the initial surgical procedure should be reconstructed immediately by an experienced surgeon performing a Roux-N-Y-Hepaticojejunostomy. Transfer of the patient to a specialized center for reconstruction by an expert is the preferred approach.
Unfortunately, many injuries are recognized at a remote time when patients recover poorly from surgery, often showing signs of bile peritonitis and intraabdominal sepsis. Reconstruction in this group of patients is performed in a delayed manner once the bile peritonitis and sepsis has been treated and resolves.
Common bile duct injuries are a source of significant morbidity for patients who have suffered from this complication.
How to Tell If You Have a Bile Duct Injury
Most often, a bile duct injury will be found by the doctor during surgery. If not, then the first sign of a bile duct injury will be failing to recover after a laparoscopic cholecystectomy. Other symptoms may include:
- Fever and chills
- Nausea and vomiting
- Abdominal swelling and pain
- General discomfort
How Bile Duct Injuries Are Diagnosed
In about 25% of cases, bile duct injuries are discovered during surgery. The surgeon might notice a leakage or a blockage by sight or by using a special exam called intraoperative cholangiography (IOC). If your bile duct injury is not discovered during surgery, the surgeon will use the following tests to help diagnose an injury:
- Transabdominal Ultrasound: This exam uses sound echoes to create images of the interior of the body and the bile duct.
- Endoscopic Retrograde Cholangiopancreatography: This exam uses a long, flexible scope inserted down your throat to take an X-ray of the bile duct.
- Percutaneous Transhepatic Cholangiography: During this test, a dye is injected into the bile duct for visibility before an X-ray is taken.
- Magnetic Resonance Cholangiopancreatography: This test uses a large magnet and electromagnetic radio waves to create images of the interior of the body and the bile duct.
How Bile Duct Injuries Are Treated
The primary goal of treatment is to manage any infection, leakage or blockage that came as a result of the injury. The surgeon will reconstruct the bile duct using a piece of intestine to remedy the blockage or the area where there was a leak. In some cases, if the injury is too complex, it may require a second surgery to reconstruct the bile duct fully.
Outcome for Patients
The outcome of a bile duct injury after laparoscopic cholecystectomy mostly depends on the extent and severity of the injury as well as how soon it was discovered after surgery. However, most bile duct injuries can be treated successfully, and the patient can recover after a few days.
Contact Our Bile Duct Repair Experts Today
If you don’t feel better a few days after a liver, bile duct or pancreas surgery, or if you begin to experience the symptoms of a bile duct injury, you should call your doctor. With over 20 years of practice and having dealt with the most complex bile duct injuries, Dr. Fraiman and his multidisciplinary team can successfully repair your bile duct injury, so you can go on to have a good quality of life.
Hear from the Expert
Leading bile duct and pancreas surgeon in Baltimore, MD, Dr. Mark Fraiman discusses common bile duct injuries and their management in his video below.