Accidental Lesions of the Common Bile Duct at Cholecystectomy

Abstract

Cases (65) of accidental lesion of the choledochus at cholecystectomy reported from 51 Swedish hospitals to the Patient''s Insurance Syndicate in Stockholm 1975-1981 were studied. The results were evaluated as to the time of detection and the primary surgical repair done. Of the 64 lesions 55 were detected and repaired at the cholecystectomy and ten were detected and repaired the first 10 days after the primary operation. In 38 of 55 lesions detected before surgery, an end-to-end choledochostomy was performed. Good results without further surgical intervention were achieved in 22%. The 17 other preoperatively detected lesions were treated with choledocho/hepaticoenterostomy, and good results were achieved without further surgical intervention in 54%. Of the 10 patients in whom the lesions were detected after surgery, 3 were reconstructed with an end-to-end choledochostomy; all developed obstruction that led into further reoperations. In the remaining 7 patients lesions were repaired within 10 days with a choledocho/hepaticoenterostomy; 3 did not require further surgical intervention and 4 had to be reoperated. There was not mortality at the 1st repair, but 2 cases of hospital mortality at reoperations. Morbidity was substantial for patients with and without obvious further surgical complications. In this selected group choledocho/hepaticoenterostomy should be the procedure of choice. The accumulated rate of biliary strictures increased with time, which requires a considerably longer follow-up to know the end results of this of avoidable complication to a straightforward cholecystectomy.