Background: One of the most frequently performed surgical procedures are the operations of the biliary tract. In spite of the experience of operating teams, surgical procedures of the biliary tract are not free from various complications — especially during the laparoscopic approach.
Material and methods: In the period from October 1991 to December 2005, 35 patients (25F/10M) underwent surgical treatment for biliary trauma. The mean age of the patients was 56 years (29–74). The authors analyzed treatment options according to type of injury as well as possible therapeutical complications and failures. The follow-up results, based on symptoms reported by patients as well as laboratory tests were described.
Results: The most common procedures resulting in biliary trauma were; open cholecystectomy — 11, laparoscopic cholecystectomy — 9, cholecystectomy with biliary tract revision — 6. Usually the biliary tract was reconstructed by end-to-end anastomosis, or Roux-Y hepaticojejunoanastomosis (13 and 12 cases respectively). During the perioperative period 1 case of anastomotic leak in an end-to-end anastomosis was observed. The problem was solved by a new reconstruction — a Roux-Y hepaticojejunoanastomosis. The late results were evaluated in 30 patients in a follow-up period from 2 months to 13 years. In this period the following compilactions were observed: death — 3, symptomatic stenosis in the anastomosis line — 3, asymptomatic stenosis of the common biliary duct — 2, choledocholithiasis — 1, cicatrical hernia — 3, intestinal obstruction — 2. The quality of life was evaluated in 27 patients in the late period after the reconstruction: 14 patients evaluated their condition as very good, 12 as good and 1 as poor.
Conclusions: Success in treating biliary trauma depends on: appropriate preoperative preparation (infection treatment, metabolic and nutritional status improvement), careful preparation of the biliary tract in the region of injury, no tension in the anastomosis line, appropriate postoperative therapy.