Bile Duct Injuries During Gallbladder Surgery
What is the gallbladder?
The gallbladder is a small, sac-like organ that sits under the liver on the right side of your abdomen (belly). The gallbladder stores a greenish-brown fluid called bile. Bile is made and released by the liver and then sent to the small intestine. There, it helps the body break down and absorb food. Bile moves through a network of tube-like structures called bile ducts.
Why would I need gallbladder surgery?
Sometimes, small, hard masses called gallstones form inside the gallbladder. These stones can cause swelling, pain, and infection. They can also damage the gallbladder. Gallstone disease is one of the most common digestive system disorders. It is the most common reason for gallbladder surgery. Surgery to remove a diseased gallbladder is called a cholecystectomy. You can live without a gallbladder, but you might need to make some changes in your diet.
A common type of gallbladder surgery, called laparoscopic cholecystectomy, is done through a few small cuts in the abdomen. For this type of surgery, a camera and light are attached to a scope and are placed into one of the small cuts. The camera projects a live-action video of the inside of the abdomen onto a screen near the surgical table. The doctor looks at the screen and uses the video to guide his or her movements. The doctor then takes out the gallbladder with surgical tools placed in the other small cuts. Benefits of laparoscopic cholecystectomy over open surgery include less pain, less time in the hospital and quicker recovery. It is now considered the “gold standard” for surgical treatment of gallbladder disease.
What is a bile duct injury?
Bile duct injuries are damage to the bile ducts that happen during gallbladder surgery. A bile duct can get cut, burned, or pinched. As a result of an injury, the bile duct will not be able to work right, leaking bile into the abdomen or blocking the normal flow of bile. Bile duct injuries lead to symptoms that can be painful, even deadly, if not treated.
What causes bile duct injuries during gallbladder surgery?
Most bile duct injuries that occur during gallbladder surgery happen because the area around the gallbladder and bile ducts is masked in some way so that the doctor cannot see it clearly. This can happen if the area’s structure (anatomy) is different than normal, or if there is a lot of bleeding, swelling, or scarring in the area.
How common are bile duct injuries during gallbladder surgery?
The numbers vary by study. Some estimate that bile duct injuries occur in one in 1,000 cases of laparoscopic gallbladder surgery. They occur less often in open surgeries.
How will I know if I have a bile duct injury?
Some bile duct injuries are found by the doctor at the time of surgery. If not, the first sign of a bile duct injury is failing to recover quickly after the procedure. Other symptoms might include:
- Abdominal pain
- Swelling of the abdomen
- General discomfort
- Jaundice (yellowing of the skin and the whites of the eyes)
How are bile duct injuries diagnosed?
In about 10 percent to 30 percent of cases, bile duct injuries are found by the doctor at the time of surgery. He or she might notice leaking bile or a blockage by sight or by using a test called intraoperative cholangiography (IOC). IOC is an X-ray exam of the bile ducts after a dye has been injected to make the flow of bile clearly visible on the X-ray image.
If your injury was not found during surgery, tests your doctor might use to help diagnose a bile duct injury include:
- Transabdominal ultrasound — This test uses sound waves and echoes to create images of the organs in the abdomen.
- Endoscopic retrograde cholangiopancreatography (ERCP) — This test uses a lighted, flexible scope inserted into the upper part of the digestive system to look at and take X-rays of the bile ducts. Sometimes, bile duct injuries can also be treated using ERCP.
- Percutaneous transhepatic cholangiography — Like IOC, during this test, X-rays are taken after dye is injected into the bile ducts.
- Magnetic resonance cholangiopancreatography (MRCP) — This test uses magnetic resonance imaging, which uses a large magnet and radio waves to create images of the inside of the body, to view the bile ducts.
How are bile duct injures treated?
The first goal of treatment is to manage any infection, leakage, or blockage caused by the injury. Then, the doctor will reconstruct the bile duct, often using a piece of intestine to bypass the blockage or the area where the duct was cut or burned.
In some cases, if the doctor finds the bile duct injury during surgery, he or she is able to repair it at that time. In other cases, if the injury is complex, it might require a second surgery by a specially trained doctor.
What is the outcome for patients with bile duct injuries?
The outcome depends on the type and extent of the injury and how soon the injury is found. Most bile duct injuries can be successfully repaired, and the patient can go on to have a good quality of life. In severe cases, with more than one surgery, many months of recovery might be needed.
Can bile duct injuries be prevented?
Some doctors think that using IOC more often will help reduce the number of bile duct injuries, while other doctors believe that not all injuries can be prevented, even with IOC. Other doctors suggest that changes in how the surgery is performed and the equipment used will reduce the number of injuries. However, not all bile duct injuries can be prevented, so they remain a possible risk of gallbladder surgery.
When should I call my health care provider?
Call your health care provider if you don’t begin to feel better a few days after gallbladder surgery or if you begin to experience any of the symptoms of a bile duct injury. Keep in mind that some of the symptoms might not affect you right away. The effects of a bile duct injury might not be obvious until weeks after your surgery.
- Way LW, Stewart L, et al.; Causes and prevention of laparoscopic bile duct injuries Annuls of Surgery April 2003; 237(4); 460-469
- Flum DR, Koepsell T, et al.; Common bile duct injury during laparoscopic cholecystectomy and the use of intraoperative cholangiography: adverse outcome or preventable error? Archives of Surgery 2001; 136(11); 1287-1292
- Manouras A, Pararas N, et al.; Management of major bile duct injury after laparoscopic cholecystectomy: a case report; Journal of Medical Case Reports 2009; 3:44
- Weber A, Fuessner H, et al.; Long-term outcome of endoscopic therapy in patients with bile duct injury after cholecystectomy; Journal of Gastroenterology and Hepatology 2009; 24(5); 762-769
- Society of Laparoendoscopic Surgeons Accessed 2/27/2014.
- Sridhar Varma BV; Common bile duct injuries during laparoscopic cholecystectomy; World Journal of Laparoscopic Surgery September-December 2009; 2(3); 15-18
- Sarno G, Al-Sarira A A, et al.; Cholecystectomy-related bile duct and vasculobiliary injuries; British Journal of Surgery 2012: 99: 1129-1136
- Mulholland MW, Doherty, GM; Bile Duct Injuries from Cholecystectomy; Complications in Surgery 2nd Edition; Walters Kluwer
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