Timing of repair of bile duct injuries associated with laparoscopic cholecystectomy.

摘要

We read with great interest the article by Sa-hajpal et al on laparoscopic cholecystec-tomy-associated bile duct injuries (LC-BDIs). It conveys a wise message that early repair (<=72 hours after LC-BDI) and late repair (>6 weeks after LC-BDI) offer the best outcomes. A minor comment is that an interval between 0 and 72 hours after LC-BDI has an unclear meaning: 0 hours suggests intraoperative repair, which was never performed. Most important, within the intermediate timing of repair (from 72 hours to 6 weeks after LC-BDI), a critical distinction should be made between the presence of a clean surgical field (ie, complete common bile duct stenosis with obstructive jaundice, without bile spillage) and a field that is inflamed or infected by bile. We believe that in the former case, surgical repair would occur in an ideal condition within 2 weeks following LC-BDI, even facilitated by the biliary dilation caused by obstruction. Of note, this ideal condition may dismally be turned into biliary peritonitis by unsuccessful nonsurgical attempts at bile duct recanali-zation. Conversely, in an inflamed or infected field, repair is less smooth because of edema, friability of tissues, and bleeding.