Changing patterns of traumatic bile duct injuries: a review of forty years experience

Table 1 Types of primary operations in 61 cases of traumaticbiliary strictures (Group A, 1963/1986, South-West Hospital Series)

Types of operation	Cases
Cholecystectomy	39
Cholecystectomy + choledochostomy	10
Gastrectomy (B-II )	7
Hepatic injury -Rt lobectomy	1
Suture + gauze packing	2
Suture + choledochostomy	1
Suture + repair of duodenum	1
Total cases	61

**29 of the 61cases were recognized by the operator during the primary operation

Table 2 Changing trend of primary operations in cases of traumatic biliary strictures (Group B: The General Hospital of PLA Series)

Types of operations	Cases
	(1989-1997)	(1998-2001)
Cholecystectomy	27	8
Mini-cholecystectomy	2
Laparoscopic cholecystectomy(LC)	4	5
Cholecystectomy + choledochostomy	9
Hepatic resection	3
Hepatic resection + HAE	1
HAE		1
Gastrectomy(B-I)	1
Total cases	42	19

Table 3 Hepato-biliary complications following HAE for cavernous hemangioma of liver

Case Embolizing No. agents	Complications	Operations	Results
1 Sod.mo.+ Lip.	Rt,Lt.CHD,GB	S-R shunt	Jaundice ↓
	Necrosis	B-jejunostomy
	Biliary cirrhosis
2 Ethanol	Liver abscess	Rt. Lobectomy	Jaundice ↓
	Biliary fistula	B-jejunostomy
3 Sod.mo.+ Lip.	Rt-Lt-HD necrosis	PTBD
	Liver abscess	Necrosectomy, U-tube	Jaundice ↓
4 Lip.wire	GB necrosis	No	Jaundice ↑
Pinyanmycin	HD stricture
	Liver abscess
5 Sod. Mo + Lip.	GB,CBD	Cholecystectomy	Jaundice ↓
	necrosis	T-tube stent
	Liver abscess
6* Sod. Mo + Lip.	Bile fistula	B-jejunostomy	Jaundice ↓
	Rt lobe atrophy	T-tube stent
	Biliary cirrhosis
7* Ethanol	Rt liver, GB,duo-	Cholecystectomy	Died
	denum necrosis	Gastro-jejunostomy
8 Sod.mo + Lip.	Rt liver abscess	Cholecystectomy	Jaundice ↓
	GB necrosis	Rt lobectomy
9* Sod. Mo + Lip	Rt liver necrosis	Repair HD	Jaundice ↑
	HD stricture		Repeated
	Portal hypertension	No	hematemesis

(Such type of bile duct injury was not included under the category of traumatic biliary injuries in the hospital records) * Treated by consultation; Sod mo. = sodium morrhuate; Lip. = iodized oil; B = biliary; GB = gallbladder; CBD = common bile duct; HD = hepatic duct; S-R = spleno-renal; PTBD = percutaneous transhepatic biliary drainage

Table 4 Bile duct injury and the type of operations in 2742 cases (Chinese literature review 1995-1999)

Type of operation	No. of cases	%
Cholecystectomy	1933	70
Laparoscopic cholecystectomy	310	11
Cholecystectomy + choledochostomy	165	6
Gastrectomy	66	2
HAE*	16	0.6
Hepatic resection	10	0.4
Other operations	66	2
Unspecified	176	6

*HAE = Hepatic arterial embolization