Vascular injuries in laparoscopic cholecystectomy: an underestimated problem.

BACKGROUND Bile duct injury is a severe complication of laparoscopic cholecystectomy and many reports focus on this topic, especially regarding the long-term success of repair of these injuries. There is some concern, however, as to whether concomitant vascular injuries can jeopardize reconstruction of a bile duct injury following laparoscopic cholecystectomy. METHODS A review of the current literature on the clinical significance and management of a concomitant vascular injury to the outcome of reconstruction of bile duct injuries following laparoscopic cholecystectomy. Relevant articles were extracted through PubMed, with secondary references obtained from key articles. RESULTS Although the relevant literature is generally poor, there is a trend of appearance of relatively large series on the topic over the last five years, as opposed to case reports or small series during the previous decade. CONCLUSION The disruption of the hepatic arterial flow during laparoscopic cholecystectomy is usually well tolerated in an otherwise healthy patient. There is strong evidence that concomitant vascular injuries do not have any impact on mortality after biliary reconstruction. There is also evidence that does increase overall morbidity, but when it comes specifically to long-term anastomotic stricture formation, there is no strong evidence to support a negative impact of a concomitant vascular injury; this is especially true for centers/surgeons with HPB interest.