Left Hepatectomy for Vasculobiliary Injuries Following Laparoscopic Cholecystectomy
DOI:
https://doi.org/10.11603/2414-4533.2026.3.16480Keywords:
laparoscopic cholecystectomy, vasculobiliary injuries, left hemihepatectomy, ischemic hepatic hypotrophy, liver resectionAbstract
The aim of the work: to evaluate the clinical indications, anatomical characteristics, and surgical outcomes of left hepatectomy in patients with iatrogenic vasculobiliary injuries following laparoscopic cholecystectomy, as well as the features of the postoperative recovery period.
Materials and Methods. Between January 2004 and December 2024, 64 patients with vasculobiliary injuries were treated at the Department of Liver Transplantation and Hepatic Surgery of the State Institution "O.O. Shalimov National Scientific Center of Surgery and Transplantology" of the National Academy of Medical Sciences of Ukraine. Of these, 17 patients underwent isolated hepaticojejunostomy, one underwent liver transplantation, and 46 underwent hepatic resection. Right hepatectomy was the predominant procedure (n=40), whereas left hepatectomy was performed in six patients, who constituted the study cohort. Demographic characteristics, medical history, type and mechanism of injury, intraoperative findings, length of hospital stay, and postoperative complications were analyzed.
Results. All six patients underwent left hepatectomy in the presence of severe hilar adhesions and clinical manifestations of cholangitis. The mean operative time was (366.7±60.2) minutes. Mean intraoperative blood loss was (333.3±188.6) mL, and the mean duration of the Pringle maneuver was (36±9.3) minutes. Injury to the left portal vein branch was identified in four patients (66.7 %), resulting in ischemic hypotrophy of liver segments II–IV. Three patients required dismantling of previously constructed hepaticojejunostomies. In two cases (33.3 %), left hepatectomy was combined with total caudate lobectomy. The mean postoperative hospital stay was 39.2 days. No postoperative mortality occurred. One patient required additional ultrasound-guided drainage of a postoperative fluid collection. Clinical stabilization was achieved in all patients.
Conclusions. Left hepatectomy for iatrogenic vasculobiliary injuries is an uncommon but technically demanding procedure that requires thorough knowledge of hepatobiliary anatomy, meticulous preoperative assessment of vascular and biliary injuries, and extensive experience in complex hepatobiliary reconstruction. The present findings demonstrate that hepatic resection is an effective treatment option for patients with ischemic atrophy of the left hepatic lobe associated with recurrent cholangitis. Successful outcomes depend on adequate control of infection, relief of biliary obstruction, and optimization of the patient's general condition before surgery.
References
1. Stewart L. Iatrogenic biliary injuries: identification, classification, and management. Surg Clin North Am. 2014 Apr.; 94(2):297-310. DOI: 10.1016/j.suc.2014.01.008. PMID: 246 79422. DOI: https://doi.org/10.1016/j.suc.2014.01.008
2. Booij KAC, de Reuver PR, van Dieren S, van Delden OM, Rauws EA, Busch OR, van Gulik TM, Gouma DJ. Long-term Impact of Bile Duct Injury on Morbidity, Mortality, Quality of Life, and Work Related Limitations. Ann Surg. 2018 Jul.; 268(1):143-50. DOI: 10.1097/SLA.0000000000002258. PMID: 28426479. DOI: https://doi.org/10.1097/SLA.0000000000002258
3. Schreuder AM, Booij KAC, de Reuver PR, van Delden OM, van Lienden KP, Besselink MG, Busch OR, Gouma DJ, Rauws EAJ, van Gulik TM. Percutaneous-endoscopic rendezvous procedure for the management of bile duct injuries after cholecystectomy: short- and long-term outcomes. Endoscopy. 2018 Jun.; 50(6):577-87. DOI: 10.1055/s-0043-123935. Epub. 2018 Jan. 19. PMID: 29351705.
4. Zidan MHE, Seif-Eldeen M, Ghazal AA, Refaie M. Post-cholecystectomy bile duct injuries: a retrospective cohort study. BMC Surg. 2024 Jan. 3; 24(1):8. DOI: 10.1186/s12893-023-02301-2. Erratum in: BMC Surg. 2024 Feb. 7; 24(1):48. DOI: 10.1186/s12893-024-02332-3. PMID: 38172774; PMCID: PMC10765830. DOI: https://doi.org/10.1186/s12893-024-02332-3
5. Kodali R, Anand U, Parasar K, Priyadarshi RN, Kumar R, Singh BN, Kant K. The impact of vascular injuries on the management of bile duct injury following laparoscopic cholecystectomy- insights from a prospective study. HPB (Oxford). 2025 Apr.; 27(4):544-52. DOI: 10.1016/j.hpb.2024. 12.022. Epub. 2025 Jan. 6. PMID: 39824715.
6. Pesce A, Fabbri N, Feo CV. Vascular injury during laparoscopic cholecystectomy: An often-overlooked complication. World J Gastrointest Surg. 2023 Mar. 27; 15(3):338-45. DOI: 10.4240/wjgs.v15.i3.338. PMID: 37032796; PMCID: PMC10080601. DOI: https://doi.org/10.4240/wjgs.v15.i3.338
7. Barauskas G, Paškauskas S, Dambrauskas Z, Gulbinas A, Pundzius J. Referral pattern, management, and long-term results of laparoscopic bile duct injuries: a case series of 44 patients. Medicina (Kaunas). 2012; 48(3):138-44. PMID: 22588345. DOI: https://doi.org/10.3390/medicina48030019
8. Eid N, Allouh M, Ito Y, Taniguchi K, Adeghate E. Accessory right hepatic artery and aberrant bile duct in the hepatocystic triangle: a rare case with clinical implications. Folia Morphol (Warsz). 2022; 81(3):798-803. DOI: 10.5603/FM.a2021.0065. Epub. 2021 Jul. 5. PMID: 34219214.
9. Mercado, Miguel Angel MD; Sanchez, Norberto MD; Urencio, Miguel MD. Major Hepatectomy for the Treatment of Complex Bile Duct Injury. Annals of Surgery. March 2009; 249(3):542-43. DOI: 10.1097/SLA.0b013e31819aa93d. DOI: https://doi.org/10.1097/SLA.0b013e31819aa93d
10. Sarno G, Al-Sarira AA, Ghaneh P, Fenwick SW, Malik HZ, Poston GJ. Cholecystectomy-related bile duct and vasculobiliary injuries. Br J Surg. 2012 Aug.; 99(8):1129-36. DOI: 10.1002/bjs.8806. Epub. 2012 Jun. 14. PMID: 22695869.
11. Iskandar ME, Radzio A, Krikhely M, Leitman IM. Laparoscopic cholecystectomy for a left-sided gallbladder. World J Gastroenterol. 2013 Sep. 21;19(35):5925-8. DOI: 10.3748/wjg.v19.i35.5925. PMID: 24124340; PMCID: PMC3793148. DOI: https://doi.org/10.3748/wjg.v19.i35.5925
12. Singla S, Singh RK, Kumar S, Prasad U, Mandal M, Kumar S. Cholecystectomy associated vasculobiliary injuries: Incidence and impact on surgical repair outcomes. Turk J Surg. 2025; 41(1):24-30. DOI: 10.47717/turkjsurg.2025.6577. DOI: https://doi.org/10.47717/turkjsurg.2025.6577
13. Pereira R, Singh T, Avramovic J, Baker S, Eslick GD, Cox MR. Left-sided gallbladder: a systematic review of a rare biliary anomaly. ANZ Journal of Surgery. 2019; 89:1392-97. DOI: 10.1111/ans.15041. DOI: https://doi.org/10.1111/ans.15041
14. Laurent, Alexis MD, PhD; Sauvanet, Alain MD; Farges, Olivier MD, PhD; Watrin, Thierry MD; Rivkine, Emmanuel MD; Belghiti, Jacques MD. Major Hepatectomy for the Treatment of Complex Bile Duct Injury. Annals of Surgery. July 2008; 248(1):77-83. DOI: 10.1097/SLA.0b013e 31817b65f2. DOI: https://doi.org/10.1097/SLA.0b013e31817b65f2
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Олександр Гриненко, Олена Підопригора
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish their work in Hospital Surgery. Journal by L. Ya. Kovalchuk agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
