Publication:

Management of iatrogenic bile duct injury in cholecystectomy: a single centre experience

Background Iatrogenic bile duct injury during cholecystectomy is associated with high morbidity and is a potentially life threatening complication. The aim of the study was to present single centre experience in managing bile duct injuries and outcome after surgical repair.

Methods The study was retrospective analyses of prospectively collected data. Bile duct injury patients admitted from June 2010 to August 2016 were studied. Following patient characteristics were studied demography, indication of surgery, laparoscopic or open cholecystectomy, conversion (done or not), clinical presentation, evaluation, management and outcome. Strasberg classification system was used to classify bile duct injury patients. Patients were categorized in three groups depending upon time of presentation. Group I- patients detected intraoperatively. Patients presenting within 2 weeks of cholecystectomy were categorized as Group II. Group III- Cases admitted after 2 weeks of cholecystectomy. Regular follow up was done every 6 months.

Results Regular follow up every 6 months was done in all the patients. Mean follow up period was 24.5 months (1-60 months). In summary of the 14 patients requiring hepaticojejunostomy 1 required revision surgery (poor outcome), rest of the 13 patients had excellent outcome.

Conclusions Minor bile duct injuries can be managed successfully with endoscopic and stenting. Major injuries can be managed optimally with Roux-en-Y hepaticojejunostomy with good long term results.