Objective
To evaluate the management strategies following bile duct injuries.
Design and duration
This was a prospective analysis conducted from March 2015 to March 2017.
Setting
The study was conducted at the Department of Surgery, Zagazig University
Hospitals.
Patients and methods
The study included all patients who were admitted with iatrogenic biliary injuries
during this period. The patients were evaluated according to their clinical features
and certain laboratory and imaging investigations. After appropriate preparations,
they were managed based on Bismuth Classification.
Results
A total of 27 patients presented with iatrogenic biliary injuries over a period of 2 years
among all 420 cases that underwent cholecystectomy during this period. There were
16 females and 11 males, with a median age of 40 years. A total of 18 patients had
laparoscopic cholecystectomy, whereas nine had open cholecystectomy. Twelve
cases belonged to our unit whereas 15 were referred from other institutes. Four
patients were detected intraoperatively, 15 patients presented with obstructive
jaundice, four patients presented with biliary fistula, and four patients presented
with collection. Of which, one had ultrasound-guided aspiration and five had
endoscopic retrograde cholangiopancreatography (ERCP) stenting done, whereas
two underwent peritoneal lavage with drain placement, 16 patients had
hepaticojejunostomy, and one patient had choledechodoudenostomy. We had one
postoperative mortality owing to hepatorenal failure.
Conclusion
Strategies need to be developed for dealing with bile duct injuries, with a view to
reduce morbidity and mortality, as early recognition and timely management
improve the outcome of these patients.