Bile Duct Injury and Repair: Case Series from 1989 to 2020

Abstract

BACKGROUND: The benign lesion of the bile duct is a complication of difficult diagnosis and treatment; which has increased due to the use of laparoscopic cholecystectomy (LC) in the management of cholecystolithiasis. Rates of 0.2 to 0.4% of bile duct injuries have been reported, becoming a significant cause of mortality at the time of repair. METHODS: This is an observational, descriptive study, a retrospective case series, based on primary sources of information. The universe of the study are the patients who underwent surgery for bile duct injury from 1989 to 2020, in a private clinic in the city of Cuenca-Ecuador. RESULTS: In more than 30 years, 24 bile duct injury repairs were performed, which occurred: 6 during conventional surgery and 18 during laparoscopic surgery. 54.2% of the lesions occurred less than two centimeters from the confluence of the hepatic ducts. 58.4% of lesions were repaired with Roux-en-Y anastomosis. Antibiotic therapy and drainage were administered to 100% of the patients; 45.83% of the drains placed were tubular drains. 70.8% of the patients didn´t have complications after the repair procedure; the complications that occurred are: bilioma, fistulas, stenosis, cholangitis. CONCLUSION: In most patients who had bile duct injury, the injury occurred during laparoscopic surgery. The injury was most often located less than two centimeters from the confluence of the hepatic ducts. The most frequently performed repair procedure was the Roux-en-Y anastomosis. The most frequent complication after repair was cholangitis.