Bile Duct Injury: Surgical Use of Endobiliary Stents for the Management in Emergency Situations

Abstract

This study reviews bile duct injuries (BDI) most commonly found in our setup and a novel technique of endobiliary stent usage for management in emergency situations leading to significantly less morbidity and mortality. A total of 211 patients were analyzed out of 214 BDI. All the data regarding demographic details, time of injury, time to referral, surgeons’ perception of anatomy, anatomical variance, and the type of presentation were collected. We propose a new technique and management guideline in the current era of endoscopy and surgery together for the treatment of BDI and benign biliary stricture. We have observed that the mean age was 45.5 years. Out of 211 cases, 175 were after laparoscopic cholecystectomy. Exploration and external drainage of bile was done in initial 12 patients, out of which 3 patients had a combined endobiliary surgical internal stent and T tube. Later on, all patients (38) were internally drained with endobiliary stents. All patients of minor bile duct injury were managed with endoscopic retrograde cholangiography and papillotomy, and endobiliary plastic stenting. Overall, 76% of patients with biliary laceration and segmental injury (less than 1 cm) were managed with endoscopic stent techniques, without definitive surgery. Only 24% of the patient with minor or less than 1-cm laceration group of patients needed hepatico jejunostomy (HJ) along with all major-type bile duct injuries. We propose the use of an endobiliary plastic stents for internal drainage and repair of BDI in emergency and intraoperative situations in order to avoid long-term external drains as well as nutritional and electrolytes issues following high-output biliary fistula. Furthermore, it prevents the progression of biliary stricture.