Iatrogenic bile duct injury: experience of a multidisciplinary team in a Federal University in Brazil

Abstract

Background: Iatrogenic bile duct injury (BDI) is the most feared complication associated with cholecystectomy. Despite laparoscopic improvments, inflammation of the gallbladder, anatomical variations, poor technique employed and bleeding are some of the risk factors associated with this injury. In this study, we aim the results of surgical treatment of BDI, with emphasis on clinical preoperative conditions, results and complications. Methods: Data from thirty three patients who had suffered a BDI were reviewed. The following variables were analyzed: gender, age, conditions of cholecystectomy, type of surgery, symptoms, classification of injury (Bismuth classification), treatment and complications. Results: Twenty two patients were female and eleven were male, with a mean age of 46.1 years. Twenty four patients (72.7%) had an open cholecystectomy and 9 (27.3%) had a laparoscopy approach. Only 1 patient underwent intraoperative cholangiography. Nine injuries (27.3%) were diagnosed intraoperatively. Twenty six patients (78.8%) had cholestasis, 6 (18.2%) had biliary fistula and 9 (27.3%) showed biliary peritonitis. Three patients (9.1%) had a type I injury, 14 (42.4%) type II, 10 (30.3%) type III, 5 (15.1%) type IV, and 1 (3.1%) type V. Hepaticojejunostomy was the most frequently performed surgery as definitive treatment for BDI (84.8%). Nine patients (27.3%) developed late complications, and 2 patients (6.1%) died. Conclusion: Most injuries occurred during open cholecystectomy and intraoperative cholangiography was rarely used. Therefore, few injuries were diagnosed intraoperatively. For most injuries, hepaticojejunostomy was performed as definitive surgical treatment due to the complexity of injuries.