Iatrogenic Bile Duct Injury Following Open and Laparoscopic Cholecystectomy and Treatment Outcome

Abstract

Objective • To find out the frequency of iatrogenic bile duct injury following open and laparoscopic cholecystectomy and their postoperative outcome. Study design Descriptive case series. Place & Duration of study Department of Surgery, Hayatabad Medical Complex (HMC) Peshawar, from April 2014 to May 2016. Methodology Twenty patients with iatrogenic bile duct injuries were admitted through OPD and emergency department. Routine baseline investigations were done. MRCP and ERCP were performed in selected cases. Postoperatively patients were monitored in surgical ward and sent home after removing their drains. Patients were followed up in the OPD for six months. Data was collected and analyzed on SPSS version 10. Results Out of 20 cases, 8 (40%) sustained injuries in our unit while 12 (60%) were referred from peripheral hospitals. Mean age of patients was 40±3 year and male to female ratio was 1:4. Presenting complaints were jaundice, abdominal pain and persistent bile discharge. Procedure performed included Roux en Y choledochojejunostomy (n=13 - 65%), choledochoduodenostomy (n=5 - 25%) and primary repair over T-tube (n=2 - 10%). Postoperative complications were bile leak (n=2 - 10%), wound infection (n=3 - 15%) and recurrent cholangitis (n=1 - 5%). Hospital stay was between 10-15 days. Conclusion Roux en Y choledochojejunostomy was the preferred surgical procedure for iatrogenic bile duct injuries with minimal postoperative complications. Key words Bile duct injury, Biliary leak, Roux en Y choledochojejunostomy.