Iatrogenic Lesions of the Bile Ducts - a Surgical Strategy

Abstract

Background: Bile duct injury is a complex and serious complication. Recently reported incidence of major BDI ranges from 0.3 to 0.55%. The objective of our study was to evaluate diagnostic and management strategies for the treatment of patients with iatrogenic lesions of the bile ducts (open and laparoscopic). Patients: Retrospective study of 81 patients with BDI was done - 57 female, 24 male. 72 of them had their primary surgery in another clinic. According to the site of lesion, the distribution was the following: d. hepaticus com. - 34; d. hep. dex - 15; confluens - 9; d. choledochus - 20. The most important factors predisposing to BDI are: anatomic variations and abnormalities of the biliary tract; severe fibroplastic adhesions in Callot`s triangle; extreme obesity in the region of the porta hepatis; local intraoperative hemorrhage; emergency surgeries; insufficient preoperative diagnosis; low qualification of the operating staff.Results: The appropriate management of biliary tract injuries depends on: time of diagnosis after the initial injury; type of lesion; extent and level of the injury. The performed operative procedures were: hepatico/choledocho/-jejunostomy - 61, T-tube drainage - 6; choledocho-duodenostomy - 3; T-T anastomosis with T-dr. - 4; hepato-jejunostomy - 2; endoprosthesis - 2. There was no postoperative mortality but there was high postoperative morbidity leading to prolonged hospitalization and high hospital cost.Conclusions: Factors related to the prognosis that must be emphasized are: surgeons` experience and skills; location of the stricture; diameter of the anastomosis. Long-term follow-up is necessary to fully evaluate the results of biliary reconstruction for BDI. They are best achieved in highly qualified hepatobiliary centers performing biliary reconstruction with a Roux-en-Y hepatico-jejunostomy.