Immediate surgical repair of post-laparoscopic cholecyctectomy bile duct injuries: The earlier the better

Abstract

Background: Most of bile duct injuries (BDI) diagnosed during laparoscopic cholecystectomy requires surgical reconstruction, and this repair is preferably performed in the late period. We aimed to assess long-term outcomes after repair, focusing on immediate surgical treatment. Methods: Between January 2012-October 2015,patients,who underwent immediate surgical repair(within 72 hours) for post-cholecystectomy BDI by the same surgical team expert in hepatobiliary surgery.Demographics,type of BDI,time to diagnosis,surgical procedures and outcome were recorded. Results: There were 11 patients with a median age of 46(24–65). Classification of BDIs were as follows:Type E in five patients (45%),TypeD in three patients(27%),Type C1,TypeB and TypeA in one patient each(9%).Median time to diagnosis was 12(5–48) hrs. Surgical procedures included Roux&Y hepaticojejunostomy for 5 patients with type E injury, primary repair of common bile duct for 3 patients with TypeD injury and primary suturing of the gallbladder bed was performed in one case with typeC injury. Other two patients with typeB and A injury underwent removal of clips that placed on common bile duct during index operation and re-placing of clips on cystic duct where stump bile leakage was observed.Median length of hospital stay was 5 days(3–12).Morbidity rate 27%(n = 3) was observed during a median follow-up period of 25 months(6–40). Conclusion: Immediate surgical repair of post-cholecystectomy BDIs by an experienced surgical team results in promising outcome.