Management of bile duct injury in a Mayor Referral Center: experience on 93 cases

Abstract

Introduction: Bile duct injury is a great concern for surgeons, after laparoscopic cholecystectomy the incidence is double compared with open procedure and now the incidence is 0.7 %; The objective of this study is demonstrate how the specialization in referral centers improve the outcomes of the management of these injuries. Methods: The study included 93 patients with bile duct injury post cholecystectomy From January 2009 to August 2015. We analyzed the features and treatment of this mayor bile duct injuries. Results: The mean age was 36.8 years. 57 (62%) were females and 36(38%) males. 54 (58%) BDI were after laparoscopic and 39 (42%) after open procedure, the time of reference in 65 (70%) was within a month. and 28 (30%) after a month. According to theBismuth classification: 28 (30%) cases were Bismuth I, 34 (37%) Bismuth II, 18 (19%) Bismuth III and 13 (14%) Bismuth IV. In all the cases, we performed Roux-in -Y hepaticojejunostomy, the cases Bismuth III we performed Hepp–Couinaud hepaticojejunostomy; in 9 cases of Bismuth IV we performed 2 duct anastomosis and in 2 of them with transanastomotic stent and; 4 cases included hepatic resection. During the five years of follow up there was no mortality after surgery, but there were 3 (3.1%) cases of postoperative stricture (2 were treated with percutaneous dilatation and one went to a new surgery). Conclusions: Management of bile duct injuries by specialized surgeons improves the operative and long results and encourage to early referral all the cases of bile duct injury to hepatobiliary service.