Management of cholecystectomy-induced biliary injuries at Zagazig University Hospital

Abstract

Objective To evaluate the management strategies following bile duct injuries. Design and duration This was a prospective analysis conducted from March 2015 to March 2017. Setting The study was conducted at the Department of Surgery, Zagazig University Hospitals. Patients and methods The study included all patients who were admitted with iatrogenic biliary injuries during this period. The patients were evaluated according to their clinical features and certain laboratory and imaging investigations. After appropriate preparations, they were managed based on Bismuth Classification. Results A total of 27 patients presented with iatrogenic biliary injuries over a period of 2 years among all 420 cases that underwent cholecystectomy during this period. There were 16 females and 11 males, with a median age of 40 years. A total of 18 patients had laparoscopic cholecystectomy, whereas nine had open cholecystectomy. Twelve cases belonged to our unit whereas 15 were referred from other institutes. Four patients were detected intraoperatively, 15 patients presented with obstructive jaundice, four patients presented with biliary fistula, and four patients presented with collection. Of which, one had ultrasound-guided aspiration and five had endoscopic retrograde cholangiopancreatography (ERCP) stenting done, whereas two underwent peritoneal lavage with drain placement, 16 patients had hepaticojejunostomy, and one patient had choledechodoudenostomy. We had one postoperative mortality owing to hepatorenal failure. Conclusion Strategies need to be developed for dealing with bile duct injuries, with a view to reduce morbidity and mortality, as early recognition and timely management improve the outcome of these patients.