Management of postcholecystectomy biliary injury in Assiut University Hospital clinical audit

Abstract

Introduction Laparoscopic cholecystectomy, first introduced in France in 1987, has rapidly substituted open cholecystectomy for the treatment of symptomatic cholelithiasis. Bile duct injuries have remained an important complication and have become more frequent in the era of laparoscopic cholecystectomy. Aim The aim was to compare the management of post-cholecystectomy biliary leakage in patients in Assiut University Hospital with management guidelines through planning for improving our management of biliary leakage, correction of obstacles to achieve less morbidity and less mortality which result from biliary leakage. Patients and methods An observational study was conducted on 30 patients with post-cholecystectomy biliary injuries admitted in the Surgery Department of Assiut University Hospitals from 2017 to 2018. All patients were grouped into either surgical or endoscopic, percutaneous drainage managed groups. Results The most common presentation postoperatively is bile leakage in 14 of the patients (46.66%), followed by jaundice in six patients (20%), and abdominal pain in four patients (13.3%); only two patients discovered during operation has bile duct injury (6.66%) and in the postoperative period in the first month (86.6%). The most common type of bile duct injury occur in open cholecystectomy (73.33) more than in laparoscopic (26.66). Cholangiogram was done in 25 patients. The main cholangiographic picture was minor leakage in about 52% from Cystic duct (CD), stricture above the level of CD in 8%, and common bile duct (CBD) ligation injury in 40%. Conclusion In conclusion the most common type of post-cholecystectomy problems are biliary leakage, followed by ligation of CBD, missed CBDSs, and finally biliary stricture. Endoscopic management is relatively simple, reversible, and minimally invasive. Thus, endoscopic management should be an integral part of the therapeutic algorithm in majority of patients with significant biliary tract injuries.