Outcome of Post Cholecystectomy Bile Duct Injury Management in a High Volume Referral Center in Iran

Abstract

Introduction: However more than a century pass from first cholecystectomy and iatrogenic bile duct injury, still this is a big problem, here we report our experience in a high volume referral center in Iran about handling of this complication. Methods: We collect data of 59 patient who referred us , suspected to post-cholecystectomy bile duct injury for 3 years since may 2016 both retrospectively through review of charts and calling them and prospectively by regular out-patient visit. Results: In this period 59 patients with age range of 20 to 74y/o referred our center, 15 male and 44 female. 21 patients underwent definite repair in 2 weeks from injury,17 patient after 2 weeks and before 6 weeks and 21 patients after 6 weeks. The most common presenting feature was bilious drain discharge, MRCP and ERCP was falsely negateive in 23.07% and 11.53% repsctively and the most reliable point was primary surgeon think of “something is wrong during surgery”.17% of patients had failed repair in original hospital and 33.9% had exploration ,irrigation and drainage.laboratory abnormality just in 66% of patients detected, most injuries was in Bismuth classII(18%),III(16%)and IV(16%),and Rt hepatic artery injury detected in 27(45.8%)patients.hepatectomy did in two patients and two patients died. No significant deference found when interval from injury to definite surgery compared between groups. Conclusion: Best decision for patients suspected to bile duct injury is referring to a high volume center at any time before exploration and with any interval from injury, HPB surgeon can go for repair.