Prompt Repair of Post Cholecystectomy Bile Duct Transection Recognized Intraoperatively and Referred Early: Experience from a Tertiary Care Teaching Unit.

Abstract

Postcholecystectomy bile duct injuries are a cause of significant morbidity and occasional mortality. Intraoperative recognition and repair of complete biliary transection with hepaticojejunostomy is the recommended treatment; however, it is possible only in few patients as either the injury is not recognized intraoperatively or the center is not geared up to perform an urgent hepaticojejunostomy in these patients with a nondilated duct. Retrospective analysis of data from a tertiary care referral center over a period of 10years from January 2000 to December 2009 to report the feasibility and outcomes of prompt repair was done (defined as repair within 72h of index operation) of postcholecystectomy bile duct injury. Ten patients of postcholecystectomy bile duct injury detected intraoperatively and referred early underwent prompt repair. All patients had a complete transection of the bile duct (type of injuries as per Strasberg classification: Type E V: 1, Type E III: 5, Type E II: 3 and Type E I: 1). The mean duration between injury and bile duct repair in the form of Roux-en-Y hepaticojejunostomy (RYHJ) was 22.7 (range 5-42) hours. The mean diameter of the anastomosis was 1.63 (range1-2.1) cm, and the anastomosis was stented in 7 patients. The mean duration of surgery was 4.6 +1.7h. One patient developed bile leak on the first postoperative day, which settled by day 5. The mean duration of hospital stay was 5.1 (range 4-8) days. With a mean follow-up of 42 (range 24-110) months, all patients had excellent (70%) or good outcome (30%). Prompt RYHJ (within first 72h) for postcholecystectomy biliary transection is an effective treatment and potentially limits the morbidity to the patient.