Short and Long-term Results after Surgical Repair in Patients with Iatrogenic Biliary Injuries

Abstract

Purpose: Iatrogenic bile duct injury is a complication associated with significant perioperative morbidity and mortality. The aim of this work is to analyse the results of surgical repair after biliary duct injury in our institution. Methods: This is a retrospective study from 2007 to 2019. All patients who underwent surgical repair were included. Demographic variables, type of lesions, surgical complications and evolution after surgical repair of the iatrogenic lesion were analyzed. Results: During this period a total of 41 surgical repairs were performed for iatrogenic injuries after cholecystectomy. The mean age of the patients was 57 years (28-82), 51.2% were male. Biliary iatrogenic procedures were performed laparoscopically in 78% of cases; 17.1% occurred during emergency cholecystectomy. At the initial surgery, cholecystectomy was described as a difficult procedure in 42.5% of the cases. The main indication in 78% of the patients was symptomatic cholelithiasis. In 4 patients (9.8%) an attempt at repair was made after intraoperative detection, and 10 patients (24.4%) underwent reoperation prior to referral to our unit. The highest percentage of lesions were located in the common bile duct 58.5%, according to the Strasberg classification, the most common type of lesion was E2 in 31.7% followed by E3 in 19.5%. The repair performed in 78% of the cases was hepaticojejunostomy. Postoperative complications occurred in 43.9% of patients, with severe Clavien-Dindo ≥ III complications in 17.1%. Two patients (4.8%) died postoperatively. Survival free of biliary complications was 89.8%. The median time from iatrogenic to repair was 21 days. No differences were found between patients operated on before or after 3 weeks post injury (45% vs. 42.9%; p = 0.75). Conclusion: The most frequent site of injury was the common bile duct. Hepaticojejunostomy was the most frequently technique used. Long-term results of surgical repair are satisfactory. We did not find differences between repair before three weeks or later.