Surgical Injury of the Common Bile Duct

Abstract

Operative trauma to the biliary tract represents the most dreaded complication during a common and often considered benign cholecystectomy. 23 cases of biliary trauma were collected through a retrospective study conducted between 2012 and 2022 in the visceral surgery department B of the Avicenne University Hospital in Rabat. The mean age was 50 years. The F/M sex ratio was 3.6 with a major female predominance. Acute cholecystitis, pyocholecystitis, obesity, and anatomical variations were the main risk factors found in our patients. For 4 patients, the diagnosis was made intraoperatively upon discovery of bile in the surgical field. For 19 patients, the trauma was discovered postoperatively, with findings such as obstructive jaundice (12 patients), bilioma (3 patients), bile peritonitis (1 patient), and external biliary fistula (1 patient). Paraclinical investigations deployed included abdominal ultrasound performed in 56.5% of cases, endoscopic ultrasound in 17.4%, computed tomography in 21.6%, magnetic resonance cholangiopancreatography in 34.7%, and retrograde cholangiography in 39% of cases. The latter two were the most contributory in making the diagnosis. Repair methods varied from simple surgical drainage for 2 patients, to suturing of the bile duct on a Kehr drain for 2 cases, to hepaticojejunostomy for 17 cases. Only one case could not be repaired due to complicated bile cirrhosis. Long-term outcomes were favorable for 52.4% of cases, with a median follow-up of 13 months. Secondary stenosis was reported in only one case. Prevention and adherence to surgical rules during cholecystectomy remain the best means of avoiding these traumas.