Surgical management and follow up of patients with bile duct injuries in tertiary health care institute

Abstract

Background: Bile duct injury is an iatrogenic catastrophe associated with significant mortality, morbidity, decrease quality of life and higher rates of subsequent litigation. We conducted a study to analyse the presentation and pattern of bile duct injury managed at our surgical unit. Operative details, type of surgery, complications associated with the repair and Follow up in terms of liver function tests.Methods: The study included evaluation of 56 patients who had suffered bile duct injuries and then were subsequently being managed surgically at our institute retrospectively from October-2009 to 2012 and prospectively onwards till October- 2014. The mean follow up period in case of our study was 26.8 months. The follow up LFTs were performed at regular intervals. MRCP was used as a gold standard investigation.Results: jaundice (64.2%) was the most common presentation. Injuries noted were, type E1 in 16 (28.5%),type E2 in 11(19.6%), type E3 in 1 (1.8%), type A in 2 (3.6%), type B in 3 (5.4%), type C in 5 (9%) and type D in 18 (32.1%) of patients. Roux-en-y Hepatico-jejunostomy was the common definitive repair performed (85.7%) with various modifications. The mean bilirubin levels and ALP levels showed a downward trend in follow up .5 patients were readmitted with features of cholangitis in which 2 patients were reoperated and 3 patients were managed conservatively, 2 patients died.Conclusions: The management of patients with BDI is a challenge for a surgeon and often requires the skills of experienced hepatobiliary surgeons at tertiary referral canters.