Surgical management and follow up of patients with bile duct injuries in tertiary health care institute
DOI:
https://doi.org/10.18203/2349-2902.isj20210933Keywords:
ALP, Bileduct injuries, Hepatico-jejunostomy, LFTAbstract
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.
References
Strasberg S. Error traps and vasculo-biliary injury in laparoscopic and open cholecystectomy J Hepatobiliary Pancreat Surg. 2008;15:284-92.
Perini RF, Uflacker R. Isolated right segmental hepatic duct injury following laparoscopic cholecystectomy. Cardiovasc Intervent Radiol. 2005;28:185-95.
Ferguson CM, Rattner DW, Warshaw AL. Bile duct injury in laparoscopic cholecystectomy. Surg Laparosc Endosc Percutaneous Techniques. 1992;2:1-7.
Walker AT, Brooks DC, Tumeh SS, Braver JM. Bileduct disruption after laparoscopic cholecystectomy. Semin in Ultrasound CT MR. 1993;14:346-55.
Lillemoe KD, Petrofski JA, Choti MA, Venbrux AC, Cameron JL. Isolated right segmental hepatic duct injury: a diagnostic and therapeutic challenge. J Gastrointest Surg. 2000;4:168-77.
Puente SG, Bannura GC. Radiological anatomy of the biliary tract: variations and congenital abnormalities. World J Surg. 1983;7:271-6.
Stewart L, Robinson TN, Lee CM, Liu K, Whang K, Way LW. Right hepatic artery injury associated. With laparoscopic bile duct injury: incidence, mechanism, and consequences. J Gastrointest Surg. 2004; 8523-531.
Yamamoto S, Sato Y, Oya H, Nakatsuka H, Kobayashi T, Hara Y, et al. Risk factors and prevention of biliary anastomotic complications in adult living donor liver transplantation. World J Gastroenterol. 2007;13:4236-41.
Ishiko T, Egawa H, Kasahara M, Nakamura T, Oike F, Kaihara S, et al Duct-to-duct biliary reconstruction in living donor liver transplantation utilizing right lobe graft. Ann Surg. 2002;2:235-40.
Schol FP, Go PM, Gouma DJ. Risk factors for bile duct injury in laparoscopic cholecystectomy: analysis of 49 cases. Br J Surg. 1994;81:1786-8.
Sicklick JK, Camp MS, Lillemoe KD, Melton GB, Yeo CJ, Campbel KA, et al. Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy. Ann Surg. 2005;241(5):786-95.
Helmy MA. Iatrogenic bile duct injuries: management of ten patients. J Egypt Soc Parasitol. 2008;38(3):873-82.
Lubikowski J, Post M, Białek A, Kordowski J. Surgical management and outcome of bile duct injuries following cholecystectomy: a single-centre experience. Langenbecks Arch Surg. 2011;396:699-707.
Rossi RL, Schirmer WJ, Braash JW, Saunders LB, Munnson JL. Laparoscopic bile duct injuries, risk factors, recognition and repair. Arch Surg. 1992;127:596-601.
Hajjar NA, Tomuş C, Mocan L, Mocan T, Graur F, Iancu C, et al. Management of bile duct injuries following laparoscopic cholecystectomy: long-term outcome and risk factors influencing biliary reconstruction. Chirurgia (Bucur). 2014;109(4):493-9.
Khalid TR, Casillas VJ, Montalvo BM. Using MR cholangiopancreatography to evaluate iatrogenic bile duct. Injury Am J Roentgenol. 2001;177:1347-52.
Sandberg A, Alinder G, Bengmark S. Accidental lesion of common bile duct at cholecystectomy. Ann Surg. 1985;201:328-32.
Sahajpal AK, Chow SC, Dixon E, Greig PD, Gallinger S, Wei AC. Bile duct injuries associated with laparoscopic cholecystectomy: timing of repair and long-term outcomes. Arch Surg. 2010;145(8):757-63.