Management of bile duct injuries : comparative study between Roux-en-Y hepaticojejunostomy and primary repair with stent placement

الملخص EN

Bile duct injury (BDI) is a major complication in biliary surgery such as laparoscopic cholecystectomy.

The management of major BDI is a surgical challenge even for experienced hepatobiliary surgeons.

The aim of this study was to introduce a new surgical technique for reconstruction of the biliary duct by primary repair after stent placement. Patients and methods : The present study was carried out on a selected group of BDI patients (34 patients), who were referred for management of BDIs.

Patients were divided into two equal groups : group A underwent primary repair of the bile duct by placement of a plastic stent (which is used in endoscopic retrograde cholangiopancreatography) and group B underwent Roux-en-Y hepaticojejunostomy. Results : The study included 34 patients, 10 men (30.9 %) and 24 women (69.1 %) with a mean age of 40.84 years, whose main presentations were postoperative jaundice (82 %) and bile leak (15 %).

All the patients underwent surgery successfully.

There was no intraoperative mortality and bile leakage during the observation period, but primary repair of the bile duct with plastic stent placement was associated with better results as regards operation time, hospital stay, cost, safety, and postoperative complications. Conclusion : Primary repair of the bile duct with stent placement showed good results, involved minimal morbidity, hospital stay, and cost; and helped avoid the drawbacks of Roux-Y hepaticojejunostomy.

It also replaced exploration of the common bile duct with a T-tube, with advantages of function of the Oddis sphincter.