Timing of surgical repair of IatrogenicMajor bile duct injury during cholecystectomy

Abstract EN

ObjectivesComparison between early and delayed surgical repair of an iatrogenic biliary duct injury during cholecystectomy referred to a hepatobiliary surgeon in terms of mortality and early and long-term morbidity.

Methods and MaterialsBetween January 2004 and June 2018, a retrospective analysis was done on 63 patients with bile duct injuries who were referred to KHMC (King Hussein medical centre/ Hepatobiliary Unit).

All patients with an attempt at repair by the primary surgeon (11 cases) managed non-surgically were also excluded (13 cases) from the study.

The remaining 39 patients were analysed in this study, 13 males and 26 females with biliary injury.

Of these, 11 patients were diagnosed intraoperatively, and 28 patients were diagnosed postoperatively.

In all, 8 patients developed biliary injury during open cholecystectomy and 31 patients during laparoscopic cholecystectomy.

ResultsThe bile duct injuries were classified using the Bismuth-Strasberg classification of bile duct injury, ranging from type A to type E.

Complete preoperative cholangiography was achieved in almost all cases.

Preoperative percutaneous drainage required in ten patients for bile collections, and one for a subhepatic abscess.

Twenty patients underwent biliary reconstruction within 6 weeks of the injury (median time = 2 weeks) and 19 patients after 6 weeks (median time= 13 weeks).

All patients were managed by Roux-en-Y hepaticojejunostomy, except one patient who was managed by laparoscopic suture closure of the cystic duct.

Three patients required surgical revision of the hepaticojejunostomy, one in the late and two in the early group.

Successful surgical reconstruction was possible in early surgical repairs.

There was no mortality among both groups in the early perioperative period.

ConclusionEarly surgical repair of biliary injury is successful in most of the cases when undertaken by a hepatobiliary surgeon, with early referral to a tertiary care centre, and the outcome is similar to that of delayed repair.