Iatrogenic bile duct injuries; experience at Allied Hospital, Faisalabad

ABSTRACT

This retrospective study was conducted in Surgical Unit-III, Allied Hospital, Faisalabad. This study was conducted in order to define the frequency and type of bile duct injury both during open and laparoscopic cholecystectomy and to suggest most feasible method of managing these patients with the facilities available. Total number of fifteen cases was collected. Twelve patients were female and three were male with a median age of 38years. Ten cases were operated at some other hospital and five cases had biliary injury at Allied Hospital. Eight patients had biliary tract injury during open cholecystectomy while seven patients sustained such injury during laparoscopic cholecystectomy. Injury was recognized in three patients while operating whereas in 12 cases it went unrecognized. Unrecognized injuries presented in the postoperative period as obstructive jaundice in 03, increased drain output in 04, peritonitis in 03 and cholangitis in 02 patients. Ultrasound, CT, drain contrast studies were the main radiological investigations used in addition to essential biochemical profile of the patients. Classification of the injury was according to Strasberg classification. Primary repair over T-Tube was done in 03 patients whose injury got recognized at the time of primary surgery. Roux en Y hepaticojejeunostomy was performed in 07 patients, T-Tube drainage was provided in 04 and simple intraperitoneal drainage was offered in 01 patient. Cholangitis occurred in 02 patients requiring systemic antibiotics. One patient died due to intraabdominal sepsis. Follow up ranged from 6-18 months. Liver function tests, T-Tube cholangiogram and HIDA Scan were used in selected patients. Tear in CBD is the most common type of injury recognized. Roux -en-Y hepaticojejunostomy is the choice. The prevention is in identifying the anatomy during operation