Critical study of latrogenic bile duct injuries

ABSTRACT

latrogenic bile duct injury remains a serious and challenging complication following surgeries of the biliary tract, specially cholecystectomies. Numerous factors influence the outcome of repair of bile duct injuries. This prospective research was performed on 20 patients we received between May 1998 and March 2001, aiming to study different bile duct injuries following open or laparoscopic cholecystectomy as regards the type of injury. aiming of identification, the clinical presentation, methods of investigations and various modalities of correction and follow up. We received 14 cases after open cholecystectomy and 6 patients after laparoscopic cholecystectomy. 4 of them were recurrent after previous repair. One case was detected intraoperatively and primary repair was done while the time of presentation of the other cases ranged between days and 18 months. The main presentations were or biliary peritonitis. ERCP succeeded in treatment of 4 cases and one case was treated by percutaneous transhepatic dilatation and stenting. The other cases were treated either by primary repair in one case, delayed primary in one case, choledecro-doodenostomy in one case, cholectecro-jejunostomy in one case and 12 cases were treated by either Rouxen-Y or simple loops hepatico-jejunostomy. We had only one recurrence in a redo case which was treated by PTC dilatation and stenting. High or left duct approach offers good results in complicated or recurrent cases. Percutaneous transhepatic dilaration and stenting has to be considered first in recurrent cases