Reconstruction of Iatrogenic Bile Duct Injuries following Laparoscopic Cholecystectomy

Abstract

Objectives: To find out the management outcomes of iatrogenic bile duct injuries following laparoscopic cholecystectomy. Methodology: In this descriptive case series study total of 90 patients of both gender and who sustained extra hepatic biliary injuries, were included. Patients managed through ERCP and stenting and those with hepatobiliary malignancy were excluded. These 90 cases included those patients who sustained biliary injury during laparoscopic cholecystectomy at the department of surgery, Hayatabad Medical complex, Peshawar from July 2021 to June 2024 and those referred from peripheral hospitals and Afghanistan. Investigations modalities included abdominal ultrasonography and MRCP in all referred cases while ERCP was performed in selected cases. Procedures were performed by senior surgeons. Patients were followed up in outpatient department (OPD) for six months. Data was collected on a predesigned proforma and analyzed through SPSS version 16. Results: The age range of patients was 28-56 years with a mean age of 43 years (SD ± 2.5 years). Male to Female ratio was 1:5. The presenting complaints were pain (77.8%), jaundice (76.7%), fever (74.4%), biloma (50.0%) and persistent biliary leak (40.0%). Sites of injury involved CHD (26.7%), CBD (53.3%), porta hepatis (7.8%) and 12.2% cases had biliary strictures. The most commonly performed procedure was Roux-en-Y hepaticojejunostomy (54.4%) followed by Choledochodudenostomy (21.1%), primary repair (16.7%) and Roux-en-Y Portoenterostomy (7.8%). Postoperative morbidity included bile leakage (8.9%), wound infection (16.7%), recurrent cholangitis (20.0%) and anastomotic stenosis (3.3%). Mortality rate was 4.4% and overall success rate was 95.6%. Conclusions: CBD was the most frequent site injured during laparoscopic cholecystectomy. Roux-en-Y hepaticojejunostomy is the most commonly performed procedure with a good success rate in experienced hands.