Postcholecystectomy bile duct injuries: experience with 49 cases managed by different therapeutic modalities.
OBJECTIVE
In this study we present our experience in the management of iatrogenic biliary injuries. Forty-nine cases with iatrogenic biliary injuries were managed in our center during the period from 1984 to 1995.


METHODS
Forty patients were referred from other hospitals after cholecystectomy, and 9 cases underwent the original operation in our center. Four (0.3%) of our patients after 1300 conventional cholecystectomy, and 5 (0.9%) cases after 550 laparoscopic cholecystectomy.


RESULTS
The injuries were recognized intraoperatively in 5 (10%) cases and were immediately repaired, 3 cases by axial anastomosis and T-tube drainage, 2 cases by hepatico-jejunostomy (Roux-en-Y). The injuries were detected in the remaining 44 patients postoperatively from one week up to 2 months, the mode of presentation was jaundice in 39 (89%) cases, biliary fistula with or without jaundice and biliary peritonitis were detected in 13 (30%) and in 4 (9%) cases respectively. Eleven (25%) cases were treated endoscopically by sphincterotomy, stent in 8 cases, dilatation and double stent in two cases, and dilatation using rigid dilators and stent in one case. The remaining 33 (75%) cases were treated surgically by hepatico-jejunostomy in 21 (64%) cases, and hepatico-duodenostomy in 12 (36%) cases. No hospital mortality occurred, but late mortality occurred in two (5%) patients after surgery due to biliary restricture with progressive cirrhosis in one case, and due to advanced colon cancer in the other case, an din one (9%) case after endoscopic treatment. We achieved 87% excellent surgical results during the period of follow-up (36 months), while 80% excellent results were achieved after endoscopic treatment. Good final results (95%, 83%) were achieved after hepatico-jejunostomy and after hepatico-duodenostomy respectively.


CONCLUSIONS
Postcholecystectomy biliary injuries present a surgical problem needing extra efforts and careful management. Hepatico-jejunostomy appears to be the procedure of choice in repairing these injuries. Immediate surgical repair of bile duct injury offers excellent results with lower morbidity rates. Endoscopic treatment may be a less invasive technique and have a role in some types of injuries, but needs more time for accurate evaluation.
Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
M
M
Abdel Wahab
G
G
el-Ebiedy
A
A
Sultan
N
N
el-Ghawalby
O
O
Fathy
N
N
Gad el-Hak
A
A
Abo Elenin
M
M
Abo Zid
F
F
Ezzat
D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000293:injuries* / Q000473:pathology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy; D003251:Constriction, Pathologic; D004106:Dilatation; D004385:Duodenostomy; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007582:Jejunostomy; D008099:Liver / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery / Q000628:therapy*; D016717:Sphincterotomy, Endoscopic