title: Bile Duct Injury-from Injury to Repair: an Analysis of Management and Outcome.
abstract: Despite advances in speciality care, mortality and morbidity remain the most important issues in the management of post-cholecystectomy bile duct injuries. We analysed the peri-operative management of post-cholecystectomy bile duct injuries to assess their outcomes. Of 150 patients with post-cholecystectomy bile duct injuries, 13 patients who presented with strictured hepaticojejunostomy were excluded from the analysis. The records of the remaining 137 patients were analysed for type of presentation, management and follow-up. Of 137 injuries, 88 were open and 49 were laparoscopic. Various presentations include acute bile duct injury (n = 5), bile collection (n = 45), external biliary fistula (n = 46) and stricture (n = 41). After initial management, three patients died (sepsis, n = 2; pseudoaneurysmal bleed, n = 1). Of 107 patients who underwent definitive repair, three died (portal hypertension, n = 2; sepsis, n = 1). At median follow-up of 30 months, 100 patients had good outcome (grade A, B), and only 4 had bad outcome (grade C, D) as per McDonald grading. Peritonitis and sepsis in the early phase and portal hypertension and cirrhosis in the late phase are the main causes of mortality in patients sustaining bile duct injury during cholecystectomy. Successful management in a specialist hepatobiliary centre can limit the morbidity in more than 90 % cases.
authors.affiliation: Department of Gastrointestinal Surgery, G B Pant Hospital and Maulana Azad Medical College, Room no. 219, 2nd floor, Academic Block, 1, Jawaharlal Nehru Marg, 110002 New Delhi, India.
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Mishra
authors.affiliation: Department of Gastrointestinal Surgery, G B Pant Hospital and Maulana Azad Medical College, Room no. 219, 2nd floor, Academic Block, 1, Jawaharlal Nehru Marg, 110002 New Delhi, India.
authors.forename: Sundeep Singh
authors.initials: SS
authors.lastname: Saluja
authors.affiliation: Department of Gastrointestinal Surgery, G B Pant Hospital and Maulana Azad Medical College, Room no. 219, 2nd floor, Academic Block, 1, Jawaharlal Nehru Marg, 110002 New Delhi, India.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Nayeem
authors.affiliation: Department of Gastroenterology, G B Pant Hospital and Maulana Azad Medical College, Room no. 203, 2nd floor, Academic Block, Jawaharlal Nehru Marg, 110002 New Delhi, India.
authors.forename: Barjesh Chander
authors.initials: BC
authors.lastname: Sharma
authors.affiliation: Department of Gastrointestinal Surgery, G B Pant Hospital and Maulana Azad Medical College, Room no. 219, 2nd floor, Academic Block, 1, Jawaharlal Nehru Marg, 110002 New Delhi, India.
authors.forename: Nilesh
authors.initials: N
authors.lastname: Patil
keywords: Benign biliary stricture; Bile duct injury; External biliary fistula; Hepaticojejunostomy