IATROGENIC BILE DUCT INJURIES: EXPERIENCE AT PIMS

Authors

  • Rasool Bakhsh
  • MA Zahid
  • Faisal Saud Dar
  • Zafar Iqbal Malik
  • Noor Akhtar
  • Samia Akhtar

Abstract

Background: Cholecystectomy is one of the most familiar and commonly performed elective operation in general surgery. However, bile duct injury is a rare but one of the worst complications of this procedure. Although infrequent in expert hands, it is usually encountered when comparatively inexperienced surgeons are operating. These injuries present at variable time after the primary surgery. The prompt recognition and active management affects the morbidity and mortality associated with it. We evaluated the data of the hospital to find out the nature of injuries inflicted to extra hepatic bile duct and its management. Methods: This is a study of 20 cases of iatrogenic bile duct injury managed at the Department of Surgery Unit 1, PIMS. The study includes cases that had undergone cholecystectomy, open or laparoscopic in previous 11 years and sustained injury to the biliary tree and were managed accordingly. Patients with hepatobiliary malignancy were excluded. Results: Twenty cases were found to have various types of bile duct injuries. All patients were females, and their average age was 35 years. In four cases the injury occurred during surgery at our hospital, while remaining 16 cases were referred from other hospitals. All the patients were explored and managed accordingly. They had uneventful recovery and had good outcome at 6 months. Conclusion: Although the fact is that, the sooner an injury is recognized and treated, the better is the outcome. However, in this study the duration of injury had no effect on final outcome.KEYWORDS: Bile duct injuries, Cholecystectomy, Iatrogenic.

References

Ahrendt SA, Pitt HA. Biliary tract. In: CM Townsend. Sabiston Textbook of Surgery. WB Saunders Company, Philadephia, Pennsylvania. 2001: 1076- 1111.

Neuhaus P, Schmidt SC, Hintze RE, Adler A, Veltzke W, Raakow R, et al. Classification and treatment of bile duct injuries after laparoscopic cholecystectomy. Chirurg 2000; 71(2): 166-73.

Branum G, Schmitt C, Baillie J, Suhocki P, Baker M, Davidoff A. Management of major biliary complications after laparoscopic cholecystectomy. Ann of Surg 1993 ;( 217): 532-41.

ldar S, Sabo E, Nash E, Abrahamson J, Matter I. laparoscopic versus open cholecystectomy in acute cholecystitis Surg Laparosc Endosc 1997;7(5):407-14

Zacks SL, Sandler RS, Rutledge R, Brown RS. A population-based cohort study comparing laparoscopic cholecystectomy and open cholecystectomy. Am J Gastroenterol 2002;97(2):334-40

Pleas HCC, Garden OJ. Bile duct injury: prevention and management. Johnson CD, Taylor I. Ed. Recent Advances in Surgery. Churchill Livingston. 1998, 21:1-16.

Ahrendt SA, Pitt Ha. Surgical therapy of iatrogenic lesions of biliary tract. World J Surg 2001; 25(10)):1360-5

Azagra JS, De Simone P, Goergen M. Is there a place for laparoscopy in management of post cholecystectomy biliary injuries? World J Surg 2001; 25(10): 1331-4

Huang ZQ, Huang XQ. Changing patters of traumatic bile duct injuries: a review of forty years experience. World J Gastroenterol 2002;8(1):5-12

Fletcer DR, Hobbs MS, Tan P, Valinsky LJ, Hockey RL, Pikora TJ, et al. Complications of cholecystectomy: risks of the laparoscopic approach and protective effect of operative cholangiography. Ann Surg 1999; 229(4):449-57

Chaudhary A, Negi SS, Puri SK, Narang P. Comparison of magnetic resonance cholangiography and percutaneous transhepatic cholangiography in the evaluation of bile duct strictures after cholecystectomy. Br J Surg 2002;89(4):433-6

Polat F R, Abci I, Coskun I, Uranues S. The importance of intraoperative Cholecystectomy. JSLS 2000; 4: 103-7.

Csendes A, Navarrete C, Burdiles P, Yarmuch J. Treatment of Common bile duct injuries during laparoscopic cholecystectomy: Endoscopy and surgical management World J Surg 2001;10:121-5

Raute M, Podlech P, Jaschke W, Manegold BC, Trede M, Chir B. Management of bile duct injuries and strictures following cholecystectomy. World J Surg 1993; 17, 553-62.

Sawaya DE Jr, Johnson LW, Sittig K, McDonald JC, Zibari GB. Iatrogenic and non iatrogenic extrahepatic biliary tract injuries: a multi-institutional review. Am Surg 2001; 67(5): 473-7

Jeffery S B, Gerald MF, Alan NB, Harvey HS, John EH, Jacob G et al. Cholecystectomy without operative Cholangiography. Ann of Surg 1993; 218: 371-9.

Al-Ghnaniem R, Benjamin IS. Long term outcome of hepaticojejunostomy with routine access loop formation following iatrogenic bile duct injury. Br J Surg 2002; 89(9): 1118-24.

Palacio-Ve'lez F, Casro-Mendoza A, Oliver Guerra AR. Results of 21 years of surgery for related iatrogenic bile duct injuries. Rev Gastroenterol Mex 2002;67(2): 76-81

Azagra JS, De Simone P, Goergen M. Is there a place for laparoscopy in management of post cholecystectomy biliary injuries? World J Surg 2001; 25(10): 1331-4