Title: Bile Duct Injuries Following Laparoscopic Cholecystectomy and their Outcome
Authors: Dr Manawor Ahsan, Dr Mohammad Eqbal Ahmad
DOI: https://dx.doi.org/10.18535/jmscr/v5i6.77
Abstract
Introduction: Bile duct injuries are still among the most common and dreadful complications, following laparoscopic cholecystectomies despite advancement of training and technology.
Methods: Prospective study of bile duct injuries occurring in the period 2013 to 2015 at Nalanda Medical College Patna.
Results: in total, 40 patients (28 women and 12 men) with a median age of 45 (range 10–76) Years had a leak or a lesion of the bile ducts during the study period. Total incidence of Postoperative bile leaks or bile duct injuries was 0.9% and for bile duct injuries separately, 0.4%. Median delay from injury to repair was 5 days (range 0–68 days). In 12 patients (18%), the injury was discovered intraoperatively. Bile leak was the major symptom in 59%, and 52% had a leak from the cystic duct or from assumed aberrant ducts in the liver bed of the gall bladder. Following the clavien–dindo classification, 39% and 45% were classified as IIIA and IIIB, respectively, 10% as IV, and 6% as V. in all, 21 patients had injuries to the common bile duct or hepatic ducts, and in these patients, 21% were treated with a hepaticojejunostomy , 70s% had an uncomplicated event, whereas 2.5% later on developed a stricture. Out of 21 patients with injuries to the cystic duct/aberrant ducts, 14 could be treated with stents or sphincterotomies and percutaneous drainage.
Conclusion: half of injuries following cholecystectomies are related to the cystic duct, and most of these can be treated with endoscopic or percutaneous procedures. A considerable number of patients following hepaticojejunostomy will later on develop a stricture.
Keywords: Laparoscopic cholecystectomy; bile duct injuries; complications; mortality.
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Dr Manawor Ahsan
Assistant Professor, Dept. of Surgery
NCMH, Patna