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LAPAROSCOPIC BILE DUCT INJURY.EFFECT OF SURGICAL REPAIR.

Shahidur Rahman, Professor. Bangobandhu Sheikh Mujib Medical University

Introduction: The aim of this study was to analyze the surgical  treatment results of major bile duct injuries.

A single institution prospective analysis of 30 patients with bile duct injuries , underwent surgical repair.

Methods: From January 2004 to september 2018, a prospective records of  all patients with a BDI following LC was The bile duct injuries were classified using the Stewart–Way classifion. Class II injuries  consisted of lateral damage to the hepatic duct with a resultant stenosis and/or fistula. Class III injuries, the most common  involved transection and excision of a variable length of the duct, which always included the cystic duct–common duct junction. The surgeon transected the common duct (deliberately, thinking it was the cystic duct) early in the dissection and transected the common hepatic duct. Class III injuries were subdivided based on the proximal extent of the injury as follows: in class IIIa injuries, a remnant of the common bile duct or common hepatic duct remained; in class IIIb injuries, the proximal transaction was at the bifurcation of the common hepatic duct; in class IIIc injuries, the bifurcation of the common hepatic duct had been excised, and in class IIId injuries, the proximal line of resection was above the first bifurcation of the lobar ducts (into segmental ducts).

Results: Over 14 years, 30 patients were treated for a major BDI following LC. Patient demographics were notable for  women with a mean age of 45.5 years (median 44 years). All patients  sustained their BDI at outside hospital. The mean interval from the time of BDI to referral was 22 weeks (median 3 weeks).  Thirty patients underwent definitive biliary reconstruction hepaticojejunostomY. Five patients sustained at least 1 postoperative complication. The most common complications were wound infection, cholangitis, and intraabdominal abscess/biloma  The mean postoperative length of stay was 9.5 days (median 9 days). Later repairs might have been more successful than earlier ones.Multivariate analysis, however, showed that the timing of the repair was unimportant. Instead, success correlated with: eradication of intra-abdominal infection; complete preoperative cholangiography; use of correct surgical technique, and repair by a biliary surgeon. 

Conclusions: In conclusion, this study demonstrates that the most important factors associated with the success of biliary reconstruction include the complete eradication of intra-abdominal infection (drainage of all bile and fluid collections), complete characterization of the injury with cholangiography, use of the correct surgical technique, and repair performed by an experienced biliary surgeon.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 94333

Program Number: P240

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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