SURGICAL MANAGEMENT AND OUTCOME OF COMPLEX BILE DUCT INJURY AFTER LAPAROSCOPIC CHOLECYSTECTOMY: LOCAL EXPERIENCE IN SULAYMANI CENTER 

Karzan Seerwan Abdullah a



Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq. 
 
 
Submitted: 13/3/2019; Accepted: 29/7/2019; Published: 21/9/2019

ABSTRACT


Background 

Iatrogenic complex bile duct injury (ICBI) is one of the most complex situations produced by a surgeon and is associated with a significant rate of morbidity and low mortality rate. It needs a multidisciplinary team approach to offer a better chance for initial diagnosis and treatment options. 


Objectives 

To review surgical management of ICBI, morbidity, and mortality following surgical repair.


Methods

This is a retrospective study on 29 patients with ICBI who were diagnosed intra-operatively during cholecystectomy or referred post operatively to our center in Sulaymaniyah governorate from January 2013 to March 2018.


Results

In all, 59 patients of bile duct injuries have been treated through surgical repair. In this study, 29 patients were selected according to the inclusion criteria. The age was ranging from 22-65 years. There were 19(65.5%) female patients and 10 (34.48%) male patients. In only 5 (17.2%) of patients, the injury was identified during cholecystectomy. The most common type of ICBI is type III according to Strasberg Classification. 19 of them had satisfactory outcomes after surgical repair of their injuries. Six patients developed stricture within 6 months and they underwent re-do anastomosis. Three patients were referred for liver transplantation. Two patients died within 10 days of surgery because of sepsis. Both patients with porto-eneterostomy developed stricture and subsequent biliary cirrhosis.

Conclusion

Complex bile duct injury has a significant morbidity rate that may affect the quality and quantity of the patient’s life. The more proximal injury has worse prognosis. Porto-enterostomy has a very bad outcome.



KEYWORDS

Complex biliary injury, Management, Outcome.