Bile Duct Injuries During Open and Laparoscopic Cholecystectomy

Abstract

Background: Common Bile duct injury after cholecystectomy remains one of the most serious iatrogenic catastrophes associated with significant postoperative morbidity and may lead to death after a short period of systemic inflammatory response and multi-organ failure syndrome. Aim of Study: To study the diagnosis and management of bile duct injuries during open and laparoscopic cholecystectomy, to avoid further bile duct injuries and its morbidity and mortality. Patients and Methods: This Study was a prospective comparative study on iatrogenic bile duct injury (BDI) after laparoscopic and open cholecystectomy. The cases were performed in the period from April 2015 till February 2018. In which 40 patients with bile duct injuries, 20 after open cholecystectomy (OC) and 20 after laparoscopic cholecystectomy (LC) were managed. Results: The number of cases done was 40 patients: 20 patients; 7 (17.5%) males, 13 (32.5%) females post laparoscopic cholecystectomy, Mean age was 44.3 while overall age range from 25-62 years. 20 patient 9 (22.5%) males, 11 (27.5%) females post open cholecystectomy, Mean age was 42.2 while overall age range from 27-65 years, Fifteen (37.5%) of them associated with diabetes mellitus. Management of BDI after open cholecystectomy was one conservatively, 14 by ERCP with stent, 3 by hepaticojejunostomy and 2 by Choledochojejunostomy. After laparoscopic cholecystectomy were managed 2 conservatively, 12 by ERCP and 6 by hepaticojejunostomy. Conclusion: CBD injury complication with early diagnosis and prompt treatment can save patient's life with subsequent few or no complication even after its reconstructive surgery. Training must be emphasized to find all possible ways of recognizing biliary tract anatomy during surgery and possess skills to overwhelm the primary and leading cause of bile duct injury i.e. the visual misperception.