Clinical presentation, types and treatment outcomes of Bile Duct Injuries (BDI) in laparoscopic cholecystectomy.

Abstract

Objectives: To study the types of Biliary injuries (BDIs), their timing and clinical presentation, diagnosis and treatment outcomes in patients undergoing laparoscopic cholecystectomy. Study Design: Descriptive study. Setting: Department of General Surgery Hayatabad Medical Complex (HMC) Peshawar. Period: From October 2017 to October 2018. Materials & Methods: including 32 patients with biliary duct injuries (BDIs). Results: This study included 32 patients with BDI, 28 patients were referred to HMC and 4 patients had their primary operation at Department of General Surgery HMC Peshawar. There were 23 females and 9 males with a mean age of 47 years (range, 20–65 years). After diagnostic workup, the type of BDIs was classified according to the Strasberg classification. As for BDI, 4(12.5%) patients had a leak related to the cystic duct (Type A injury).In 11(34.3%) patients, there was lateral injury of CBD (Type D injury). In 15(46.8%) patients, there was complete transection of CBD (Type E injury). In 2 (6.2%) patients, it was impossible to determine the cause of bile leak which was assumed to be related to aberrant ducts although this was difficult to prove. Conclusion: Laparoscopic cholecystectomy is best if done with proper training and expertise otherwise it can lead to biliary injury thus turning the patient into a "biliary cripple". They mainly result from anatomical variations and cognitive misinterpretation of anatomy .Biliary injuries can be prevented to some extent if principles of laparoscopic surgery are followed.

Retrospective Study of Common Bile Duct Injury after Laparoscopic Cholecystectomy

“…The study includes 50 patients undergone laparoscopic cholecystectomy and complicated by biliary duct injuries and Table (1) shows the descriptive data of 50 patients undergone L.C. complicated by BDI according to their sex as we got 31 females and 19 males with higher incidence with female sex as they are higher incidence for L.C.…”

“…A study performed on 32 patients undergone laparoscopic cholecystectomy and complicated by bile duct injury and found that 12 patients presented by obstructive jaundice and 20 patients presented by bile leak, vomiting, abdominal pain and peritonitis, so increased incidence of obstructive jaundice than bile leak [1].…”

“…Reported study on 32 patients undergone laparoscopic cholecystectomy and complicated by bile duct injury with needed radiological investigations as all 32 patients made pelviabdominal ultrasonography, 7 patients needed CT abdomen, 2 patients needed MRCP and 23 patients needed ERCP, so it indicates that pelvi-abdominal ultrasonography is mandatory as it is cheap and non-invasive followed by ERCP as it can be used as diagnostic and curative in many cases [1].…”

“…A study on 32 patients undergone laparoscopic cholecystectomy and complicated by bile duct injury with screening of different management plans, 2 patients went through conservative treatment and follow up of sub-hepatic drain, 7 patients went through ERCP, stent application and endoscopic sphincterotomy, 4 patients went through abdominal exploration with CBD repair over T-tube, 2 patients went through abdominal exploration and cystic duct closure, 16 patients went through Roux-en-y hepaticojeujonostomy. So the plan of management differs according to type of injury as shown in chapter of results [1].…”

Comparison Between Outcome of Patients Following Saline Irrigation Versus Dry Mopping after Laparoscopic Cholecyetectomy

“…Two most common complications after laparoscopic cholecystectomy contributing to 5-40% 5 cases are the bile leakage and stone spilling intraoperatively with lost stones frequency is not known much. Bile leakage due to rupture of gall bladder contributes to 7% -21.77% 4,5,7 according to most studies with conversion of laparoscopic into open cholecystectomy. Studies showed stone spillage with its retrieval from the fossa of gall bladder can be done by irrigation or be mopping with surgical gauze 7,8 .…”