Post-cholecystectomy bile duct injuries: when to repair?

Abstract

Background: Post cholecystectomy bile duct injury (BDI) though rarely happens; it has its own impact on postoperative outcomes. There is controversy on the optimal time for repair of such injuries. The aim of this study was to analyze the different time modalities used for repair of these injuries and its outcomes.Methods: This was a prospective randomized study conducted at General Surgery Department, Sohag university hospital, from August 2013 to March 2017. It included forty patients diagnosed to have BDI after cholecystectomy divided into 3 groups according to the time of intervention; early, intermediate, and late. We compared them regarding the pre-operative, operative variables and analyzed the post-operative outcomes among groups with one year follow-up after repair. Results: Bile leakage was the main presenting symptom in 100% of patients of early intervention group while there was combination of jaundice (71.43%) and bile leakage (28.57%) in the other two groups, 28.57% of patients of intermediate intervention required ICU admission. In the early intervention group there were tendency towards less severe injuries requiring simpler maneuvers for repair with primary repairs or end to end anastomoses while in late intervention group there were tendency towards more severe injuries requiring more complex maneuvers for reconstruction. In the post-operative course there was a tendency for intermediate intervention group to have higher incidence of complications in the early and late post-operative course (57%, p=0.007). Add to this the intermediate intervention group had the longest hospital stay (p=0.008) and was plagued by mortality rate of 21% (p=0.049).Conclusions: Late repair is superior to other time modalities of intervention in post-cholecystectomy BDI in terms of postoperative outcomes.