Abstract

Postcholecystectomy bile duct injuries are the causes of significant morbidity and occasional mortality. Intra-operative recognition and repair of complete biliary transaction with hepaticojejunostomy is the recommended treatment; however, it is possible only in few patients as either the injury is not recognized intraoperatively or the center is not geared up to perform an urgent hepaticojejunostomy in these patients with a nondilated duct. Retrospective analysis of data from our tertiary care referral center over a period of 10 years from January 2010 to December 2019 to report the feasibility and outcomes of prompt repair was done (defined as repair within 72h of index operation) of postcholecystectomy bile duct injury. Ten patients of postcholecystectomy bile duct injury detected intra operatively and referred early underwent prompt repair. All patients had a complete transaction of the bile duct (type of injuries as per Strasberg classification: Type EV: 1, Type E III: 7, Type E II: 3 and Type E1: 1). The mean duration between injury and bile duct repair in the form of Roux-en-Y hepaticojejunostomy (RYHJ) was 22.7 (range 5 - 42) hours. The mean stomal diameter of the anastomosis was 1.63 (range 1 - 2.1) cm, and the anastomosis was stented in 7 patients. The mean duration of surgery was 4.6 + 1.7h. One patient developed bile leak on the first postoperative day, which were settled by day 5. The mean duration of hospital stay was 8 (range 8 - 12) days. With a mean follow-up of 42 (range 24 - 110) months, all patient had excellent (70%) or good outcome (30%). Prompt RYHJ (within first 72h) for postcholecystectomy biliary transaction is an effective treatment and potentially limits the morbidity to the patient.

Keywords: Bile Duct Injury (BDI); Roux-en-Y Hepaticojejunostomy (RYHJ); Cholecystectomy; Biliary Transaction; CBD (Common Bile Duct)

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