Abstract

*Dr. Purujit Choudhury and Dr. Abhijit Sarma

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 72 h 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 (rangel – 2.1) cm, and the anastomosis was stented in 7 patients. The mean duration of surgery was 4.6 + 1.7 h. 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 72 h) for postcholecystectomy biliary transaction is an effective treatment and potentially limits the morbidity to the patient.