BILE DUCT INJURIES AND OUTCOMES: A RETROSPECTIVE MEDICAL RECORD REVIEW

Bile Duct Injuries and Outcomes

Abstract

Objective: To report on our experience of cholecystectomy associated bile duct injuries and observe factors influencing outcomes. Study Design: Simple descriptive study. Place and Duration of Study: Surgical unit IV, Military Hospital (MH) Rawalpindi, over a period of seven years from 01-01-2005 to 1-12-2012. Material and Methods: Eighty eight patients who underwent repair of bile duct injuries during this period were included in this study. Patients referred from class ‘B’ and ‘C’ hospitals to our institute were also included. Results: Fifteen immediate repairs (0-72 hours) post cholecystectomy, forty eight intermediate repairs (72hrs-6wks) and twenty five late repairs (> 6 wks) were performed (table-1). Short term morbidity was higher in patients with upper biliary tract injury (p=.04).The most common long-term complication was biliary stricture, which occurred in 28 patients (31.8%). Patients with bile duct injuries (BDIs) repaired in intermediate period were more prone to develop stricture of biliary tree than those repaired in immediate or late period (p=.03) (table 3). Long term morbidity was also higher in patients who presented with bile contamination of peritoneum (p=.03) and had sustained complex biliary tract injuries (E4/E5) (p=.03).The overall morbidity and mortality rate was 31% and 3% respectively. Conclusion: We observed that complex hilar injury, presence of intra-abdominal bile and timing of BDI repair is an important predictor of long-term outcome. Injuries repaired in early (0-72hrs) or late period (>6wks) were less likely to develop biliary stricture as compared to injuries repaired in intermediate period (72hrs-6wks). Moreover complex hilar injuries and intra-abdominal bile at presentation increases the possibility for development of late biliary stricture.