Pattern and Management of Common Bile Duct Injury After Cholecystectomy: A Tertiary Care Hospital Experience
DOI:
https://doi.org/10.54112/bcsrj.v6i5.2015Keywords:
Bile Ducts, Cholecystectomy, Common Bile Duc, Intraoperative Complications, Postoperative ComplicationsAbstract
Bile duct injury (BDI) is a serious complication of cholecystectomy with significant morbidity and mortality. This study aimed to evaluate the patterns, diagnostic approaches, management strategies, and outcomes of CBD injuries in a tertiary care hospital. Methods: This observational study was conducted at Dr. Ruth Pfao Civil Hospital, Karachi, from January 2021 to December 2023. Sixty-five patients with confirmed post-cholecystectomy CBD injury were included. Diagnosis was based on ultrasound, MRCP, ERCP, or intraoperative findings. Data on demographics, Strasberg classification, management, and outcomes were analyzed using descriptive statistics and chi-square/logistic regression tests. Results: The mean age was 50.1 ± 15.8 years; 55% were female. Injury distribution was Type A (23%), B (15%), C (20%), and D (22%), with no Type E injuries. Laparoscopic procedures accounted for 58% of cases. Jaundice (55%) and bile leak (45%) were the most frequent presentations. Management included hepaticojejunostomy (31%), endoscopic interventions (26%), surgical repair (23%), and conservative treatment (20%). The mean hospital stay was 12.0 ± 5.5 days. Outcomes included recovery (40%), persistent symptoms (29%), and mortality (31%). Conclusion: CBD injuries after cholecystectomy remain a major surgical challenge. Early recognition, referral to specialized centers, and preventive strategies such as the Critical View of Safety are essential. High mortality and absence of Type E reporting highlight the need for multicenter data and standardized classifications.
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References
de’Angelis N., Catena F., Memeo R., Coccolini F., Martínez‐Pérez A., Romeo O.et al.. 2020 wses guidelines for the detection and management of bile duct injury during cholecystectomy. World Journal of Emergency Surgery 2021;16(1). https://doi.org/10.1186/s13017-021-00369-w
Rahman M., Khan Z., Das B., Saha M., & Sowdagar M.. “types of bile duct injury and their management outcome- a cross-sectional descriptive study”. Scholars Journal of Applied Medical Sciences 2020;8(7):1794-1801. https://doi.org/10.36347/sjams.2020.v08i07.029
Pesce A., Palmucci S., Greca G., & Puleo S..
iatrogenic bile duct injury: impact and management challenges
. Clinical and Experimental Gastroenterology 2019;Volume 12:121-128. https://doi.org/10.2147/ceg.s169492Sharma A., Ruch B., Alwatari Y., Lele S., & BouHaidar D.. Delayed, recurrent bile leak from isolated right posterior sectoral duct injury after laparoscopic cholecystectomy: an unusual presentation. Clinical Case Reports 2022;10(7). https://doi.org/10.1002/ccr3.6032
Yang S., Hu S., Gu X., & Zhang X.. Analysis of risk factors for bile duct injury in laparoscopic cholecystectomy in china: a systematic review and meta-analysis. Medicine 2022;101(37):e30365. https://doi.org/10.1097/md.0000000000030365
Afaque M., Rehman N., Alam J., Varshney H., Rizvi S., & Aslam M.. Importance of critical view of safety, rouviere’s sulcus, and minimal energy device usage in reducing biliary injury in laparoscopic cholecystectomy. Surgery Insights 2022;1. https://doi.org/10.55085/si.2022.620
Fong Z., Pitt H., Strasberg S., Loehrer A., Sicklick J., Talamini M.et al.. Diminished survival in patients with bile leak and ductal injury: management strategy and outcomes. Journal of the American College of Surgeons 2018;226(4):568-576e1. https://doi.org/10.1016/j.jamcollsurg.2017.12.023
Jong I., Matton A., Praagh J., Haaften W., Wiersema‐Buist J., Wijk L.et al.. Peribiliary glands are key in regeneration of the human biliary epithelium after severe bile duct injury. Hepatology 2019;69(4):1719-1734. https://doi.org/10.1002/hep.30365
Iwasaki T., Takeyama Y., Yoshida Y., Kawaguchi K., Matsumoto M., Murase T.et al.. Identification of aberrant subvesical bile duct by using intraoperative fluorescent cholangiography: a case report. International Journal of Surgery Case Reports 2019;61:115-118. https://doi.org/10.1016/j.ijscr.2019.07.013
Zhao Y., Tao H., Liu Y., Sha G., Yi X., Qin Q.et al.. Effectiveness and clinical value of laparoscopic cholecystectomy and cholangiography in the diagnosis of biliary calculi. Frontiers in Surgery 2022;9. https://doi.org/10.3389/fsurg.2022.880266
Haroon M.. Management of bile duct injuries after laparoscopic cholecystectomy: a retrospective single-center study. Journal of Postgraduate Medical Institute 2023;37(2):103-8. https://doi.org/10.54079/jpmi.37.2.3127
Marino M., Mirabella A., Guarrasi D., Lupo M., & Komorowski A.. Robotic‐assisted repair of iatrogenic common bile duct injury after laparoscopic cholecystectomy: surgical technique and outcomes. International Journal of Medical Robotics and Computer Assisted Surgery 2019;15(3). https://doi.org/10.1002/rcs.1992
Sucandy I., Giovannetti A., Spence J., Ross S., & Rosemurgy A.. Robotic roux-en-y hepaticojejunostomy for right hepatic duct transection. application of minimally invasive technique for high bile duct injury. The American Surgeon 2021;89(4):1309-1310. https://doi.org/10.1177/0003134820956358
Fan Z., Pan J., & Ye-wei Z.. Recovery from a biliary stricture of a common bile duct ligature injury: a case report. World Journal of Clinical Cases 2020;8(16):3567-3572. https://doi.org/10.12998/wjcc.v8.i16.3567
Zhao P., Ma Y., & Yang J.. Laparoscopic cholecystectomy with communicating accessory hepatic duct injury and management: a case report. World Journal of Gastrointestinal Surgery 2024;16(12):3870-3874. https://doi.org/10.4240/wjgs.v16.i12.3870
Alkhalegy A. and Kamal A.. Management of iatrogenic bile duct injuries following cholecystectomy. The Egyptian Journal of Hospital Medicine 2023;92(1):6607-6611. https://doi.org/10.21608/ejhm.2023.316667
Shahzad M., Bangash T., Latif A., Ahmed H., Naveed M., & Ashraf M.. Surgical management of complex bile duct injuries in specialized hepatopancreatobiliary (hpb) unit. PJMHS 2021;15(7):1700-1702. https://doi.org/10.53350/pjmhs211571700
Iwasaki T., Takeyama Y., Yoshida Y., Kawaguchi K., Matsumoto M., Murase T.et al.. Identification of aberrant subvesical bile duct by using intraoperative fluorescent cholangiography: a case report. International Journal of Surgery Case Reports 2019;61:115-118. https://doi.org/10.1016/j.ijscr.2019.07.013
Rahman M., Khan Z., Das B., Saha M., & Sowdagar M.. “types of bile duct injury and their management outcome- a cross-sectional descriptive study”. Scholars Journal of Applied Medical Sciences 2020;8(7):1794-1801. https://doi.org/10.36347/sjams.2020.v08i07.029
Gallagher S. and Imagawa D.. Spontaneous choledochoduodenal fistula in a patient with a bile duct injury following laparoscopic cholecystectomy. Journal of Surgical Case Reports 2019;2019(5). https://doi.org/10.1093/jscr/rjz141
Bhatia S. and Kumar P.. Assessment of biliary leakage after cholecystectomy. International Journal of Surgery Science 2018;2(1):37-39. https://doi.org/10.33545/surgery.2018.v2.i1a.857
Ferreira C. and Noel C.. Biliary tract anatomical variance - the value of mrcp. South African Journal of Surgery 2021;59(3). https://doi.org/10.17159/2078-5151/2021/v59n3a3544
Lin Y., Lin C., & Yin W.. Subvesical duct detected by magnetic resonance cholangiopancreatography (mrcp) in a patient with bile leak after laparoscopic cholecystectomy. CRSLS Journal of the Society of Laparoscopic and Robotic Surgeons 2021;8(1):e2020.00074. https://doi.org/10.4293/crsls.2020.00074
Akool M., Al-Hakkak S., & Al-Wadees A.. The role of endoscopic retrograde cholangiopancreatography in the management of biliary complication post-laparoscopic cholecystectomy. Open Access Macedonian Journal of Medical Sciences 2021;9(B):313-317. https://doi.org/10.3889/oamjms.2021.6071
Alkhalegy A. and Kamal A.. Management of iatrogenic bile duct injuries following cholecystectomy. The Egyptian Journal of Hospital Medicine 2023;92(1):6607-6611. https://doi.org/10.21608/ejhm.2023.316667
Fong Z., Pitt H., Strasberg S., Loehrer A., Sicklick J., Talamini M.et al.. Diminished survival in patients with bile leak and ductal injury: management strategy and outcomes. Journal of the American College of Surgeons 2018;226(4):568-576e1. https://doi.org/10.1016/j.jamcollsurg.2017.12.023
Sharma A., Ruch B., Alwatari Y., Lele S., & BouHaidar D.. Delayed, recurrent bile leak from isolated right posterior sectoral duct injury after laparoscopic cholecystectomy: an unusual presentation. Clinical Case Reports 2022;10(7). https://doi.org/10.1002/ccr3.6032
Tošković B., Bilanović D., Resanovic A., Todorović S., Mrda D., Crnokrak B.et al.. Management of major bile duct injuries following laparoscopic and open cholecystectomy - single center experience. Srpski Arhiv Za Celokupno Lekarstvo 2019;147(7-8):422-426. https://doi.org/10.2298/sarh190206030t
Conde D., Gómez P., Cháves C., Recamán A., Pardo M., & Sabogal J.. Early versus delayed reconstruction for bile duct injury a multicenter retrospective analysis of a hepatopancreaticobiliary group. Scientific Reports 2022;12(1). https://doi.org/10.1038/s41598-022-15978-x
Zhao Y., Tao H., Liu Y., Sha G., Yi X., Qin Q.et al.. Effectiveness and clinical value of laparoscopic cholecystectomy and cholangiography in the diagnosis of biliary calculi. Frontiers in Surgery 2022;9. https://doi.org/10.3389/fsurg.2022.880266
Zhao J. and Dang Y.. When should endovascular gastrointestinal anastomosis transection glissonean pedicle not be used in hepatectomy? a case report. World Journal of Clinical Cases 2022;10(24):8742-8748. https://doi.org/10.12998/wjcc.v10.i24.8742
Ali M., Abd-El-Kader A., Khalfallah M., & Mansour M.. Outcomes of reconstructive hepaticojejunostomy for post-cholecystectomy bile duct injuries. Minia Journal of Medical Research 2020;31(3):320-328. https://doi.org/10.21608/mjmr.2022.220311
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