Postcholecystectomy Iatrogenic Biliary Injury Presentation, Diagnosis and Management at the National Centre of Gastroeneterology and Liver Disease - Sudan

Alaa Musa El Sayed Mohammed

Authors

Alaa Musa El Sayed Mohammed

Keywords:

open cholecystectomy, biliary injury, strasberg classification

Abstract

Background: Iatrogenic biliary duct injury is a rare but potentially devastating condition associated with significant morbidity and mortality. Related data are limited in developing countries. This study aimed to analyse the clinical presentation, diagnosing and type of biliary injuries, and management proposed and in a population treated at a tertiary care centre. Method : Retrospective and prospective analysis of patients who sustained IBDI, and presented to the Gastroeneterology surgical department at the National Centre Of Gastroenterolgy and Liver Disease Sudan , between the period of October 2010 to September 2013 (three years period). Results : Total of 40 patients diagnosed as IBDI, 36 were females and 4 were males. Their mean age was 41 years (range 23-72) years. IBDI were due to 90% (n=36) post OC and due to10% (n= 4 ) post LC. 65%presented with obstructive jaundice, 20% presented with biliary peritonitis, 15% presented with biliary cutaneous fistula (bile leak). The identification rate of intra-operative injury was 10% and 90% in the post-operative group. Time of presentation ranged between 2 days and 3 years the median was12 days .According to Strasberg type E I, II, III and type D injuries, 20%, 37.5%,35%,7.5% were seen in patients, respectively. 87.5% of patients (n=35) underwent Roux en Y HJ. 5% of patients (n=2) underwent ERCP stenting, 2.5% underwent end to end anastamosis , 2.5% underwent primary repair T tube insertion.. Fifteen patients (40.5%) had complications during their hospital stay. Total hospitalization days, ranged between 14 days and 1months the median was 18 days. Mortality was 12.5% (n=5). Conclusion : Open cholecystectomy is the main cause of IBDI in our study. In most of the cases surgical reconstruction with hepaticojejunostomy was required as the definitive treatment. ERCP should only be attempted when there is biliary continuity Intrabdominal abscess is the most common cause of death. Early referral to a tertiary centre with exp

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Postcholecystectomy Iatrogenic Biliary Injury Presentation, Diagnosis and Management at the National Centre of Gastroeneterology and Liver Disease - Sudan. (2014). Global Journal of Medical Research, 13(I4), 9-14. https://medicalresearchjournal.org/index.php/GJMR/article/view/486

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References

David Sawaya, Lester Johnson, Kevin Sittig, John Mcdonald, Gazi Zibari (2001) Iatrogenic and Noniatrogenic Extrahepatic Biliary Tract Injuries: A Multi-Institutional Review. 67(5), 473-477.

Wan-Yee Lau, Md (2007) ChineseUniversity of Hong Kong. Classification of Iatrogenic Bile Duct Injury. 6, 459-4636.

L Stewart, L Way (2009) Laparoscopic bile duct injuries: timing of surgical repair does not influence success rate. A multivariate analysis of factors influencing surgical outcomes. 11, 516-522.

Mohd Ahmed Mohdibnouf, Abdel Magidmasaad (2001) Iatrogenic Major Bile Duct Injuries in Sudan. 39, 36-39.

A Mam Ibnouf, M Majid, Massaad (2007) Iatrogenic Major Bile duct Injuries. 2, 201-208.

J Jayasundara, W De Silva, A Pathirana (2011) Changing clinical profile, management strategies and outcome of patients with biliary tract injuries at a tertiary care center in Sri Lanka. 10, 526-532.

Sicklickjk, M Camp, Meltong Lillemoekd (2005) Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients. 241(5), 786-792.

H Seeliger, A Fürst, C Zülke (2002) JauchKWSurgical management of bile duct injuries following laparoscopic cholecystectomy: analysis and followup of 28 cases. 387(7-8), 286-293.

Shamaim, Arundadawani Rabiaarooj (2007) Postcholecy stectomy Biliary Injury Presentation and Management. 23, 165-168.

K Slater, R Strong, D Wall, S Lynch (2002) Iatrogenic bile duct injury: the scourge of laparoscopic cholecystectomy. 72(2), 83-89.

L Bujanda, M Calvo, J Cabriada, V Orive, A Capelastegui (2003) MRCP in the diagnosis of iatrogenic bile duct injury. 16(8), 475-478.

T-S Yeh, Y-Y Jan, J-H Tseng, T-L Hwang, L-B Jeng, M-F Chen (1999) Value of magnetic resonance cholangiopancreatography in demonstrating major bile duct injuries following laparoscopic cholecystectomy. 86(2), 181-184.

Michael Woods, L Traverso, Richard Kozarek, Jane Tsao, Ricardo Rossi, David Gough, John Donohue (1994) Characteristics of biliary tract complications during laparoscopic cholecystectomy: A multi-institutional study. 167(1), 27-34.

J Karvonen, R Gullichsen, S Laine, P Salminen, Grönroosjm (2007) Bile duct injuries during laparoscopic cholecystectomy: primary and long-term results from a single institution. 21, 1069-1073.

Ahmed Abdel-Raouf, Emad Hamdy, Ehab El-Hanafy, Gamal El-Ebidy (2010) Endoscopic management of postoperative bile duct injuries: A single center experience. 16(1), 19.

Naureen Mushtaq, Khurram Minhas, Bilal Mazhar Qureshi, Farrah Bashir, Altaf Ahmed, Sabica Fatima, Soha Zahid, Syed Ather Enam, Shehzad Shamim, Ehsan Bari, Gohar Javeed, Altaf Ali Laghari, Saqib Kamran Bakhshi, Aneela Darbar, Shehzadi Resham, Kiran Hilal, Shayan Sirat Maheen Anwar, Fatima Mubarak, Ahmed Nadeem Abbasi, Zehra Fadoo, Sadaf Altaf, Salman Kirmani, Anirban Das, Vijay Ramaswamy, Annie Huang, Cynthia Hawkins, Uri Tabori, Ute Bartels, Eric Bouffet (2007) From Fragmented Care to Structured Multidisciplinary Management: Evaluating the Impact on Pediatric Brain Tumor Outcomes in a Resource-Limited Setting. 57, 117.

F Mihăileanu, F Zaharie, L Mocan, C Iancu (2012) VladManagement of bile duct injuries secondary to laparoscopic and open cholecystectomy. The experience of a single surgical department. 107(4), 454-460.