Abstract
Objective : To evaluate the surgical outcome and determine the difference between immediate intraoperative repair and delayed repair of iatrogenic common bile duct (CBD) injuries during laparoscopic cholecystectomy (LC) and to detect if timing of surgical repair affect success rate or not.
Patients & Methods: Between Jan. 2009 and Jan. 2013, a total of 36 bile duct injuries During LC were surgically managed by our general surgery group. With approval, we did a retrospective review of medical records of these patients; they were divided into two groups, eleven of them in (group A) from our hospital, who were discovered during the index operation and treated immediately on-table, the remaining 25 patients in (group B) were referred from other hospitals where they were recognized postoperatively at a mean of 8 days (range2-21 days).Data collected and reported for all enrolled patients .All transferred patients were resuscitated, investigated and prepared for the planed procedure. Proper operation was done for every case. The patients were followed postoperatively and closely observed. Postoperative complications were detected and managed according to classic guidelines by the surgical team. Results: our study include 36 patients with iatrogenic CBD injures during LC; divided into two groups; group A contains 4 (36.4%) males and 7 (63.6%) females with mean age of 38.33±13.77; range: 21-62 years and mean BMI of 26.8±2.04 (22-32) kg/m2. Group B contains 14 (56%) males and 11 (44%) females with mean age of 40.50±11.74; range: 23-59 years and mean BMI of 29.20±3.20 (23-34) kg/m2.we found significant correlation between time of repair (on-table or late) and operative outcome. We found a notable relation between the patient condition preoperatively and the result of surgery. Also there was a significant correlation between post-operative outcome and each of the following BMI (p=0.008) and Clinical presentation (peritonitis [p=0.001] ) with the surgical repair outcome . On the other hand the relation was insignificant between the outcome and the class or injury according to strasberg classification (p=0.563).
Conclusion: ‘On-table repair ’, is the cornerstone in success of operative repair of iatrogenic CBD injury during LC, this mean that the time factor is very important in management of such cases and no need for delay after patient resuscitation ,control of sepsis and planning for reconstruction by an experienced general surgeon if hepatobiliary surgeon not available . Our recommendation to surgeon who do the injury during LC should to call an experienced general surgeon or hepatobilliary surgeon to reconstruct the injury on-table.
Keywords: injury, common bile duct, laparoscopic cholecystectomy, hepaticojujenostomy |
