Sheikh Atiq-ur Rehman, Shahid Hussain, Muhammad Younus Khan, Umair Masood.
Management of iatrogenic common bile duct injuries: an experience in Bahawal Victoria Hospital, Bahawalpur.
Pak J Surg Jan ;37(4):237-42.

Introduction: CBD injury is one of the serious complications after open or laparoscopic cholecystectomy. It increases the morbidity & mortality of patients as well as impairs their quality of life. Objectives: To find out the type of CBD injury in open & laparoscopic cholecystectomy and early post-operative complications after surgical management of CBD injury. Study design: Descriptive, case series study. Settings: Department of General Surgery, Bahawal Victoria Hospital, Bahawalpur. Study duration:1st January, 2014 to 31st December, 2020 Material & Methods: All patients who had iatrogenic common bile duct injury during open or laparoscopic cholecystectomy of any age and gender were included in this study. CBD injuries due to other causes were excluded from the study. A well-constructed predesigned performa including demographic profile, mode of admission, clinical presentation, place of surgery, type of surgery (open or laparoscopic), investigations, operative findings, and post-operative complications were recorded. Results: A total of 35 patients were presented to the Surgical Department with CBD injuries. 20 patients had CBD injury after open cholecystectomy & 15 patients after laparoscopic cholecystectomy. The age range in this study was from 20 to 60 years with a mean age of 42.84+-8.83 years. The male to female ratio was 1:4.84. 23-patients had their cholecystectomy in some private hospitals, 9- patients had been operated on in District Headquarter (DHQ) Hospital and 3-patients were operated in a teaching hospital. In 82.85% of patients, CBD injury was of class III type according to Stewart way classification & the commonly performed operative procedure was Roux-en Y choledocho-jejunostomy. The common post-operative complication was wound infection and intra-abdominal abscess in 51.5% of patients. Conclusion: Iatrogenic CBD injury is a serious complication during cholecystectomy. The important point for successful treatment is characterized by early recognition of injury, control of infection, drainage of abdominal collection, nutritional support & repair of CBD by an experienced surgeon.

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