M Azeem, Nasir Virik, Khalid Durrani, Zulfiqar Chaudhry.
Iatrogenic Bile Duct Injuries and its Management.
J Surg Nov ;23-24:34-8.

We review 29 cases with iatrogenic injuries to the extrahepatic biliary tree over a period of 9 years at Sheikh Zayed Hospital, Lahore. Patients were divided into two main groups: those undergoing an open Cholecystectomy (OC Group) comprised 59%, whereas 41% had Laparoscopic Cholecystectomy (GC Group). In a prospective study, 29 patients (7 indigenous patients and 22 referrals) with an injury or stricture due to conventional or laparoscopic cholecystectomy were investigated. In indigenous 7 patients, (100%) injury was recognized peroperatively and immediately repaired with a good long-term result of 93% including one moderate result due to recurrent cholangitis. The 22 referred patients comprised 7 early postoperative complications (23%) and 15 strictures after an `uneventful` cholecystectomy. Most cases (76%) were repaired by bilioenteric anastomosis with an 18% restrictive rate including second and third repair for stricture, a total of 33 operations (26 primary and 2 patients had two revision and one had three revisions) were performed without hospital mortality. Of the 29 total patients, all underwent operative treatment. The mean follow-up period after surgery was 4.2 +/- 1.9 years ranging from 7 months to 9 years. A good long term result after stricture repair was achieved in 75% of the patients, whereas 14% had a poor outcome owing to restricture. The other 8% had a moderate result due to recurrent cholangitis. Immediate repair of a bile duct injury offers the better chance of a favorable prognosis compared to secondary stricture repair.

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