POSTCHOLECYSTECTOMY BILE-DUCT INJURIES - EXPERIENCE WITH 49 CASES MANAGED BY DIFFERENT THERAPEUTIC MODALITIES

Background/Aims: In this study we present our experience in the manage ment of iatrogenic biliary injuries. Forty-nine cases with iatrogenic biliary injuries were managed in our center during the period from 198 4 to 1995. Material and Methods: Forty patients were referred from oth er hospitals after cholecystectomy, and 9 cases underwent the original operation in our center. Four (0.3 %) of our patients after 1300 conv entional cholecystectomy, and 5 (0.9%) cases after 550 Laparoscopic ch olecystectomy. Results: The injuries were recognized intraoperatively in 5 (10%) cases and were immediately repaired 3 cases by axial anasto mosis and T-tube drainage, 2 cases by hepatico-jejunostomy (Roux-en-Y) . The injuries were detected in the remaining 44 patients postoperativ ely from one week up to 2 months, the mode of presentation was jaundic e in 39 (89%) cases, biliary fistula with or without jaundice and bili ary peritonitis were detected in 13 (30%) and in 4 (9%) cases respecti vely. Eleven (25%) cases were treated endoscopically by sphincterotomy , stent in 8 cases, dilatation, and double stent in true cases, and di latation using rigid dilators and stent in one case. The remaining 33 (75%) cases were treated surgically by hepatico-jejunostomy in 21 (64% ) cases, and hepatico-duodenostomy in 12 (36%) cases. No hospital mort ality occurred, but late mortality occurred in two (5%) patients after surgery due to biliary restricture with progressive cirrhosis in one case, and due to advanced colon cancer in the other case, and in one ( 9%) case after endoscopic treatment. We achieved 87% excellent surgica l results during the period of follow-up (36 months), while 80% excell ent results were achieved after endoscopic treatment. Good final resul ts (95%, 83%) were achieved after hepatico-jejunostomy and after hepat icoduodenostomy respectively. Conclusion: Postcholecystectomy biliary injuries present a surgical problem needing extra efforts and careful management. Hepatico-jejunostomy appears to be the procedure of choice in repairing these injuries. Immediate surgical repair of bibe duct i njury offers excellent results with lower morbidity rates. Endoscopic treatment may be a less invasive technique and have a role in some typ es of injuries, but needs more time for accurate evaluation.