Utpal Anand1, Ramesh Kumar2, Rajeev Nayan Priyadarshi3, Manoj Kumar4, Rakesh Kumar5, Nehal Ahmed1, Aaron George John1, Kunal Parasar1, Bindey Kumar6. 1. Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna, India. 2. Department of Gastroenterology, All India Institute of Medical Sciences, Patna, India. 3. Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, India. 4. Department of General Surgery, All India Institute of Medical Sciences, Patna, India. 5. Senior Specialist Medical Officer, CHC Minapur, Muzaffarpur, India. 6. Department of Paediatric Surgery, All India Institute of Medical Sciences, Patna, India.
Abstract
BACKGROUND: Post-cholecystectomy bile duct injury (BDI) is a serious complication that often requires surgical repair. This study aimed to analyze the outcomes of surgery performed for BDI and to determine the factors associated with post-surgical complications. METHODS: A retrospective analysis was conducted using a prospectively maintained database of 105 patients who underwent surgical repair for post-cholecystectomy BDI between March 2013 and March 2020. BDI was classified based on the Strasberg-Bismuth system, and the outcomes were graded using the McDonald criteria. Multivariable logistic regression was used to identify the significant variables associated with postoperative complications. RESULTS: In a cohort of 105 patients with post-cholecystectomy BDI who underwent bilioenteric repair, 71 (67.6%), 25 (23.8%), 2 (1.9%), and 7 (6.7%) patients had excellent, good, fair, and poor outcomes, respectively, during a median follow-up of 64 months. The incidence of recurrent biliary stricture after definitive surgical hepaticojejunostomy was 6.7% (n = 7). The presence of cholangitis, choledochoduodenal fistula, and hilar biliary strictures was among the significant variables associated with the development of both short-term and long-term complications following surgery. CONCLUSIONS: Surgical repair of BDIs with bilioenteric anastomosis can yield excellent results when managed in a tertiary care center where expertise in the reconstruction of the biliary tree is prioritized.
BACKGROUND: Post-cholecystectomy bile duct injury (BDI) is a serious complication that often requires surgical repair. This study aimed to analyze the outcomes of surgery performed for BDI and to determine the factors associated with post-surgical complications. METHODS: A retrospective analysis was conducted using a prospectively maintained database of 105 patients who underwent surgical repair for post-cholecystectomy BDI between March 2013 and March 2020. BDI was classified based on the Strasberg-Bismuth system, and the outcomes were graded using the McDonald criteria. Multivariable logistic regression was used to identify the significant variables associated with postoperative complications. RESULTS: In a cohort of 105 patients with post-cholecystectomy BDI who underwent bilioenteric repair, 71 (67.6%), 25 (23.8%), 2 (1.9%), and 7 (6.7%) patients had excellent, good, fair, and poor outcomes, respectively, during a median follow-up of 64 months. The incidence of recurrent biliary stricture after definitive surgical hepaticojejunostomy was 6.7% (n = 7). The presence of cholangitis, choledochoduodenal fistula, and hilar biliary strictures was among the significant variables associated with the development of both short-term and long-term complications following surgery. CONCLUSIONS: Surgical repair of BDIs with bilioenteric anastomosis can yield excellent results when managed in a tertiary care center where expertise in the reconstruction of the biliary tree is prioritized.