IATROGENIC BILE DUCT INJURY FOLLOWING OPEN AND LAPAROSCOPIC CHOLECYSTECTOMY: EXPLORING PATTERNS, MANAGEMENT, AND TREATMENT OUTCOMES
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Keywords
bile duct injury, cholecystectomy, laparoscopic, surgical complications, management, Roux-en-Y choledochojejunostomy, choledochoduodenostomy, postoperative outcomes, patient care, monitoring protocols
Abstract
Objective: The objective of this study is to determine the incidence rate of iatrogenic bile duct injuries occurring after open and laparoscopic cholecystectomy procedures as well as to evaluate the outcomes in the postoperative phase.
Study design: A cross-sectional study
Place and Duration This study was conducted in Zubeida Khaliq Memorial free trust Hospital Skardu from March 2022 to March 2023
Methodology: A total of 60 patients with iatrogenic bile duct injuries were admitted through the OPD and emergency department. Baseline investigations were conducted, including Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) in specific cases. Postoperatively, patients were monitored in the surgical ward and discharged after drain removal. A six-month OPD follow-up was conducted, with data analyzed using SPSS version 26.
Results: Within the cohort of 60 patients, subgroup analysis reveals that 24 cases (40%) encountered injuries within our unit, while the remaining 36 cases (60%) were referred from other hospitals. The mean age of the patients was 45±5 years, with a significant male-to-female ratio of 1:4. The primary presenting complaints encompassed jaundice, abdominal pain, and persistent bile discharge. Surgical interventions performed encompassed Roux-en-Y choledochojejunostomy (n=39 - 65%), choledochoduodenostomy (n=15 - 25%), and primary repair with a T-tube (n=6 - 10%). Analysis of postoperative occurrences indicated bile leaks (n=6 - 10%), wound infections (n=9 - 15%), and recurrent cholangitis (n=3 - 5%). The usual duration of hospitalization ranged from 11 to 16 days.
Conclusion: In conclusion, this study highlights iatrogenic bile duct injuries post-cholecystectomy, stressing improved surgical awareness and timely intervention. Surgical strategies, including Roux-en-Y choledochojejunostomy and choledochoduodenostomy, offer efficacy despite complications. Enhanced patient care and monitoring protocols are crucial for better outcomes.
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Rehana Raza
Specialist General Surgery, Zubeda khaliq Memorial Free Hospital Skardu Pakistan.
Manal Muzammil
Registrar General Surgery, Akbar Niazi Teaching Hospital Islamabad Pakistan.
Abdul Rehman
Assistant Professor of Anatomy, Bhitai Dental and Medical College Mirpurkhas Pakistan.
Lekhraj Mal
Assistant Professor of General Surgery, Bhitai Dental and Medical College Mirpurkhas Pakistan.
Imtiaz Ali Langah
Assistant Professor of General Surgery, Peoples University of medical and Health sciences for women Nawabshah Pakistan.
Rafia Unar
Women Medical Officer General Surgery, Liaquat University Hospital Hyderabad Pakistan.