Management of nonvascular postlaparoscopic bile duct injury
Bilal O Al-Jiffry1, Mohamed Al Saeed1, Majed Al-Mourgi1, Samir Badr2, Tamer Abdel-Rahman3, Abdel-Hafez Shweel4, Alaa E Younes1, Abdullah Al-Sawat1, Aseel Abu-Duruk1, Owaid Al-Malki1, Mohamed Hatem5, Mahmoud El-Meteini6
1 Department of Surgery, Taif University, Taif, Saudi Arabia
2 Department of Surgery, Taif University, Taif, Saudi Arabia; Department of Surgery, General Organization of Teaching Hospitals and Institutes, Damanhur, Benha, Egypt
3 Department of Surgery, Taif University, Taif, Saudi Arabia; Department of Surgery, General Organization of Teaching Hospitals and Institutes, Benha, Egypt
4 Department of Surgery, Zagazig University Hospitals, Zagazig, Egypt
5 Department of Surgery, Taif University, Taif, Saudi Arabia; Ain Shams Organ Transplant Center, HBP and Liver Transplant Unit, Cairo, Egypt
6 Department of Hepatobiliary Surgery, Ain Shams Center for Organ Transplant, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Department of Surgery, Taif University, Taif
Source of Support: None, Conflict of Interest: None
Background and Aim of the Work: Early management of postlaparoscopic nonvascular biliary injuries by an expert team is essential to achieve a good outcome. In this article, we would evaluate the results of this prospective multicentric study in the management of postlaparoscopic nonvascular biliary injuries.
Patients and Methods: This prospective multicentric study enrolled 168 patients with iatrogenic nonvascular bile duct injury (BDI). In all cases, endoscopic retrograde cholangiopancreatography (ERCP) was performed, and further management was done according to Strasberg type of injury.
Results: Intra-abdominal biliary collection was managed by ultrasound-guided drainage. Type A (19%) was diagnosed and treated by ERCP. Types B and C (20.2%) were treated by duct reconstruction of the isolated segment and Roux-en-Y hepaticojejunostomy (RYHJ), respectively. Strasberg type D nondevascularized partial injury (7.1%) was treated by primary repair around stent. In complete type D patients and E (10.7% and 43%, respectively), Roux en-Y hepaticojejunostomy with lowering the hilar plate was performed. After ERCP, 78% of patients developed hyperamylasemia and only 4.8% developed pancreatitis. After HJ, 9.7% of patients developed stricture and were treated by percutaneous transhepatic cholangial dilatation.
Conclusion: This study proved the safety and efficacy of the management of iatrogenic BDI by an expert team implementing different diagnostic and treatment modalities such as ultrasound, computed tomography scan, and ERCP in addition to different surgical options, particularly the use of right end-to-side and left side-to-side RYHJ, with lowering the hilar plate and anterior anastomosis.