Management of Post Cholecystectomy Bile Duct Injury: Pertinent Factors Contributing to Good Surgical Outcomes

Objective: Surgical management remains the mainstay treatment for bile duct injury (BDI) post-cholecystectomy. Achieving long-term patency and lessening anastomotic failure depends on important factors including the types of repairs, timing of repairs, and surgical expertise. The present study focused on the impact of these factors on the surgical outcomes of BDI repair. Materials and Methods: Fifty-nine patients who were treated with BDI post cholecystectomy at the surgical department between January 2003 and December 2018 were retrospectively reviewed. The patients were categorized as 11 in-house and 48 referral patients, of which 22 patients had bile duct repairs prior to referral. Surgical outcomes and factors, including types of repairs, timing of repairs, and surgical expertise, impacting on the treatment results were analyzed. Results: The mean age of the patients was 47.6 years. The BDI incidence in the authors’ hospital was 0.14%. Complications occurred in 21 patients (35.6%), of which intraabdominal collection was the most common at 10 patients (16.9%). The median length of hospital stay was 16 days for in-house patients and 17 days for the referral group (p=0.542). The mortality rate was 1.7%. The overall patency was 93% with mean follow up 106.4 months. Concerning the primary patency rate, the partial segments IV/V liver resection and hepaticojejunostomy techniques had better long-term patency compared to primary repairs at 92.3% versus 37.5% (p=0.017), and biliary bypass at 92.3% versus 80% (p=0.44). BDI repairs performed by primary surgeons increased the risk of anastomotic failure in comparison to those done by hepatobiliary surgeons with 10-year patency at 53.3% versus 95.4% (p=0.014). Delayed repairs longer than six weeks after injury offered positive long-term outcomes compared to early repairs done within six weeks after injury, with a 10-year patency at 85.4% versus 31.3% (p<0.001). Conclusion: Delayed repair performed by the hepatobiliary surgeon with appropriate surgical techniques decreased anastomosis stricture and achieved good overall surgical outcomes in the management of post cholecystectomy BDI. Keywords: Bile duct injury; Cholecystectomy; Surgical management