Pakistan Journal of Medical Sciences

Published by : PROFESSIONAL MEDICAL PUBLICATIONS

ISSN 1681-715X

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Volume 25

April - June 2009 (Part-II)

Number  3


 

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Bile duct injuries during open and laproscopic
cholecystectomy:Management and outcome

Rauf Shaikh1, Moti Ram Pohani2, Ayub3, Ali Asghar4,
Khalid Ahsan Malik5, Shafiq ur Rehman6

ABSTRACT

Objectives: To evaluate the management of twenty two patients, with bile duct injuries during open and laproscopic cholecystectomy who were referred to the tertiary center.

Methodology: It is a prospective cohort study conducted at Department of Surgery, Sindh Government Lyari General Hospital, affiliated with Dow University of Health Science Karachi. Patients who sustained bile duct injuries following open cholecystectomy and laproscopic cholecystectomy were included. Time between cholecystectomy and recognition of injury, method of repair and post operative outcome was recorded. Strassburg classification was used to delineate the type of bile duct injury.

Results: Twenty two patients of bile duct injuries following open cholecystectomy and laproscopic cholecystectomy were managed. Mean age of patients was forty six (thirty four - fifty six) years. Injury was sustained in fifteen patients during laproscopic cholecystectomy and in seven patients during open cholecystectomy. Overall fourteen patients had Strassburg E1 and E2 and eight patients had E3 and E4 injuries. In nineteen patients, Roux-en-Yhepaticojejunostomy was done, while three patients underwent lateral choledochorraphy with T-tube drainage. One patient died of septicemia, while one patient was re-explored for revision of hepaticojejunostomy for stenosis of bilioenteric anastomosis. Other minor complications were treated conservatively.

Conclusion: Bile duct injury after open and laproscopic cholecystectomy can be successfully managed in a tertiary center by hepatobiliary surgeon. Principles of management include anatomic definition of injury, control of sepsis, staged approach involving interventional radiology and refined operative technique.

KEYWORDS: Bile duct injury, Hepaticojejunostomy, Cholecystectomy, Cholangiography.

Pak J Med Sci    April - June 2009 (Part-II)    Vol. 25 No. 3    496-499

How to cite this article:

Shaikh R, Pohani MR, Ayub, Asghar A, Malik KA, Rehman S. Bile duct injuries: during open & laproscopic cholecystectomy management and outcome. Pak J Med Sci 2009;25(3): 496-499.


1. Dr. Rauf Sheikh,
Assistant Professor Surgical Unit-II,
Dow University of Health Science,
2. Dr. Moti Ram Pohani,
Consultant Surgeon,
Jinnah Post Graduate Medical Centre, Karachi.
3. Dr. Ayub,
Registrar Surgical Unit-II,
Civil Hospital, Karachi.
4. Dr. Ali Asghar
Post Graduate Trainee.
Lyari General Hospital,
5. Dr. Khalid Ahsan Malik
Professor of Surgery
Dow University of Health Sciences,
6. Prof. Shafiq Ur Rehman,
Professor of Surgery,
Surgical Unit-III,
Dow University of Health Sciences,
Karachi Pakistan.

Correspondence:

Dr. Rauf Sheikh,
Assistant Professor,
Surgical Unit II,
Civil Hospital,
Karachi - Pakistan.
Email: drrauf@hotmail.com 

* Received for publication: November 26, 2008
* Revision Received: May 26, 2009
* Revision Accepted: June 4, 2009



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