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Diagnosis and Treatment of Post-Cholecystectomy Iatrogenic Biliary Injury: A Retrospective Study

M.Sc.; Mohamed Fayek Michael W. Shaker, M.D. Abd M. Ezzat
The Medical Journal of Cairo University , Volume 88, pp 1539-1552; doi:10.21608/mjcu.2020.116246

Abstract: Background: Preventive strategies and safe surgery are of utmost importance to minimize BDI during cholecystectomy. The impor-tance of frank communication with the patient and accurate documentation cannot be overemphasized. Diagnosis requires a high index of suspicion with focused clinical, biochemical, and radiological examination. Aim of Study: Is to evaluate the best protocol in manage-ment of iatrogenic biliary injuries sustained during either laparoscopic or open cholecystectomy. Patients and Methods: 40 patients with iatrogenic bile duct injuries following cholecystectomy (open and Laparo-scopic) referred to the Department of Hepatobiliary Surgery at Sohag Teaching Hospital, Sohag Univeristy, Egypt from January 2016 to January 2018 and treated by multidisciplinary approach team including hepatobiliary surgeons, gastroenter-ologists, and interventional radiologists. Results: In this retrospective study there were 12 cases that detected intraoperatively; 2 cases of them with complete cut of CBD. 8 cases (66, 67%) with partial injury of CBD and the other 2 cases (16.67%) with partial injury of CHD; 9 cases were repaired by primary repair of CBD and 3 cases by repair over stent. There were 14 cases detected early postoperative 1 (7.14%) case with complete injury of CBD and 4 (28.57%) cases with with partial injury of CBD and 6 (42.86%) cases with ligation of CBD and one (7.14%) case with slipped cystic duct ligature and 2 cases with ligation of CHD. There were 14 cases were detected late postoperatively 3 cases of them were with slipped cystic duct ligature and 11 cases with stricture of CBD. Conclusion: Advanced laparoscopic fellowship training may decrease conversion rates of laparoscopic cholecystecto-my. This may translate into a slightly shorter duration of hospitalization for these patients, which for a high volume procedure could make a significant impact on hospital eco-nomics.
Keywords: Treatment / surgery / hospitalization / repair / laparoscopic / Retrospective study / CBD / Partial / iatrogenic

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