COMMON BILE DUCT INJURY

MANAGEMENT AND OUTCOME STUDY AT ISRA UNIVERSITY HOSPITAL HYDERABAD SIND.

Abstract

Objectives: To evaluate management and outcome of Iatrogenic Common Bile
Duct injury after cholecystectomy. Material and methods: Study Design: Descriptive study.
Place and Duration of Study: Isra University Hospital Hyderabad during the period of April
2013 to April 2014. Methodology: All patients presented with CBD injury after cholecystectomy
included while CBD tumor and CBD stone and trauma were excluded from study. Total of
sixteen patients with CBD injury were admitted from outside the hospital in surgical ward in Isra
University hospital either through OPD or Emergency Room or Endoscopy Suite depending on
the mode of presentation and failure of ERCP if performed according to the need and clinical
presentation. All patients were resuscitated and investigated thoroughly and the procedure
whether ERCP, or reconstructive surgery or conservative treatment performed based on patient’s
clinical presentation and mode of injury and is recorded in the preset approved Performa from
relative hospital’s ethical review committee and the data compiled in SPSS version 10. Results:
All 16 patients; 4(25%) male and 12(75%) females admitted from outside the hospital in two
year period. Presented in variable time interval12 (75%) patients admitted in 1 month, 3(18.8%)
in 6 months& 1(6.3%) in 12 months. Jaundice was the main presenting symptom. Patients
were resuscitated and optimized for invasive procedure i.e. ERCP and reconstructive surgery.
Six patients were treated with ERCP successfully and 9 underwent reconstructive surgery and
1with some biliary drainage responded to simple conservative treatment. Operative success
rate was 75% with 25% mortality which was related to the presence of peritonitis, development
of multiorgan failure and late repair of bile duct injury. Conclusion: Although CBD injury is one
of the most devastating complication but its early diagnosis and prompt treatment can prevent
patient’s life with subsequent few or no complication even after its reconstructive surgery.
Training must be emphasized to find the all possible ways of recognizing biliary tract anatomy
during surgery and possess skills to overwhelm the primary and leading cause of bile duct
injury i.e. the visual misperception.