Clinical presentation, types and treatment outcomes of Bile Duct Injuries (BDI) in laparoscopic cholecystectomy.

Abstract

Objectives: To study the types of Biliary injuries (BDIs), their timing and clinical presentation, diagnosis and treatment outcomes in patients undergoing laparoscopic cholecystectomy. Study Design: Descriptive study. Setting: Department of General Surgery Hayatabad Medical Complex (HMC) Peshawar. Period: From October 2017 to October 2018. Materials & Methods: including 32 patients with biliary duct injuries (BDIs). Results: This study included 32 patients with BDI, 28 patients were referred to HMC and 4 patients had their primary operation at Department of General Surgery HMC Peshawar. There were 23 females and 9 males with a mean age of 47 years (range, 20–65 years). After diagnostic workup, the type of BDIs was classified according to the Strasberg classification. As for BDI, 4(12.5%) patients had a leak related to the cystic duct (Type A injury).In 11(34.3%) patients, there was lateral injury of CBD (Type D injury). In 15(46.8%) patients, there was complete transection of CBD (Type E injury). In 2 (6.2%) patients, it was impossible to determine the cause of bile leak which was assumed to be related to aberrant ducts although this was difficult to prove. Conclusion: Laparoscopic cholecystectomy is best if done with proper training and expertise otherwise it can lead to biliary injury thus turning the patient into a "biliary cripple". They mainly result from anatomical variations and cognitive misinterpretation of anatomy .Biliary injuries can be prevented to some extent if principles of laparoscopic surgery are followed.