Assessment Of Iatrogenic Bile Duct Injuries In Iaparoscopic And Open Cholecystectomy

In this study, 30 patients with post cholecystectomy bile ductinjuries were assessed, 19.of which were females and 11 males. The agesof the patients ranged between 30 and 65 years. 5 patients were diagnosedintra - operatively while 25 patients were diagnosed in the post operativeperiod.The time of presentation of patients diagnosed postoperativelyvaried significantly among the patients ranging from a few days to 13months. 17 patients presented clinically with obstructive jaundice with orwithout cholangitis. 2 patients presented with biliary peritonitis while 4patients presented with external biliary fistulae and 2 R€l~jents presentedwith an intra abdominal collection (biloma)All the patients were assessed through a thorough history takingand physical examination, in addition to complete laboratory work - up.Abdominal ultrasound was done as a routine primary investigation for allpatients. It was very accurate in the detection of intrahepatic biliarydilatation and intraperitoneal collections and their aspirationERCP was successfully performed as a preoperative investigativetool in 15~atients with accurate results documenting the level of bile ductinjuries, failure in one case, also it was successful in management of 9cases.PTC was a successful preoperative diagnostic tool in two patients,clearly delineating the proximal biliary tree and identifying the level ofinjury. PTC with external drainage of the biliary tree (PTD) was avoidedto keep the advantage of finding dilated bile ducts in subsequent plannedsurgery shortly afterwards.MRCP was done as a preoperative diagnostic tool for 8 patients itshowed excellent results in accurately specifying the level of the injury,and the degree of dilatation of the proximal biliary tree.Management depended largely on time of diagnosis. Spatients(those diagnosed intraoperatively) were managed immediately. 11patients were managed by non - surgical treatment through ERCP or USIguided drainage. 14 patients were managed by surgery, 2 patientsmanaged by surgical drainage and 12 patients managed by bilioentericanastomosis.