| Abstract: |
AbstractOver the last two decades, laparoscopic cholecystectomy (LC) has gained worldwide acceptance and considered to be as ”gold standard” in the surgical management of symptomatic calcular cholecystitis. However, the incidence of bile duct injury in laparoscopic cholecystectomy is still great compared to classic open surgery .The care of these patients has evolved over the last 14 years by trial and error, as well as by the individual surgeon or institutional philosophy. Collaboration among surgeons, gastroenterologists, and interventional radiologists is imperative in the care of these complex injuries .Approximately 75% of patients with bile duct injuries will have a delayed presentation ranging from days to months, the variety of imaging options for the Postcholecystectomy patient who presents with pain, fever, or jaundice; ultrasound and computed tomography (CT) are both good modalities for assessing fluid collections and bile duct dilatation, and can provide guidance for percutaneous drainage. HIDA scan can compliment the evaluation by determining whether there is complete ductal obstruction, leakage of bile, or both .Regardless of the timing of repair, predictors of a good outcome include a tension-free anastomosis to a healthy duct and preservation of the bifurcation. Also, enteric anastomosis to higher, more proximal regions of the extra hepatic duct have a lower stricture rate and when all things are equal, bile duct injuries should be repaired early. Finally, success rates for repair of bile duct injuries can exceed 90% .The management of patients following major BDI is a surgical challenge often requiring the skills of experienced hepatobiliary surgeons at tertiary referral centers .Strategies need to be developed for dealing with bile duct injuries, with a view to reduce morbidity and mortality as early recognition and timely management improves the outcome of these patient.
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