Emad Hamdy Gad, Yasmin Kamel, Talat Zakaria, Mohamed Abbasy, Ali Nada and Mohamed Housseni
Menoufia University, Egypt
Posters & Accepted Abstracts: Surgery Curr Res
Aim: Laparoscopic cholecystectomyâ??associated bile duct injury (LC-BDI) continues to be a clinical problem with significant perioperative morbidity and reduced long-term survival for patients. The aim of this study was to analyze the outcome of surgical management of LC related major bile duct injury. Patients & Methods: We retrospectively reviewed and analyzed 69 patients underwent surgical management of LC related major BDI in the period from mid-2011 to mid-2016. The overall male/female ratio was 31/38. Results: Regarding BI type; the leaking, obstructing, leaking and obstructing, leaking and vascular, obstructing and vascular injuries were 43.5% (n=30), 27.5% (n=19), 18.8% (n=13), 2.9% (n=2) and7.2% (n=5) respectively. However, external biliary fistula affected 60.9 % (n=42). As regard Strasberg classification of injury, it was as follows: D=1, D, E1=2, D, E2=5, E1=22, E2=27, E3=8 and E4=4. Laparotomy, endoscopic and radiologic interventions were performed before definitive treatment in 30.4% (n=21), 50.7% (n=35) and 37.7% (n=26) of patients, respectively. The definitive procedure was as follows: 1ry repair with stent, end to end anastomosis with stent, HJ with stent, Rt hepatectomy plus biliary reconstruction with stent and HJ in 1.4% (n=1), 2.9% (n=2), 58% (n=40), 8.7% (n=6) and 29% (n=20) of patients respectively. According to time of definitive procedure from injury; the immediate (before 72 h), intermediate (between 72 h and 1.5 months) and late (after 1.5 months) management were 13 % (n=9), 14.5% (n=10) and 72.5% (n=50) respectively. The hospital and one month (early) morbidity after definitive treatment were 21.7% (n=15), while, late biliary morbidity was 17.4% (n=12), however, the overall mortality was 2.9% (n=2), on the other hand, late biliary morbidity free survival was 79.7% (n=55). On univariate analysis, the following factors were significant predictors of (early) morbidity; sepsis at referral, E4 injury, associated vascular injury, Rt hepatectomy with biliary reconstruction as a definitive procedure, intra-operative bleeding with blood transfusion, liver cirrhosis and longer operative times and hospital stays. However, the following factors were significantly associated with late biliary morbidity: sepsis at referral, operations other than HJ, reconstruction without stenting, liver cirrhosis, operative bleeding and early morbidity. Conclusion: Sepsis at referral, cirrhosis and operative bleeding were significantly associated with both early and late morbidities after definitive surgical treatment of LC related major BI.
Email: emadgadsalemaa@yahoo.com
