Bile Duct Injuries: Outcome of Early and Delayed Repair at a Tertiary Care Centre

Abstract

Bile duct injuries (BDIs) are fearsome complication following open or laparoscopic cholecystectomy (LC). Significant morbidity can accompany such injuries. Late complications such as anastomotic bile duct strictures or secondary biliary cirrhosis may result in lifelong disability. The aim of the study was to assess the outcome of early (up to 7 days) and delayed (after 6 weeks) definitive repair of BDIs. It was a prospective study from June 2015 to May 2017 done at a tertiary care centre. The patients who underwent surgical management of bile duct injuries were part of the study and were followed up until end of the study period and assessed for stricture as primary objective and other secondary objectives, e.g. post-op complications and grade of repair of bile duct injury. Stricture was defined as stricture causing sign and symptoms requiring surgical, percutaneous or endoscopic intervention. A total of 50 patients were part of the study, out of which 15 underwent early and 35 underwent delayed repair. Mean follow-up of patients was 10.8 months (1–24 months). Bile duct injuries were classified as per Strasberg classification. It included 7 patients with E1, 15 patients of E2, 20 patients of E3, 5 E4 and 3 patients with type D injuries. The surgical reconstruction done was hepaticojejunostomy (HJ) in 48 and primary repair in 2 patients. The post-op complication observed were post-op bile leak in 4 patients (3 in early and 1 in delayed group, p = 0.041) and cholangitis in 3 patients (1 in early group and 2 in delayed group, p = 0.897). On comparison of stricture rate with post-op bile leak and cholangitis, both variables had significantly high stricture rate (p = 0.014 and p = 0.002, respectively). The grades of repair as per Mc Donald’s grading was grade A in 30, B in 16, C in 1 and D in 3 patients. The stricture was seen in 2 patients of early group and 1 patient in delayed group (p = 0.153). Our result suggests that early repair has more post-op complication with comparable stricture rates in patients with no evidence of systemic sepsis and intra-abdominal collection. Such repairs should be done at specialized centres with surgeons having experience in managing these cases.