Outcomes of surgical repair for intraoperative bile duct injuries: a cohort study from a tertiary referral center

Abstract

Introduction: Iatrogenic bile duct injury remains one of the most critical complications of laparoscopic cholecystectomy, associated with significant morbidity, mortality, diminished long-term survival, impaired quality of life, and an increased incidence of legal actions. Prompt identification and early diagnosis followed by a multidisciplinary management approach led by a hepatobiliary surgeon, have been demonstrated to reduce complication rates and improve postoperative outcomes. Despite this, no consensus guidelines currently exist regarding the optimal timing for surgical reconstruction. Hepaticojejunostomy remains the standard of care for severe bile duct injuries. Materials and methods: A retrospective review was conducted on patients who underwent surgery for intraoperative bile duct injuries from January 2009 to January 2022. The analysis included demographic data, the type of bile duct injury classified according to the Strasberg system, clinical symptoms, diagnostic investigations, timing of referral, post-referral management, and associated morbidity. Results: A total of 24 patients underwent surgical repair for post-cholecystectomy bile duct injury over 13 years. Most cases (92%) were referred from other institutions, and delayed reconstruction (>21 days) was performed in 74% of patients. Roux-en-Y hepaticojejunostomy was the main procedure (71%). Postoperative morbidity occurred in 16.6%, with 2 patients requiring reoperation, and no mortality was observed. After a median follow-up of 6.2 years, anastomotic patency was maintained in 91.6% of patients, and 2 patients (8.3%) required redo reconstruction for stricture. Conclusion: Surgical reconstruction generally leads to favorable outcomes for most patients with intraoperative bile duct injury. Referral to specialized centers is crucial for optimal management due to the complexities involved. These centers should offer multidisciplinary services, including hepatobiliary surgeons, endoscopists, and interventional radiologists. This collaborative expertise is essential for accurate injury identification and enhances the likelihood of successful treatment outcomes.