MANAGEMENT OF IATROGENIC BILE DUCT INJURIES: EXPERIENCE AT SAIDU TEACHING HOSPITAL SWAT

Abstract

Objectives: To study the pattern of late presentation of iatrogenic bile duct injuries and to share our
experiences in the management of these injuries at Saidu Teaching Hospital Swat.
Material and methods: This is a case series of fourteen cases of iatrogenic bile duct injury managed at the
Department of Surgery; Saidu Teaching Hospital Swat from Jan 2003 till March 2007.We included
iatrogenic bile duct injuries with delayed presentation in this study. Patients with hepatobiliary malignancy
were excluded.The data was collected on a proforma and was analyzed on SPSS version 10.
Results: Total number of patients was fourteen. Ten patients were female and four were male. All the
fourteen patients had developed iatrogenic biliary injury after open cholecystectomy. All the fourteen
patients presented with abdominal pain, however twelve patients had jaundice, four had biliary leak and six
had fever in addition to abdominal pain. Regarding the type of the injury, complete transection of bile duct
and ligation of two ends at level of cystic duct was found in six (42%) cases; Tear in the bile duct in two
(14%) patient, Bile leakage due to slippage of cystic duct ligature in two (14%) patients and Bile duct
stricture in four cases (28%). Primary repair over a T-tube was performed in eight cases,
Choledochoduodenostomy in two patients and Choledojujenostomy in four patients. We have recorded
mortality in four (28%) of our patients. Our remaining patients are alive, healthy and under regular follow
up.
Conclusion: Iatrogenic Bile duct injuries are rare but preventable entity and bears significant morbidity and
mortality. Open surgery is an acceptable option in its management especially in the areas where minimal
invasive therapeutic modalities are not available.
Key words: Bile duct injuries, Cholecystectomy, Iatrogenic.