Nigerian Journal of Surgery

ORIGINAL ARTICLE
Year
: 2019  |  Volume : 25  |  Issue : 1  |  Page : 91--96

Management of major postcholecystectomy biliary injuries: An analysis of surgical results in 62 patients


Sushruth Shetty, Premal R Desai, Hasmukh B Vora, Mahendra S Bhavsar, Lakshman S Khiria, Ajay Yadav, Nikhil Jillawar 
 Department of Gastro Surgery, NHLM Medical College, Vadilal Sarabhai Hospital, Ahmedabad, Gujarat, India

Correspondence Address:
Dr. Premal R Desai
Department of Gastro Surgery, NHLM Medical College, Vadilal Sarabhai Hospital, Ahmedabad - 380 006, Gujarat
India

Background: Management of injuries sustained during cholecystectomy requires expertise and involves a patient who is troubled, usually drained of personal resources. There has been an increase in incidence with laparoscopic cholecystectomy. The standard surgical management done for major biliary injuries is Roux-en-Y Hepaticojejunostomy (R-en-Y HJ). Materials and Methods: Patients managed surgically for definitive management of biliary injuries in the form of R-en-Y HJ were included. Data were collected from prospectively maintained records and through outpatient follow-up. Demographic data, early and late surgical complications, long-term outcomes, and follow-up results were analyzed. Results: Among the 62 patients, 26 were males, with a mean age of 37.4 ± 13.5 years. A total of 24 patients presented with ongoing biliary fistula. The Strasberg–Bismuth type of injury included types E1 in 8 (13%), E2 in 31 (50%), E3 in 19 (30.6%), and E4 in four patients (6.4%). There were no postoperative mortality and morbidity in 27.4% of patients. Atrophy–hypertrophy complex was seen in four patients, vascular injury in six patients, and an internal fistulisation with duodenum in two patients. Presence of comorbidities (P = 0.05), male gender (P = 0.03), tobacco use (P = 0.04), low albumin (P = 0.016), and more proximal (E4-E1) type of injury (P = 0.008) were independent predictors of postoperative morbidity (P < 0.05). The mean duration of patient follow-up was 26.2 ± 21.1 months. Conclusion: Optimization of preoperative nutrition, avoidance of intraoperative blood transfusion, proper timing of repair, and tension-free R-en-Y HJ draining all the ducts which is done at an experienced hepatobiliary center provide the best outcome.


How to cite this article:
Shetty S, Desai PR, Vora HB, Bhavsar MS, Khiria LS, Yadav A, Jillawar N. Management of major postcholecystectomy biliary injuries: An analysis of surgical results in 62 patients.Niger J Surg 2019;25:91-96


How to cite this URL:
Shetty S, Desai PR, Vora HB, Bhavsar MS, Khiria LS, Yadav A, Jillawar N. Management of major postcholecystectomy biliary injuries: An analysis of surgical results in 62 patients. Niger J Surg [serial online] 2019 [cited 2019 Aug 23 ];25:91-96
Available from: http://www.nigerianjsurg.com/article.asp?issn=1117-6806;year=2019;volume=25;issue=1;spage=91;epage=96;aulast=Shetty;type=0