Current Scenario of Postcholecystectomy Bile Leak and Bile Duct Injury at a Tertiary Care Referral Centre of Nepal

Narendra Pandit; Tek Narayan Yadav; Laligen Awale; Kunal Bikram Deo; Yogesh Dhakal; Shailesh Adhikary

doi:10.1155/2020/4382307

Current Scenario of Postcholecystectomy Bile Leak and Bile Duct Injury at a Tertiary Care Referral Centre of Nepal

Minim Invasive Surg. 2020 Apr 21:2020:4382307. doi: 10.1155/2020/4382307. eCollection 2020.

Authors

Narendra Pandit¹, Tek Narayan Yadav¹, Laligen Awale¹, Kunal Bikram Deo¹, Yogesh Dhakal², Shailesh Adhikary¹

Affiliations

¹ Surgical Gastroenterology Division, Department of Surgery, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal.
² Department of Anaesthesiology and Critical Care, B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal.

Abstract

Objective: With the adoption of safe cholecystectomy principles at an academic institute, the risk of major bile duct injury has decreased. This study aims at evaluating the present status of bile duct injury, compared to the study published in 2013 by index centre.

Methods: This is a retrospective review of a prospectively maintained database of bile leak and bile duct injury from 2014 to 2019. Patients who completed postcholecystectomy bile leak or bile duct injury treatment and were on regular follow-up were included.

Results: Eighteen patients (0.78%) among 2,300 consecutive cholecystectomies presented with bile duct injury, including 8 (0.35%) major bile duct injuries and 10 (0.43%) bile leaks compared to major bile duct injury rate of 0.68% (92/11,345 cholecystectomies) between 2001 and 2010. Injuries were classified as Strasberg's type A (52.9%), type D (5.9%), and type E (41.1%). Eight patients (47%) of bile leak were managed conservatively with drains, while two required laparotomy and lavage. The mean time for spontaneous closure of bile leak was 11 days. Intraoperative repair was done in three cases: Roux en Y hepaticojejunostomy in 2 and end-to-end repair over T-tube in 1 for sharp transection of the duct. Delayed repair (Roux-en-Y hepaticojejunostomy) was done in five patients. The median postcholecystectomy hospital stay was 8 days, with no mortality. There was no restricture at a median follow-up of 13 months.

Conclusion: With the adoption of a safe culture of cholecystectomy, the major bile duct injury rate has decreased currently. Repair of bile duct injury by experienced hepatobiliary surgeon results in excellent outcome.