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Original Article

PAFMJ. 2016; 66(2): 185-189


BILE DUCT INJURIES AND OUTCOMES: A RETROSPECTIVE MEDICAL RECORD REVIEW

Adeel Qamar Ghumman, Maqbool Ahmad, Aurangzeb Khan, Zafar Iqbal Gondal, Zaka Ullah Malik, Manan Masud.

Abstract
Objective: To report on our experience of cholecystectomy associated bile duct injuries and observe factors influencing outcomes.
Study Design: Simple descriptive study.
Place and Duration of Study: Surgical unit IV, Military Hospital (MH) Rawalpindi, over a period of seven years from 01-01-2005 to 1-12-2012.
Material and Methods: Eighty eight patients who underwent repair of bile duct injuries during this period were included in this study. Patients referred from class B and C hospitals to our institute were also included.
Results: Fifteen immediate repairs (0-72 hours) post cholecystectomy, forty eight intermediate repairs (72hrs-6wks) and twenty five late repairs (> 6 wks) were performed (table-1). Short term morbidity was higher in patients with upper biliary tract injury (p=.04).The most common long-term complication was biliary stricture, which occurred in 28 patients (31.8%). Patients with bile duct injuries (BDIs) repaired in intermediate period were more prone to develop stricture of biliary tree than those repaired in immediate or late period (p=.03) (table 3). Long term morbidity was also higher in patients who presented with bile contamination of peritoneum (p=.03) and had sustained complex biliary tract injuries (E4/E5) (p=.03).The overall morbidity and mortality rate was 31% and 3% respectively.
Conclusion: We observed that complex hilar injury, presence of intra-abdominal bile and timing of BDI repair is an important predictor of long-term outcome. Injuries repaired in early (0-72hrs) or late period (>6wks) were less likely to develop biliary stricture as compared to injuries repaired in intermediate period (72hrs-6wks). Moreover complex hilar injuries and intra-abdominal bile at presentation increases the possibility for development of late biliary stricture

Key words: Bile duct injury, Cholecystectomy, Post-operative complications.



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