The analysis of our patients with biliary injuries
Musa Dirlik, Mehmet Çağlıkülekçi, Hakan Canbaz, Bora Üstünsoy, Koray Öcal, Tahsin Çolak, Tamer Akça, Süha Aydın
Mersin Universitesi Tıp Fakültesi Genel Cerrahi AD, MERSİN
Purpose: The aim of this study is to review risk factors, prevention, management and timing of surgery, presentation, investigation and principles of treatment for biliary injuries and strictures with retrospective examination of our cases.
Background: Bile duct injuries still continue to be one of the most serious problems in surgical practice. By far iatrogenic strictures following upper abdominal surgery,especially cholecystectomy are the most common problem.
Materials and Methods: Eight patients with biliary injury and strictures who were treated between May 1999 and January 2005 in Mersin University Medical School General Surgery department were investigated retrospectively according to age, gender, risk factors, management and timing of surgery, presentation, investigation and principles of treatment, early and long-term outcomes.
Results: Biliary injuries in all patients who were treated in our department were occurred during laparoscopic cholecystectomy. 4 patients were diagnosed during the operation, 4 patients were diagnosed in the immediate postoperative period. Roux-En-Y hepaticojejunostomy and closure of the defect with sutures over a T-tube was performed in our patient to repair these injuries. Two patients were died and 6 patients were followed-up for short and long term results. Biliary complications like bile fistula and biliary injury and strictures were not observed in none of these patients in long term follow-up.
Conclusion: Bile duct injuries during laparoscopic cholecystectomy continue to be an important clinical entity. Injury rates have decreased; but have not reached open cholecystectomy levels. Most injuries in our study are diagnosed intraoperatively or early postoperatively, and with management the long term results are acceptable.
Keywords: biliary injuries, Laparoscopic cholecystectomy, Roux-En-Y hepaticojejunostomy