BILE DUCT INJURIES ASSOCIATED WITH LAPAROSCOPIC AND OPEN CHOLECYSTECTOMY: SINGLE CENTER EXPERIENCE

Aim: To summarize the experience in diagnosis, and management of iatrogenic bile duct injuries (IBDI). 
Methods: Forty patients with IBDI were included in this study, were managed from January 2008 to January 
2011 at Al-Zahraa University Hospital. Demographic data, clinical presentation, immediate and long-term 
results of surgical repair are analyzed from a prospective database. 
Results: Only 12.5% of injuries are recognized during operation, while the remaining 87.5% of patients were 
diagnosed postoperatively. According to Strasberg, (1995) classification 20% of patients type A, while 77.5% 
of patients were type E1, E2, and 2.5% of patients were type E3. All type A injuries were treated 
endoscopically with 100% success rate. Type E1, type E2 and type E3 underwent repair by a Roux-en 
hepatico jejunostomy (HJ). Long-term follow-up revealed one case (3.1%) with anastomotic stricture, which 
was managed by refashioning of the site of anastomosis HJ from end-to-side HJ to side-to-side anastomosis 
left duct approach. 
Conclusion: (i) Minor bile duct injuries can be well treated by endoscopic techniques, (ii) Major injuries of 
bile ducts require operative intervention after good and adequate preparation, (iii) Raux-en-Y HJ is the gold 
standard operation for these major bile duct injuries. So, it imperative for this operation to be in the surgical 
armamentarium of any biliary surgeon, (iv) Junior surgeons should be acquainted with OC as well LC to 
avoid many injuries in difficult OC.