Outcomes of reconstructive hepaticojejunostomy for postcholecystectomy bile-duct injuries

Aim
To analyze and evaluate the presentation, characteristics, related investigation, and outcomes of reconstructive hepaticojejunostomy in patients with postcholecystectomy bile-duct injuries (BDI).
Patients and methods
This study was done in Minia University Hospital (Minia Hepatobiliary Unit), including 26 patients who underwent hepaticojejunostomy Roux-en-Y for postcholecystectomy BDI between May 2017 and May 2020, retrospectively and prospectively.
Results
The study included 26 patients who suffered from iatrogenic BDIs; 19 (73%) patients underwent open cholecystectomy (OC), and seven (27%) patients underwent laparoscopic cholecystetomy (LC). Regarding injury type, the leaking, obstructing, collection, peritonitis, and vascular injuries were 26.9, 46.1, 19.3, 7.7, and 4.4%, respectively. However, the Strasberg classification of injury was as follows: E1=15.4%, E2=46.1%, E3=30.8%, and E4=7.7%. In this retrospective study, between May 2017 and December 2020, 26 patients with major BDI sustained during cholecystectomy and requiring surgical treatment in the form of HJ Roux-en-Y were referred to Minia Hepatobiliary Center. Preoperatively, ultrasound was done for all patients, computed tomography in three (11.5%), PTC in three (11.5%), endoscopic retrograde cholangio-pancreatograpgy (ERCP) in 17 (65%), and magnetic resonance cholangio-pancreatograpgy (MRCP) was done for 16 (61.5%) patients.
Conclusion
Early detection of BDI and early referral to specialized hepatobiliary referral centers are essential for early management of BDI and prevention of its complications. Surgical reconstruction using Roux-en-Y hepaticojejunostomy mucosa to mucosa repair remains the golden-standard procedure of choice for treating these injuries with successful outcome and better long-term result.