Outcomes of reconstructive hepaticojejunostomy for postcholecystectomy bile-duct injuries

• Published in: The Egyptian journal of surgery : official organ of the Egyptian Society of Surgeons = Majallat al-jirāhah al-Misrīyah Vol. 40; no. 4; pp. 1469 - 1475
• Main Authors: Ali, Motassem, Mohamed, Mohamed, Mansour, Abdel-Moniem, Abd-El-Kader, Amr
• Format: Journal Article
• Language: English
• Published: Wolters Kluwer India Pvt. Ltd 01.10.2021; Medknow Publications and Media Pvt. Ltd
• Subjects: Medical research; Medicine, Experimental; Minia; bile-duct injuries; hepaticojejunostomy
• ISSN: 1110-1121; 1687-7624
• DOI: 10.4103/ejs.ejs_266_21

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.