Surgery

Biography

Biography: Emad Hamdy Gad,

Abstract

Objectives: Laparoscopic cholecystectomy–associated bile duct injury (LC-BDI) continues to be a clinical problem with significant peri-operative morbidity and reduced long-term survival for patients. The aim of this study was to analyze the outcome of surgical management of LC related major bile duct injury. Patients and methods: We retrospectively reviewed and analyzed 69 patients underwent surgical management of LC related major BDI, in the period from mid 2011 to mid 2016. The overall male/female ratio was 31/38. Results: Regarding BI type; the Leaking, Obstructing, leaking and obstructing, leaking and vascular, and obstructing and vascular injuries were 43.5% (n=30), 27.5% (n=19), 18.8%(n=13), 2.9%(n=2), and7.2%(n=5) respectively. However, external biliary fistula affected 60.9 %(n=42). As regard Strasberg classification of injury, it was as follow:  D=1, D, E1=2, D, E2=5, E1=22, E2=27, E3=8, and E4=4. Laparotomy, Endoscopic, and Radiologic interventions were performed before definitive treatment in 30.4 %( n=21), 50.7 %(n=35), and 37.7%(n=26) of patients respectively. The definitive procedure was as follow: 1ry repair with stent, End to end anastomosis with stent, HJ with stent, Rt hepatectomy plus  biliary reconstruction with stent, and HJ in 1.4%(n=1), 2.9%(n=2), 58%(n=40), 8.7%(n=6), and 29%(n=20) of patients respectively. According to time of definitive procedure from injury; the immediate (before 72 h), intermediate (between 72 h and1.5 months), and late (after1.5  months) management were 13 %( n=9), 14.5 %( n=10), and 72.5 %( n=50) respectively. The hospital and 1month (early) morbidity after definitive treatment were 21.7 %( n=15), while, late biliary morbidity was 17.4 %( n=12), however, the overall mortality was 2.9 %( n=2), on the other hand, late biliary morbidity free survival was 79.7%(n=55). On univariate analysis, the following factors were significant predictors of (early) morbidity; Sepsis at referral, E4 injury, associated vascular injury, Rt hepatectomy with biliary reconstruction as a definitive procedure, intra-operative bleeding with blood transfusion, liver cirrhosis and longer operative times and hospital stays. However, the following factors were significantly associated with late biliary morbidity: Sep