Evaluating the Outcome of Direct Repair of Bile Duct Injury

Abstract
Background: Bile duct injury (BDI) during laparoscopic cholecystectomy is a surgical catastrophe with an incidence ranging. Between 0.3 to 1,4%. Many surgeons think that direct repair of BDI carries a high risk of stricture that is why the bilioenteric reconstruction is more popular.
Aim of Study: Evaluating the results of direct repair in selected cases and compare it to the classic bilioenteric reconstruction.
Methods: We had 2 groups, group A had direct bile duct repair and group B had bilioenteric reconstruction. The choice of doing the direct repair was based on the absence of risk factors for biliary complications. Both are compared as regards the presence of postoperative complications either leakage or stricture and hospital stay. All cases were done in Ain Shams university hospitals during the period between January 2013 until December 2017.
Results: Bile leakage had happened in one case of group A (11%) and 2 cases of group B (16.7%) with no statistically significant difference, (p-value is 0.72). One case of group A (11.1%) had biliary stricture which was presented at 6 months follow up, managed first by ERCP and stent twice and required reconstruction by Roux en Y after 15 months. For group B, 2 cases had anastomotic strictures presented at 9 and 12 months. They were managed by PTC, dilatation, and stenting and followed by redo reconstruction of the anastomosis at 15 and 17 months after the surgery.
Conclusions: Direct repair of the Bile duct can be safely done in properly selected patients with comparable results to bilioenteric reconstruction and no increase in the incidence of postoperative complications.