CONTROVERSIAL QUESTIONS IN TREATMENT OF IATROGENIC BILE DUCT INJURIES: WAYS OF DECISION

Abstract

Purpose: Iatrogenic bile duct injuries (BDI) is an important problem in abdominal surgery. According to the literature, different methods of surgical reconstruction are performed in patients with BDI. The most frequent procedure is the Roux-en-Y hepaticojejunostomy (HJS) which recommended by most authors.Materials and Methods: 66 patients with BDI were admitted to our hospital and operated on in period of 1997-2013. Primary end-to-end ductal repair was used in 2 cases in 1-2 days after injury without T-tube drainage and in the third case 5 day after the accident using forenamed drainage. Successful right hemihepatectomy was performed in 1 patient; in 62 patients - Roux-en-Y HJS, 23 among them using our antireflux modification of the anastomosis (Russian Fed. Patent N 2470592).Results: There were the following criteria for research: wound infection, cholangitis attacks, anastomotic leak, period of time for postoperative blood- and liver function analyses restitution. Total 30-days mortality was 1,5% (1 patient). Mortality wasn’t registered in the group of antireflux interventions. Estimation of follow-up results showed the advantages of the proposal method.Summary: The method of choice in surgery of iatrogenic BDI and subsequent biliary ductal obstruction due to BDI is repair using antireflux Roux-en-Y HJS.

Keywords

• iatrogenic bile duct injury
• hepaticojejunostomy
• antireflux biliodigestive anastomosis