MANAGEMENT OF IATROGENIC BILE DUCT INJURIES: EXPERIENCE AT SAIDU TEACHING HOSPITAL SWAT

Objectives: To study the pattern of late presentation of iatrogenic bile duct injuries and to share ourexperiences in the management of these injuries at Saidu Teaching Hospital Swat.Material and methods: This is a case series of fourteen cases of iatrogenic bile duct injury managed at theDepartment of Surgery; Saidu Teaching Hospital Swat from Jan 2003 till March 2007.We includediatrogenic bile duct injuries with delayed presentation in this study. Patients with hepatobiliary malignancywere excluded.The data was collected on a proforma and was analyzed on SPSS version 10.Results: Total number of patients was fourteen. Ten patients were female and four were male. All thefourteen patients had developed iatrogenic biliary injury after open cholecystectomy. All the fourteenpatients presented with abdominal pain, however twelve patients had jaundice, four had biliary leak and sixhad fever in addition to abdominal pain. Regarding the type of the injury, complete transection of bile ductand ligation of two ends at level of cystic duct was found in six (42%) cases; Tear in the bile duct in two(14%) patient, Bile leakage due to slippage of cystic duct ligature in two (14%) patients and Bile ductstricture in four cases (28%). Primary repair over a T-tube was performed in eight cases,Choledochoduodenostomy in two patients and Choledojujenostomy in four patients. We have recordedmortality in four (28%) of our patients. Our remaining patients are alive, healthy and under regular followup.Conclusion: Iatrogenic Bile duct injuries are rare but preventable entity and bears significant morbidity andmortality. Open surgery is an acceptable option in its management especially in the areas where minimalinvasive therapeutic modalities are not available.Key words: Bile duct injuries, Cholecystectomy, Iatrogenic.