Incidence and Impact of Concomitant Vascular Injury on Biliary Enteric Repair in Post-Cholecystectomy Bile Duct Injury Patients

Abstract Background: Concomitant vascular injury occurs in significant proportion of patients with post cholecystectomy biliary injury. Such vascular injury mostly remains asymptomatic but may manifest with liver abscess, lobar ischemia or anastomotic strictures in long term. Our aim is to determine incidence of associated vascular injury in such patients and its impact on early complications rates and outcomes following biliary repair. Methods: This prospective study was done between November 2019 and December 2021. All patients with post cholecystectomy bile duct injury were investigated for vascular injury by contrast enhanced computed tomography. The presentation and outcomes of biliary repair were studied in patients with and without associated vascular injury.The outcomes were graded according to Mcdonald classification scheme. Results: Concomitant vascular injury incidence was 39% (n=19) in total of 48 patients studied. Incidence of vascular injury was proportional to the grade of biliary injury. In Strasberg type 4 injury, 87% had vascular injury while in type 3, 42% had vascular injury, and in type 2, 27% patients had vascular injury. Liver abscess was significantly higher in patients with concomitant vascular injury. Mean duration of hospital stay was 6.6± 3.9 days. After 1 year of biliary repair, irrespective of vascular repair, 60% patients had Mcdonald Grade A outcome. Conclusion: 39%patients with biliary injury have concomitant vascular injury. Higher grade of biliary injury is associated with vascular injury. Vascular injury is not associated with increased morbidity, length of hospital stay or inferior medium term repair complications if delayed repair is done.