TITLE:
Pattern of Presentation of Iatrogenic Biliary Injury Following Laparoscopic Cholecystectomy
AUTHORS:
Fahmid-Uz-Zaman, Mohammad Aminul Islam, Md. Saba Al Galib, Md. Mashkurul Alam, Md. Shamsuddoha Khan, Muhammad Tanvir Alam Akhanda, Sania Hossain, Laila Siddika, Mohammad Emrul Hasan Khan, Abul Bashar Md. Jamal
KEYWORDS:
Bile Duct Injury, Laparoscopic Cholecystectomy, Post-Operative Complications, Bangladesh
JOURNAL NAME:
Open Journal of Clinical Diagnostics,
Vol.12 No.4,
December
6,
2022
ABSTRACT: Background: Cholecystectomy is one of the most now common abdominal surgeries performed every day. The incidence of bile duct injury (BDI) following open cholecystectomy is only 0.1% - 0.2%. After the introduction of laparoscopic cholecystectomy, the incidence has gone up to 0.4% - 0.7%. The present study is a prospective analysis of all patients with bile duct injury who were admitted to Dhaka Medical College Hospital during or at a variable period following cholecystectomy. Methods: To determine the pattern of presentation of iatrogenic biliary injury following cholecystectomy in the department of surgery of Dhaka Medical College Hospital, a total of 30 patients were purposively selected from May 2018 to November 2018. Patient particulars, records of physical and clinical evaluation, and operative details were collected by individual researchers. Data analysis was done by SPSS for windows version 21. Results: BDI was found very common among the age group 21 - 30 yrs (36%) and female dominant (60%). Majority of the patients presented with abdominal pain (96%), intra-abdominal collection (88%), biliary peritonitis (68%), cholangitis (60%), and obstructive jaundice (40%), and biliary fistula (40%). Laparoscopic cholecystectomy (84%) was the principal cause of biliary injury in our study. 48% of patients experienced clinical features within 7 days post-cholecystectomy. Per-operative diagnosis was done in only 12% of cases. 44% of patients in this study were recognized as Bismuth grade-3, followed by 36%, grade-2 patients. Management outcomes included wound infection (41.66%), minor bile leak (25%), peritonitis (8.33%), and renal impairment (8.33%). Conclusion: The effect of BDI is an extremely distressful clinical condition for the patients and their family members, hence proper care and management protocol should be followed.