Endoscopic management of post operative bile duct injuries

Objective: to evaluate the pattern of post-operative bile duct injuries and their subsequent endoscopic management. methods: the prospective, non-randomised, cross-sectional study was conducted at the endoscopic suite of surgical unit-iv of the civil hospital, karachi, over a period of three years. a total of 97 patients were included in the study. post-procedure patients were followed up for resolution of symptoms and cessation of the bile leak. patients with complete biliary cutoff or transection on endoscopic retrograde cholaugio-paucreatography (ercp) were advised magnetic resonance cholaugio-papereatography (mrcp). average followup of patients in our study was for 3 months. mann whitney u test was applied for non-parameteric data. results: out of 97 patients in the study, 82(84.5%) presented with post-operative bile leakage and 15(15.5%) with obstructive jaundice. the age of the study population ranged between 20-70 years with a mean age of 40.80 ± 13.45 years. male-to-female ratio was 1:3. ercp findings in our study included 41 (42.26%) patients with bile leakage out of which 27 (27.8%) had high-grade leak and 5 (5.1%) had low-grade leak, while 9 (9.3%) patients had common bile duct (cbd) stones. among the patients, 39 (40.2%) had complete cutoff of cbd. there were 15 patients with strictures and 6 with normal ercp. as for the bile leads, 36/41 (87.8%) patients were managed successfully by endoscopic stenting, stone removal or simple sphincterotomy. of the 41 patients, 5 (12.2%) with bile leak developed biliary stricture on subsequent ercp. nine of the 15 patients (60%) with complete cutoff on initial endoscopy were successfully stented on subsequent ercp after demonstration of biliary continuity on mrcp. six (40%) patients were referred for surgery. conclusion: patients with postoperative biliary leaks fare much better than those with complete cutoff or strictures. mrcp should be done in all patients where ercp shows loss of biliary continuity. re-exploration should be deferred till all other non-invasive modalities have been tried.