Factors influencing early and long-term outcomes in patients undergoing surgical repair due to bile duct injury

Introduction and Objective Cholecystectomy is the most commonly performed elective abdominal surgery both in our country and worldwide. With the development of laparoscopy, laparoscopic cholecystectomy has become the gold standard method for cholecystectomy. However, the incidence of bile duct injury has increased with the advancement of laparoscopy. Bile duct injury is a complication with high morbidity and mortality, requiring a multidisciplinary treatment approach. In this study, we aimed to illuminate the factors influencing postoperative early and late-term outcomes in patients undergoing surgical repair due tobiliary tract injury. Material and Methods A total 66 patients, who were admitted from external centers due to biliary tract injury and underwent hepaticojejunostomy between January 2005 and June 2022 at the General Surgery of Cukurova University Faculty of Medicine, were examined. Demographic characteristics of the patients, laboratory values before and after surgery, preoperative imaging, and types of anastomoses performed during surgery were recorded, and statistical analysis was conducted. The postoperative early and long-term outcomes of the patients were investigated, utilizing the McDonald classification during long-term follow-ups. Results Of the patients, 18 were male and 48 were female. The mean follow-up period was 105±58 (12-216) months. In 42.4% of the patients, one or more complications occurred in the early period. A significant association was found between the development of wound site infection and diabetes and positive culture (p: 0.032) (p: 0.001). The McDonald classification was used in long-term follow-ups. A significant effect of pre-repair ALP and post-repair ALP-GGT on the McDonald classification was detected (p: 0.012) (p<0.05) (p: 0.05). However, pre-repair GGT and CRP were found to have no significant relationship with the McDonald classification (p>0.05). There was a significant relationship between the presence of vascular injury and isolated ALP-GGT elevation observed in postoperative follow-ups (p<0.05). Anastomotic stricture developed in 8 patients during follow-ups. While 2 patients responded to dilation with a balloon, revision surgery was performed in 5 patients. One patient for whom revision surgery was planned succumbed to uncontrollable cholangitic sepsis. Conclusion Bile duct injury is the most feared complication following cholecystectomy. The surgeon's experience, technical capabilities, local risk factors, and anatomical anomalies play crucial roles in these injuries. Bile duct injuries necessitate a multidisciplinary approach and require follow-up at a center with hepatobiliary expertise. Keywords: Cholecystectomy, laparoscopic cholecystectomy, bile duct injury, hepaticojejunostomy