Incidence and Early Management of Post-Cholecystectomy Bile Duct Injury

Abstract

Background: Bile duct injury (BDI) is an uncommon but potentially devastating complication of cholecystectomy that carries substantial risk of long-term morbidity when recognition or repair is delayed¹, and outcomes are strongly influenced by injury grade, timing of diagnosis, and the expertise of the treating team².

Objectives: To determine the incidence of bile duct injury among patients undergoing cholecystectomy at a tertiary care centre, and to describe the clinical profile, management strategies and outcomes of the affected patients.

Methods: This retrospective observational study analysed a masterchart of 150 consecutive patients who underwent open or laparoscopic cholecystectomy at this tertiary care centre over the study period. Patients who developed bile duct injury were identified from this cohort, and data on their Strasberg classification, timing and mode of presentation, procedure performed, postoperative complications, hospital stay, and follow-up outcome were extracted and analysed descriptively.

Results: Of the 150 patients who underwent cholecystectomy, the mean age was 46.8 ± 15.5 years, with a female preponderance (68.0%), and the index procedure was performed laparoscopically in 84.0%. Bile duct injury occurred in 4 of 150 patients, an overall incidence of 2.7%. Among these four patients, Strasberg type E2 injury was the commonest (2 of 4, 50.0%), with one type E1 and one type D injury (25.0% each). Injury was recognised intraoperatively in 1 patient; among the remaining three, diagnosis was most often made between postoperative days 4–7 (2 of 4, 50.0%). Jaundice and bile leak were the leading modes of clinical presentation. Roux-en-Y hepaticojejunostomy was performed in 2 of 4 patients (50.0%), with primary repair and ERCP with stenting used in one patient each. One patient (25.0%) developed a postoperative bile leak that resolved with conservative management; the mean hospital stay among the four affected patients was 10.5 ± 3.2 days. At follow-up, all four patients (100%) had normal liver function tests and patent biliary drainage; three (75.0%) were classified as fully recovered and one (25.0%) recovered after a secondary endoscopic intervention.

Conclusion: Bile duct injury occurred in a small minority of patients (2.7%) undergoing cholecystectomy at this centre. Structured, early referral-based management tailored to Strasberg grade was associated with excellent recovery and low morbidity in all affected patients, reinforcing the case for prompt recognition and centralised repair of this complication.