Current Scenario of Postcholecystectomy Bile Leak and Bile Duct Injury at a Tertiary Care Referral Centre of Nepal

Table 1

Demographics, details of index operation, presentation, and staging of injury.

Parameters	Total patients, n = 18
Age (years), mean (range)	40 (16–55)
Male : female (M : F)	7 : 11
Place of injury
Outside hospital	5 (27.8%)
In hospital	13 (72.2%)
Indication for cholecystectomy
Biliary colic	9 (50%)
Acute cholecystitis	4 (22.2%)
Mucocele	4 (22.2%)
Xanthogranulomatous cholecystitis	1 (5.5%)
Surgery started as
Open	3 (16.7%)
Laparoscopic	15 (83.3%)
Any conversion from laparoscopy to open	0
Methods of cholecystectomy
Dissection of hepatocystic triangle first	13 (72.2%)
Unknown	5 (27.8%)
Methods of cystic duct identification
Critical view of safety	11(61.1%)
Infundibular approach	1(5.5%)
Top-down	1(5.5%)
Unknown	5(27.8%)
Detection of injury
Intraoperative	4 (22.2%)
Postoperative	14 (77.8%)
Injury occurred during which part of procedure
Open	3 (16.7%)
Laparoscopic	15 (83.3%)
Management of recognized injury
End-to-end anastomosis + T-tube	1(5.5%)
Hepaticojejunostomy	2 (11.1%)
Suture closure of rent in common hepatic duct	1 (5.5%)
Indication for referral (n = 15)
Jaundice	5 (29.4%)
Intra-abdominal sepsis	8(35.3%)
Biliary fistula	2 (11.8%)
Time from index operation to referral for surgical repair
Intraoperative	3 (16.7%)
0–3 days	3(16.7%)
4–7 days	3(16.7%)
8 days–6 weeks	5 (27.8%)
6 weeks–3 months	4 (22.2%)
Staging of injury
A	9 (50%)
D	1 (5.5%)
E1	5(27.8%)
E2	1 (5.5%)
E3	2 (11.1%)
Vasculobiliary injury	0
Other organs injured	0