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HPB Surgery
Volume 2014 (2014), Article ID 575136, 12 pages
http://dx.doi.org/10.1155/2014/575136
Clinical Study

Iatrogenic Biliary Injuries: Multidisciplinary Management in a Major Tertiary Referral Center

1Department of Hepatobiliary Surgery, National Liver Institute, Menophyia University, Shiben Elkom, Egypt
2Department of Radiology, National Liver Institute, Menophyia University, Shiben Elkom, Egypt
3Department of Hepatology, National Liver Institute, Menophyia University, Shiben Elkom, Egypt

Received 20 June 2014; Revised 21 September 2014; Accepted 13 October 2014; Published 10 November 2014

Academic Editor: Christos G. Dervenis

Copyright © 2014 Ibrahim Abdelkader Salama et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Iatrogenic biliary injuries are considered as the most serious complications during cholecystectomy. Better outcomes of such injuries have been shown in cases managed in a specialized center. Objective. To evaluate biliary injuries management in major referral hepatobiliary center. Patients & Methods. Four hundred seventy-two consecutive patients with postcholecystectomy biliary injuries were managed with multidisciplinary team (hepatobiliary surgeon, gastroenterologist, and radiologist) at major Hepatobiliary Center in Egypt over 10-year period using endoscopy in 232 patients, percutaneous techniques in 42 patients, and surgery in 198 patients. Results. Endoscopy was very successful initial treatment of 232 patients (49%) with mild/moderate biliary leakage (68%) and biliary stricture (47%) with increased success by addition of percutaneous (Rendezvous technique) in 18 patients (3.8%). However, surgery was needed in 198 patients (42%) for major duct transection, ligation, major leakage, and massive stricture. Surgery was urgent in 62 patients and elective in 136 patients. Hepaticojejunostomy was done in most of cases with transanastomotic stents. There was one mortality after surgery due to biliary sepsis and postoperative stricture in 3 cases (1.5%) treated with percutaneous dilation and stenting. Conclusion. Management of biliary injuries was much better with multidisciplinary care team with initial minimal invasive technique to major surgery in major complex injury encouraging early referral to highly specialized hepatobiliary center.