Background: In utero complex development of the liver, and the biliary system can result in multiple anatomic variations. Knowledge about these anatomic variants is required for the safe performance of any hepatobiliary surgery. Cholecystectomy remains the major source ofbile duct injuries (BDI) given the frequency with which it is performed. Various studies worldwide have documented an increase in the frequency of bile duct injuries associated with the laparoscopic approach, ranging from 0.4% to 1.3%.

Aims and Objectives: To study the incidence of bile duct injuries managed at our hospital and note the conditions contributing to them, document the site of the injury and their methods of management.

Materials and Methods: A prospective observational study was performed with 25 patients from July 2018 to June 2020 in the Department of General Surgery, King George Hospital, Visakhapatnam. Patients of age 35 to 70 years who had BDI as a complication of open/laparoscopic cholecystectomy were included. 

Details regarding the presence of aberrant anatomy, timing of the onset of symptoms and the time from injury to recognition of BDI were noted.

Results: The incidence of bile duct injury was 1.82% with a mean age of 48.7 years. Majority of the injuries were seen in patients undergoing cholecystectomy for cholecystitis >72 hours duration. BDI was documented to be of common hepatic duct (CHD) in 40%, common bile duct (CBD) in 40%, and cystic duct in 20%.

Conclusion: Factors contributing to BDI are acute cholecystitis, cholangitis, pancreatitis, and choledocholithiasis. Definitive repair should be done only after detailed investigation of site and type of injury.

Keywords: Bile duct injury, laparoscopic cholecystectomy, open cholecystectomy, complications of cholecystectomy, Iatrogenic injury of bile duct, hepatobiliary surgery, common bile duct, cystic duct, anomalies of biliary system.

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Dr T. Durga Samyukta

M.B.B.S, Post Graduate in Department of General Surgery, Andhra Medical College, Visakhapatnam, Andhra Pradesh