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Gunshot injuries of the extrahepatic biliary ducts
E Degiannis1, K Khelif, E Leandros
1Department of Surgery, University of the Witwatersrand Medical School, Johannesburg, Republic of South Africa. degiannis@yebo.co.za
Objective:
To assess our management of gunshot injuries of the extrahepatic biliary ducts.
Design:
Retrospective study.
Setting:
Urban teaching hospital, South Africa.
Subjects:
17 patients who were found to have gunshot injuries of the extrahepatic bile ducts, January 1993-June 1998.
Interventions:
Packing and damage control, staged repair, or definitive repair.
Main Outcome Measures:
Morbidity and mortality: Three of the 17 died intraoperatively or postoperatively from causes unrelated to the biliary injury. Of the 14 survivors, 3 were managed initially with packing and damage control, 7 by staged repair, and 4 by definitive biliary repair. Eleven patients had a Roux-en-Y biliary jejunostomy, of whom 1 developed a late biliary stricture related to a postoperative anastomotic leak. End-to-end anastomosis of the bile duct was done for 2 patients and they both developed late biliary strictures. Ligation of the injured duct and cholecystojejunostomy was done for I patient.
Conclusion:
Roux-en-Y biliary-jejunal anastomosis is appropriate in the treatment of gunshot injuries of the extrahepatic biliary ducts as there is always a degree of tissue loss and some debridement is required, making it difficult to do a tension-free anastomosis.