Repair of extrahepatic biliary duct over T-tube
Mohammed Shamim1, Syed Asim Ali Jaffary, Shahid Shamim
1Department of Surgery, Ziauddin Medical University, Karachi.
Objective:
To evaluate the result of surgical procedures adopted for repair of iatrogenic injuries of extrahepatic biliary tract over T-tube.
Methods:
An interventional study conducted at Surgical Unit 1 of Abbasi Shaheed Hospital, Karachi; and private hospitals in Karachi, from 1974 to 2004 (30 years). All the iatrogenic injuries of extrahepatic biliary tract during open cholecystectomies were recorded. The records included age and sex of patients, site and extent of injury, method of repair and post-operative complications, if any. All primary repairs were done over T-tube. For injuries at the confluence, the T-tube was converted into a Y-tube, and its short limbs were introduced into the lumen of right and left hepatic ducts. Follow up was done in the outpatient department weekly for a month after discharge, and then annually for maximum 5 years.
Results:
A total number of 5,000 open cholecystectomies were performed during the study period. Eleven patients (0.22%) had intraoperative extrahepatic biliary tract injury: 6 out of 11 had injury of common bile duct (CBD), 2 had common hepatic duct (CHD) and 3 had injury at the confluence. One patient was lost to follow up after a year. One patient died of myocardial infarction after two years. Nine patients were clinically and biochemically well at five years follow up after primary repair of the injuries.
Conclusion:
Primary repair of extrahepatic duct injuries, situated at CBD, CHD or at the confluence, over the T-tubes is safe. In case of injury at the confluence the T-tube may be shaped like a Y-tube for secure anastomosis of all the three cut ends.
